Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

3a psychiatry > Psychosis > Flashcards

Psychosis Flashcards

1
Q

Define phenomenology

A

study of symptoms and signs of objectively describing abnormal states of mind

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When is a hallucination non pathological?

A 
when tired
when vigilance high 
hypnosis
hypnagogic = experience on going to sleep
hypnapompic = experience on waking up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a pseudo-hallucination?

A

a perceptual experience which differs from a hallucination in that it appears in subjective inner space of mind

  1. vivid mental images but not perceived in external stimulus/ space but within the mind
  2. person recognises that experience does not correlate with real world
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 8 different types of hallucination

A 
auditory 
visual
olfactory 
tactile
somatic 
gustatory 
autoscopic 
reflex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe auditory hallucinations

A

2nd person = talking to the individual “you are worthless” , telling them to do things (= command) e.g. depressive psychosis, mania, personality disorder

3rd person= running commentary, several voices “she is” , e.g. 1st rank Schneider symptom

echo “de la pense” = voice speaks persons thoughts
commands = “hit her”
voices talking to each other e..g schizophrenia
gedankenlautwerden = voice anticipates what person thinks moments later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define delusions

A

a firmly held, false belief which is out of keeping of their culture, intelligence and social background and held with great conviction

(vs over valued idea which is held with less rigidity than a delusion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How are delusions described?

A
  1. fixity = complete or partial
  2. onset = primary autochthonous or secondary delusion
  3. other delusional experiences
  4. theme/ content
  5. other features
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define disorders of thinking

A

broader category involving delusions and obsessions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the types of disorders of thinking?

A

formal thought disorder e.g. flight of ideas, perseveration, loosening of association

abnormal thought content e.g. passivity phenomena, concrete thinking, circumstantiality, confabulation

abnormal beliefs about possession of thought e.g. thought broadcast, thought withdrawal, thought insertion

disorders of stream of thought e.g. pressure of speech, poverty of thought, blocking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe “flight of ideas”

A

rapid skipping from one thought to another distantly related ideas
jumps between topics
logical sequence of ideas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe “perseveration”

A

persistent and inappropriate repetition of the same thoughts
associated with dementia , organic disorder, wernickes encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe “loosening of association”

A

loss of normal / logical structure of thinking

answers muddled and illogical attempts to clarify results

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the types of loosening of association?

A
  1. knights moves/ derailment = jumps between sentences with no logical connection and no evidence of links
  2. word salad = extreme derailment, grammatical structure of speech lost
  3. talking past the point = never gets to the point of the conversation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe “pressure of speech”

A

lots of thoughts passing through mind rapidly
unusual associations , use of rhymes and puns
wander off the point of conversation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe “poverty of thought”

A

few thoughts
thoughts slow through mind
a negative symptom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe “thought blocking”

A

sudden interruption in train of thought, leaving a blank
patient may believe thoughts are blocked by someone
(negative symptom)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the abnormal beliefs about the possession of thought (thought alienation)

A

thought broadcast= own thoughts are made available by others
thought withdrawal= somebody is removing thoughts from head
thought insertion = somebody is putting thoughts in their head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe “concrete thinking”

A

lack of abstract thinking (e.g. inability to understand metaphors)
normal in childhood aspergers and autism , frontal lobe disorders, learning disability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Define obsessions (the thought)

A

recurrent, persistent thoughts, impulses or images that enter the mind despite patients efforts to resist/ exclude them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

define compulsions (the act)

A

repetitive and seeming purposeless behaviour performed in a stereotyped way accompanied by subjective sense they must be carried out and urge to resist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

List the types of obsessions

A 
obsessional thoughts
obsessional ruminations
obsessional doubts 
obsessional impulses
obsessional phobias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the proposed cause of schizophrenia?

A 
mixture of genetics and environment 
neurochemical imbalance:
dopamine overactivity
glutamate overactivity 
serotonin overactivity 
GABA under activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

List the risk factors for schizophrenia

A 
genetics 
traumatic life events
drug abuse 
pregnancy and birth complications 
disturbed childhood behaviour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are schneiders first rank symptoms?

