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Y3 PSYCHIATRY > Psychosis > Flashcards

Psychosis Flashcards

1
Q

What is schizophrenia and how is it characterised?

A

Group of brain disorders characterised by disorders of thought, behaviour, perception and emotion

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2
Q

What is the one pathognomonic symptom of schizophrenia?

A

There isn’t one!

Having more than one symptom increases the risk

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3
Q

There is a strong genetic link to schizophrenia. True/False?

A

True

Triggered by environmental stressors

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4
Q

List 4 “positive” symptoms of schizophrenia

A

Delusions
Hallucinations
Thought disorder
Passivity phenomena

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5
Q

List 4 “negative” symptoms of schizophrenia

A 
Reduced amount of speech
Reduced motivation/ drive
Reduced interest/ pleasure
Reduced social interaction
Blunting of affect
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6
Q

Positive symptoms are harder to treat than negative symptoms in schizophrenia. True/False?

A

False

Positive symptoms are often easier to treat

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7
Q

According to Schneider’s first rank symptoms for schizophrenia, list some thought interferences

A

Thought withdrawal
Thought broadcasting
Thought insertion
Thought blocking

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8
Q

What is passivity phenomena?

A

Experience where acts/emotions/feelings are being controlled by an external party

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9
Q

A patient must have Schneider’s first rank symptoms to be diagnosed with schizophrenia. True/False?

A

False

They are not pathognomonic and can be seen in other psychoses

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10
Q

What is a delusion?

A

A fixed belief that cannot be changed by logical thought or evidence
Primary (arises out of the blue) or secondary (attempt to explain anomalous experiences)

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11
Q

What is a hallucination?

A

Perceptual, fantastical experience that is believed to be real in absence of external stimulus

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12
Q

List the different modalities by which hallucinations can occur

A 
Auditory (most common)
Visual
Olfactory
Gustatory
Tactile
Haptic (feel deep organs)
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13
Q

Which type of auditory hallucination - 1st, 2nd or 3rd person - is more typical of schizophrenia?

A

3rd person

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14
Q

According to Schneider’s first rank symptoms for schizophrenia, list some thought disorders

A 
Neoligisms (own dictionary) 
Circumstantiality/ tangentiality 
Clanging and punning
Loosening of associations
Word salad
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15
Q

What is meant by thought withdrawal?

A

Belief that thoughts are being removed by an external party - a delusional explanation for thought blocking

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16
Q

What is meant by thought broadcasting?

A

Belief that people have access to and understand your thoughts without you having to voice them

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17
Q

List features of emotional disorder that can occur in psychoses such as schizophrenia

A 
Blunted affect
Incongruent mood
Apathy
Lack of motivation
Anhedonia
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18
Q

What is the main motor disorder that may occur in schizophrenia?

A

Catatonia

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19
Q

What is catatonia?

A

State of increased tone of muscles at rest, abolished by voluntary activity

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20
Q

What are the main treatments for catatonia?

A

ECT

Benzodiazepines

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21
Q

What is the peak incidence of schizophrenia for men and women?

A

Men: 15-25
Women: 25-35

22
Q

List factors that indicate good prognosis for schizophrenia

A

Older onset
Female
Marked mood disturbance e.g. elation
FHx of mood disorder

23
Q

List factors that indicate poor prognosis for schizophrenia

A

Long duration of untreated psychosis
Insidious early onset
Cognitive impairment
Enlarged brain ventricles

24
Q

Psychosis is a diagnosis. True/False?

A

False

Description of symptoms rather than diagnosis

25
Q

List psychotic experiences

A 
Hallucinations
Delusions
Thought disorders
Emotional disturbance
Passivity phenomena
Idea of reference
26
Q

List the main differential diagnoses of psychosis

A 
Schizophrenia
Schizoaffective disorder
Drug toxicity or withdrawal
Mania
Depression
Delusional disorder
Puerperal psychosis
Delirium
Dementia
27
Q

How does tangential thinking differ from circumstantial thinking?

A

Tangential: wander off from topic/question and never return
Circumstantial: excessive detail relating to topic, eventually return to topic

28
Q

What is meant by idea of reference vs. self-referential experience?

