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PSYCHIATRY > Psychosis > Flashcards

Psychosis Flashcards

1
Q

Define psychosis

A

An inability to distinguish between subjective experience and reality

(it is a description of symptoms rather than a diagnosis)

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2
Q

What are the main symptoms of psychosis?

A

Hallucinations

Delusions

Ideas of reference

Formal thought disorder

Thought interference

Passivity phenomena

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3
Q

What type of auditory hallucinations occur in mood disorders and what type occurs in schizophrenia?

A

2nd person - mood disorders
(voices directly address the patient)

3rd person - schizophrenia
(voices are talking about the patient/ form a running commentary)

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4
Q

What are somatic hallucinations?

A

Hallucinations to do with bodily sensations

E.g insects crawling under the skin

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5
Q

What are ideas of reference?

A

innocuous or coincidental events have significant meaning for the patient

E.g seeing meaning in people’s gestures

E.g thinking objects have been arranged in a specific way to convey hidden meanings

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6
Q

What are hallucinations?

A

Perceptions which occur in the absence of external stimuli

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7
Q

What are delusions?

A

Fixed and falsely held beliefs which are unaffected by evidence suggesting otherwise

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8
Q

What are the typical themes of the delusions which occur in depression, mania and schizophrenia?

A

Depression; disease, nihilism, poverty, guilt

Mania; grandiosity, religion, persecution

Schizophrenia; love, religion, control, persecution

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9
Q

What is the difference between primary and secondary delusions?

A

Primary delusions = any type of delusion e.g paranoid, persecution, grandiosity e.t.c

Secondary delusions = attempts to explain anomalous experiences (e.g delusions as a result of hallucinations)
E.g “My thoughts aren’t my own they are coming from outside me”

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10
Q

What are self referential experiences?

A

The belief that external events are related to oneself

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11
Q

What are neologisms?

A

New words the patient makes up

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12
Q

What is meant by clanging and punning?

A

Making associations between words which sound the same rather than by their meaning

E.g Dr Pell, ding dong bell, go to hell.

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13
Q

What is meant by Knight’s move thinking?

A

When the logical sequence of ideas is lost, resulting in the jumping from one topic to another with no obvious links

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14
Q

What are the different types of thought interference?

A

Thought insertion

Thought withdrawal

Thought broadcasting

Thought blocking

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15
Q

What is passivity phenomena?

A

The patient feels that their behaviour is being controlled by someone else/ an external influence or that they are experiencing the feelings/ actions of someone other than themselves.

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16
Q

What is the differential diagnosis for psychosis?

A

Drug induced psychosis

Dilirium

Depressive psychosis

Mania - bipolar disorder

Schizophrenia

17
Q

What is the management for psychosis?

A

Antipsychotics

..duh

18
Q

What are some risk factors for schizophrenia

A

Strongest risk factor is FH

Birth complications

Drug use

Urban living

Social adversity and deprivation

19
Q

When is the typical age of onset for schizophrenia?

A

Mid-twenties for men

Late twenties for women

(more common in men)

20
Q

What are 5 subtypes of schizophrenia?

A

Paranoid

Hebephrenic

Catatonic

Residual

Simple

21
Q

What are good prognostic indicators for schizophrenia?

A

Older age of onset

Female gender

Marked mood disturbance, especially elation

FH of mood disorders

22
Q

What are poor prognostic indicators for schizophrenia?

A

Early onset

Long duration of untreated psychosis

Cognitive impairment

Enlarged ventricles

23
Q

What are some of the positive symptoms of schizophrenia?

A

Hallucinations (usually 3rd person auditory)

Delusions (usually persecutory)

Passivity phenomena

Thought interference

24
Q

What are some of the negative symptoms of schizophrenia?

A

Reduced speech

Reduced movement

Reduced interest and pleasure

Reduced social interaction

Blunting of affect

25
Q

How is schizophrenia managed?

A

Antipsychotics

CBT

CVS risk factor modification

26
Q

Neurobiology of schizophrenia

A

Enlarged ventricles and thinned cortices

Reduced volume of the frontotemporal lobe

Reduced activation of the prefrontal areas on specific tasks (e.g executive functions)

Gene alterations

Altered dopamine signalling

27
Q

What are the most common causes of visual hallucinations?

A

Delirium and substance misuse

28
Q

If a patient is experiencing auditory hallucinations, what questions should you ask to gain a further understanding about the nature of the hallucinations?

A

“Do you think the voices are your own thoughts?”

“Do the voices come from inside your head or from outside your head and body?”

29
Q

What is meant by ‘overvalued ideas’?

A

These are not delusions

They are ideas which are overvalued but the patient has insight and can recognise they may not be true

30
Q

Describe mood in schizophrenia

A

Euthymic

Depression may follow an episode

31
Q

What is meant by poverty of speech, a type of thought disorder?

A

Minimal verbal communication

32
Q

What is meant by perseveration, a type of thought disorder?

A

Inability to switch ideas along with social context

33
Q

What is meant by circumstantiality, a type of thought disorder?

A

Inability to answer questions without unnecessary and excessive detail

The patient will go off on tangents, but will come back to answer the question eventually

34
Q

Subcortical dopamine hyperactivity accounts for which symptoms of psychosis?

A

Positive symptoms

35
Q

Mesocortical dopamine hypoactivity accounts for which symptoms of psychosis?

A

Negative symptoms

36
Q

What are the features of catatonic schizophrenia?

A

Stupor

Mutism

Waxy flexibility (unresponsive to stimuli and immobilised for long periods of time)

37
Q

Schizophrenia involves overactivity of what pathways in the brain?

A

Dopamine pathways

38
Q

What is tangentiality, a type of thought disorder?

A

The patient goes off on tangents and doesn’t return to the original topic/ question

39
Q

What is an illusion?

A

Misconception/ misinterpretation of a real stimulus

PSYCHIATRY (11 decks)

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