A
  1. thought alienation - thought withdrawal, insertion and broadcast
  2. delusional perception
  3. passivity phenomena = someone else controlling thoughts and actions , includes somatic
  4. 3rd person auditory hallucinations - arguing voices or commenting on persons actions “he is rubbish”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are schneiders second rank symptoms?
``` delusions of reference paranoid and persecutory delusions 2nd person auditory hallucinations thought disorders catatonic behaviours ```
26
What is the difference between positive and negative symptoms?
positive symptoms= excess or a distortion of normal functioning (respond well to medications), often acute, mesolimbic dopamine pathway negative symptoms= a decrease or loss of functioning (respond less well to medications) , often chronic , mesocortical dopamine pathway
27
What are positive symptoms?
delusions e.g. persecutory, passivity, thought interference hallucinations e.g. auditory, visual, olfactory formal thought disorder incongruent = bursts out laughing for no reason or very angry (mismatch between emotional expression and content) speech disorders disturbance in mood lack of insight catatonia
28
What are negative symptoms?
flattening of affect (= reduced range of emotional expression) blunting decreased motivation poverty of speech or thought deterioration in functioning psychomotor retardation (slowing of thoughts and movement)
29
What are the 3 presentations of schizophrenia?
1. prodromal schizophrenia = premorbid change in individual who later develop disease, non specific negative symptoms followed by positive symptoms 2. 1st schizophrenic episode = usually in late adolescence or early adult years e.g. withdrawal, onset of personality change 3. subsequent disorders = relapse of psychotic symptoms after remission, deterioration or crisis in life
30
What are the types of schizophrenia?
``` paranoid schizophrenia hebephrenic schizophrenia catatonic schizophrenia post schizophrenic depression residual schizophrenia simple schizophrenia ```
31
Describe paranoid schizophrenia
key symptoms= delusions and hallucinations leads more normal life and functional auditory hallucinations and persecutory delusions revolve around them and consistent
32
Describe hebephrenic schizophrenia
key symptoms= disorganised thoughts and flat inappropriate thoughts impaired emotional process (unstable, blunted, flattened), difficulty in daily living
33
Describe catatonic schizophrenia
key symptoms= psychomotor disturbance | dramatic reduction in motor activity, waxy flexibility, unusual body positions/ facial contortions/ posturing
34
What investigations are necessary to rule out other causes of schizophrenia?
urine drug screening - rule out amphetamines and cannabis as cause FBC, LFTs - indicative of alcohol abuse EEG - rule out epilepsy serological tests - for syphilis or AIDs
35
How is schizophrenia diagnosed?
ICD-10 CRITERIA: 1. duration of over 1 month 2. social or occupational dysfunction 3. 1st first rank symptom or 2 2nd rank symptoms
36
How do you assess the risk in psychotic patients?
1. assess risk of suicide 2. assess risk of unintentional harm to themselves 3. assess risk from others e.g. safeguarding, vulnerability 4. assess risk of harm to others e.g. history of violence, emotions, victims of delusions
37
How is schizophrenia managed?
1. treat acute episodes e.g. intervene early, antipsychotics, psychosocial therapy 2. reduce risk of relapse e.g. maintenance therapy, family therapy, support 3. promote long term recovery e.g. maintenance therapy, CBT, support employment
38
how are acute episodes of schizophrenia treated?
1. second generation anti psychotic (atypical) e.g. olanzapine, risperidonem quetiapine 2. benzodiazepine long acting e.g. diazepam IM or oral
39
Which medications are used to treat schizophrenia maintenance?
1st line = 2nd gen atypical antipsychotic start at lowest dose possible taken for 4-6 weeks before deciding if ineffective continue drug for 5 years to prevent relapse
40
Which psychological therapy is used to treat schizophrenia?
CBT** +/- family therapy
41
What is acute psychosis?
brief psychotic disorder with sudden onset and resolves in less than 3 months. Usually caused by an acute stressor e.g. bereavement, divorce, childbirth, trauma within 2 weeks often don't need treatment
42
What are the main clinical symptoms of post partum psychosis?
= an acute psychotic episode following post partum (peak at 2 weeks post partum) 1. prominent affective = mania +/- depression and psychosis 2. schizophreniform disorder 3. acute organic psychosis
43
What are the risk factors for post partum psychosis?
previous history of psychosis family history of psychosis first time mothers lack of social support and single parent hood
44
Describe persistent delusional disorder
a fixed delusion or delusional system with other areas of thinking and function well preserved (no hallucinations) - often in elderly
45
What are the clinical features of persistent delusional disorder?
presence of delusions for >3 months (non bizarre delusions that could happen in real life) - associated with smell/ contamination/ food thought process unimpaired cognition and memory intact irritable, angry and low mood
46
What is schizoaffective disorder?
features of both affective (mania or depression) and schizophrenia in equal proportions must have periods of uninterrupted illness and episode of mania/depression whilst psychotic
47
How is schizoaffective disorder managed?
antipsychotic (paliperidone) + anti depressant/ mood stabiliser + psychotherapy
48
Which medication is used to treat "treatment resistant schizophrenia"?
clozapine SE: agranulocytosis
49
What are the features of "acute dystonic reaction"?
facial grimacing oculogyric crisis torticollis opisthotonos (muscle spasm causing head to arch back) dystonia of the laryngeal/pharyngeal muscles