A

Innocuous events will be ascribed significant meaning by the person
Belief that environment is reacting to you, i.e. external events are related to oneself
e.g. TV/radio is talking to you specifically

29
Q

List some common drugs that can cause drug-induced psychosis

A 
Steroids
Cannabis
Amphetamine
Cocaine
Tobacco
Alcohol
Opioids
30
Q

How is depressive psychosis classically typified?

A

Mood congruent with psychosis - delusions of guilt/pessimism/worthlessness on top of depressed mood
Can be accusing/ insulting/ threatening voices (usually secondary hallucinations)

31
Q

List types of delusions

A 
Paranoid
Persecutory (somebody is trying to harm you)
Grandiose
Religious
Misidentification
Guilt
Sin
Nihilistic (delusion about something non-existent)
Love
Jealousy
32
Q

What is schizoaffective disorder?

A

Mixed picture of schizophrenia + bipolar disorder where someone displays schizophrenia but their mood is also affected

33
Q

At what time of day is delirium typically worse at?

A

Night

34
Q

What are the 3 main cortical changes that occur in schizophrenia?

A

Reduced frontal lobe volume
Reduced frontal lobe grey matter
Enlarged (lateral) ventricles

35
Q

Which neurotransmitter causes a psychotic state when in excess?

A

Dopamine

36
Q

List the 3 main dopaminergic pathways in the brain

A

Nigrostriatal (extrapyramidal)
Mesolimbic (motivation and reward system)
Tuberoinfundibular (control of PRL release)

37
Q

Which dopaminergic pathway is typically involved in schizophrenia?

A

Mesolimbic system

38
Q

Subcortical dopamine hyperactivity/hypoactivity leads to psychosis
Mesocortical hyper/hypoactivity leads to cognitive symptoms

A

Subcortical dopamine hyperactivity leads to psychosis

Mesocortical hypoactivity leads to cognitive symptoms

39
Q

List the 3 main subtypes of schizophrenia and give a brief description of each

A

PARANOID: most common, typical, 1st rank symptoms
HEBEPHRENIC: youth and frivality - tells jokes a lot, pranks
CATATONIC: movement disorder predominates

40
Q

An acute and transient psychotic disorder can be attributed to two main causes. State these.

A

Stress

Substance misuse

41
Q

What is meant by the term ‘schizoaffective disorder’

A

Symptoms of both schizophrenia and either depression or bipolar disorder - episodes of low mood and/ or mania

42
Q

List risk factors for schizophrenia

A

Genetics
Birth complications and/or illness in pregnancy
Drug use
Urban dwelling
Social adversity or deprivation
Neurodevelopmental or neurochemical changes

43
Q

Outline the natural history of schizophrenia

A

Motor, cognitive or social deficits in childhood

Gradual onset of prodromal features - odd ideas, experiences, behaviours, eccentricity, altered affect

44
Q

When is suicide risk in schizophrenia the highest?

A

1st week of discharge from hospital

45
Q

List signs to watch out for in a schizophrenic patient, that could lead to homocide

A

Command hallucinations

Delusions of jealousy

46
Q

What is psychosis and how is it characterised?

A

Inability to distinguish subjective experience from reality, characterised by lack of insight and harm to functioning
Hallucinations, delusions, thought disorders

47
Q

List phrases that can be used to confront someone about their psychotic beliefs

A

‘I just want to check I’m not misunderstanding you’
‘What would you say if someone said they’re not true’
‘I think there’s evidence you are unwell and need to be in hospital for treatment although I recognise you disagree with this’

48
Q

How is depressive psychosis classically typified?

A

Mood congruent with psychosis - delusions of grandeur/ special ability/ persecutions/ religiosity and flight of ideas
Can be secondary auditory hallucinations e.g God’s voice

49
Q

How is delirium classically typified?

A

Acute treatment disturbance with fluctuating severity
Clouding of consciousness, disorientation to time and place, impaired concentration/ memory, irritability
Can be secondary hallucinations (usually visual, or auditory) and persecutory delusions

50
Q

Which recreational drug has the highest risk for developing schizophrenia with use?

A

Cannabis

51
Q

Which recreational drug releases dopamine and therefore produces a psychotic state?

A

Amphetamine

Y3 PSYCHIATRY (23 decks)

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