50
What is the management options for acute dystonic reaction?
stop antipsychotic anti-cholinergic medication e.g. procyclidine
51
What is neuroleptic malignant syndrome?
life threatening emergency reaction in response to anti psychotics
52
What are the symptoms in neuroleptic malignant syndrome?
``` Hyperthermia labile BP sweating tachycardia muscle rigidity raised CK ```
53
What are the management options for neuroleptic malignant syndrome?
supportive: fluids, benzodiazepines | bromocriptine
54
What other adverse events do you need to look out for in a patient on anti psychotics?
``` extrapyramidal symptoms anti-muscarinic symptoms increased prolactin reduced seizure threshold prolonged QT interval (esp haloperidol) ```
55
What are "extra pyramidal symptoms"?
acute dystonia akathisia (restlessness) (Rx - propanolol, benzodiazepines) Parkinsonism tardive dyskinesia (chewing, jaw movements)
56
What are "anti-muscarinic" symptoms?
dry mouth blurred vision urinary retention constipation
57
What are the different sections of the mental health act?
Section 4 is used to admit a patient when only one doctor can be found - this doctor may be the GP (72 hr detention) Section 2 – Requires 2 doctors (one section 12 approved) and AMP to make recommendation. Allows for assessment up to 28 days. Section 3 – As above. For patients under section 2 or who are known to the service. Allows for 6 months of treatment and can be renewed. Section 5 (2) – For patients in hospital (informal admission) gives doctors 72hrs holding power. (Section 5(4) for nurses)
58
Define persecutory delusions
someone out to get them
59
Define grandiose delusions
thoughts of self importance and super naturalness
60
Define self-referential delusions
special significance to something | e.g. everyone in white tops are out to get me
61
Define nihilistic delusions
pessimistic ideas about the world, about to die, world doomed e.g. intestines disappeared associated with depression
62
define misidentification delusions "Cagras syndrome"
someone close to them has been replaced with an intruder
63
define religious delusions
belive in communication with God
64
Define hypochondriacal delusions
believe they have an illness or will die
65
Define guilt delusions
thoughts of self worthlessness, depression
66
Define sexual delusions
(de Clerambaults) | believe someone is in love
67
Define eromatic delusions
believe someone of higher social standing is in love with them
68
Define Morbid jealousy (othello syndrome) delusions
believe their sexual partner is being unfaithful
69
Define delusions of reference
believe a message is about them in the media
70
Define delusional perception
delusional belief resulting from a real perception = attributing a new delusional meaning to a familiar concept e.g. red traffic light means the FBI if after me 1st rank Schneider symptoms
71
Define fregolis delusion
belive a number of different people are the same person
72
describe olfactory hallucinations
rare schizophrenia = smell gas depression = rotting body
73
describe tactile hallucinations
formacations (crawling over skin ) - e.g. cocaine abuse, schizophrenia or delusional parasitosis
74
which signs are seen in depressive psychosis?
``` olfactory hallucinations - rotting body 2nd person auditory hallucinations nihilistic delusions cotard delusions guilt delusions ```
75
define neologism
abnormality of speech where patient uses own words/ phrases invented by themselves
76
List the psychotic disorders that affect the elderly
1. paraphrenia = late onset schizophrenia, persistent delusional disorder 2. dementia = delusions, hallucinations 3. cotards syndrome 4. Charles bonnet
77
what is cotards syndrome?
where the affected patient believes that they (or in some cases just a part of their body) is either dead or non-existent This delusion is often difficult to treat and can result in significant problems due to patients stopping eating or drinking as they deem it not necessary. associated with severe depression and psychosis
78
What is Charles bonnet syndrome?
complex visual or auditory hallucinations ('little children' colourful animals') in clear consciousness + visual impairment (usually has insight)
79
what are the risk factors for Charles bonnet syndrome?
``` Advanced age Peripheral visual impairment - cataract, glaucoma Social isolation Sensory deprivation Early cognitive impairment ```
80
define illusion
misperception of real stimuli
81
define hallucination
perception in the absence of an external stimulus (real to the person)
82
who are visual hallucinations common in?
Lewy body dementia / organic causes | not common in pure psychiatric disorders
83
define circumstantiality
talking at great length around the subject but returns to the topic
84
define tangential
does not return to the topic
85
define somatic passivity
delusional belief that patient is passive recipient of bodily sensation imposed from outside forces (1st rank Schneider)
86
define stupor
loss of activity with no response to stimuli, may mark a progression of motor retardation
87
define depersonalisation
thoughts and feelings do not seem to belong to oneself
88
define derealisation
feeling as if you are looking at yourself from the outside
89
teams to help with psychosis presentation
CRISIS team | early intervention team/ 1st episode psychosis team
90
define residual schizophrenia
chronic negative symptoms
91
Describe the bio psycho social management plan for psychosis
BIO - antipsychotics PSYCHO - family therapy, CBT SOCIAL- family intervention/ carer support, employment, education, support with engagement/ benefits/ PSI
92
how is post partum psychosis managed?
admitted to hospital section under mental health act high risk of recurrence pscyh emergency

3a psychiatry (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions