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Psychiatry > Psychosis > Flashcards

Psychosis Flashcards

1
Q

Causes of psychosis

A

Drug induced, steroid induced, temporal lobe epilepsy, delirium, dementia, schizophrenia, depression, mania

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2
Q

Schizophrenia risk factors + symptoms (Schneiders, positive + negative)

A

Risk factors: adverse life events, cannabis, obstetric complications, encephalitis, males Schneiders first rank symptoms: Auditory hallucinations (3rd person, running commentary) Thought interference (insertion, withdrawal, broadcasting) Delusions of control/ passivity Schizophrenia usually has an insidious prodromal phase with subtle problems in language, cognitive ability + behaviour Positive symptoms: hallucinations, delusions Negative symptoms: flattened affect, apathy, anergy, anhedonia, alogia (decreased speech)

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3
Q

Dopamine hypothesis + dopamine pathways

A

Dopamine agonists (levodopa, amphetamines) cause schizophrenia like symptoms Dopamine antagonists (antipsychotics) can help treat schizophrenia +ve symptoms = due to dopamine overactivity in mesolimbic system -ve symptoms = dopamine underactivity in mesocortical system Nigrostriatal pathway = when dopamine is reduced by antipsychotics in this pathway, you get Parkinson like symptoms + EPSEs Tuberoinfundibular pathway = when dopamine is reduced by antipsychotics in this pathway, you get prolactinaemia (dopamine has negative feedback with prolactin)

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4
Q

ICD 10 criteria for schizophrenia

A

Symptoms present for most of the time for at least 1 month 1) Thought interference 2) Delusions of control, passivity, delusional perception 3) Auditory hallucinations 4) Persistent delusions

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5
Q

Types of schizophrenia

A

Paranoid - common, paranoid delusions, hallucinations + perceptual disturbances Hebephrenic - prominent affective changes, inappropriate mood, thought disorder, negative symptoms Catatonic - psychomotor disturbances, stupor

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6
Q

Physical investigations for schizophrenia

A

FBC, U+E, LFT, TFT, HbA1c, lipids Drug screen

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7
Q

Treatment for schizophrenia

A

1st: antipsychotic (usually atypical) 2nd: try another AP, then combine 3rd: clozapine 4th: add benzo, lithium or anticonvulsant Continue on drug for 12-24 months

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8
Q

Antidopaminergic drug effects

A

Improves +ve symptoms SE: EPSEs, hyperprolactinaemia, NMS, weight gain

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9
Q

Serotonergic drug effects

A

Improves -ve + affective symptoms SE: anxiety, insomnia, weight gain, DM

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10
Q

Antihistaminergic drug effects

A

Sedation, weight gain

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11
Q

Antiadrenergic drug effects

A

Postural hypotension, tachycardia, sexual dysfunction

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12
Q

Anticholinergic drug effects

A

Dry mouth, blurred vision, urinary retention, constipation

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13
Q

Extrapyramidal SE

A

Acute dystonia Akathisia Parkinson like symptoms Tardive dyskinesia

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14
Q

Acute dystonia - S+S, high risk groups, treatment

A

Acute reaction to AP Painful spastic contractions of muscles Tongue protrusion, torticollis, oculogyric crisis Common with haloperidol Common in young males Give anticholinergics (procyclidine)

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15
Q

Akathisia S+S, treatment

A

Acute reaction to AP Restlessness Give anticholinergics (procyclidine) or propranolol

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16
Q

Parkinson like symptoms S+S, high risk groups, treatment

A

Acute reaction to AP Tremor, rigidity, bradykinesia Common in elderly females Give anticholinergics (procyclidine)

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17
Q

Tardive dyskinesia - S+S, high risk groups, treatment

A

Long term reaction to AP Involuntary repetitive movements (tongue, lips, face, extremeties, chorieform hand movements) Worse with stress More common in elderly women DON’T give anticholinergics Switch to clozapine/ quetiapine

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18
Q

NMS - S+S, pathology, complications

A

Neuroleptic malignant syndrome Reaction to AP due to blockage of hypothalamospinal tracts Hyperthermia, muscle rigidity, altered mental state and autonomic instability (labile BP, tachycardia) Rhabdomyolysis - high CPK Can cause respiratory, CV + renal failure, seizures + DIC

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19
Q

Schizoaffective disorder

A

Schizophrenia + affective symptoms in same episode

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20
Q

Persistant delusional disorder

A

Single delusion - may be hallucinations

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21
Q

Orthello, de Clerambaults + Ekboms syndrome

A

Orthello = partner is cheating de Clerambaults = being loved by someone inaccessible (celebrity, famous) Ekboms = skin is infected by parasite

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22
Q

Cortards, Capgras + Fregoli syndrome

A

Cortards = delusion you no longer exist/ dead/ rotting Capgras = familiar person replaced by imposter Fregoli = familiar person is disguising themself as strangers

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23
Q

Folie impose/ communique

A

Impose = only A suffers from primary psychotic disorder, B’s delusions disappear if separated Communique = B maintains delusions when separated from A

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24
Q

Folie simultanee/ induite

A

Simultanee = both A+B suffer from primary psychosis but share same delusion Induite = both A+B suffer from primary psychosis but transfer their delusions to each other

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25
Q

Typical antipsychotics - names, action

A

Older gen - haloperidol, chlorpromazine Increase prolactin, EPSEs Block all 4 dopamine pathways Dopamine receptor antagonists at D2

26
Q

Atypical antipsychotics - action, effect

A

Only block mesolimbic + mesocortical Effective against positive and negative symptoms Anticholinergic + antihistaminergic side effects Also good mood stabilisers

27
Q

Haloperidol - SE, uses

A

High risk of EPSE + high prolactin High risk of NMS Sexual dysfunction QTC prolongation - must have ECG before starting Good antiemetic Good for rapid tranquilisation

28
Q

Chlorpromazine - uses, SE

A

Antiemetic properties SE: photosensitivity, hepatotoxicity, weight gain, antiadrenergic (bradycardia, hypotension), sedation, hyperprolactinaemia

29
Q

Clozapine - uses, SE, complications, OD, effect of smoking

A

Effect on D4 - used for treatment resistant schizophrenia or psychosis in Parkinsons Complications: agranulocytosis, GI hypomotility (constipation, bowel obstruction) SE: hypersalivation, weight gain, anticholinergic + adrenergic, sedation, diabetes, urinary incontinence Can cause myocarditis (flu symptoms, chest pain, tachycardia) + cardiac myopathy Causes hypotension OD causes seizures Smoking reduces plasma levels of clozapine - levels rise when stopping smoking

30
Q

Amisulpride SE

A

Increases prolactin - avoid in women No sedation or anticholinergic SE

31
Q

Risperidone action, SE

A

Acts on tuberoinfundibular pathway - biggest increase in prolactin - avoid in women Also causes postural hypotension + sexual dysfunction

32
Q

Aripiprazole uses, SE, action

A

Small dose decreases prolactin - use with other APs Causes akathisia Doesn’t prolong QTC interval No metabolic SE Good antidepressant Partial dopamine agonist

33
Q

Olanzapine SE

A

Most sedative + weight gain Diabetes risk

34
Q

Quetiapine SE, uses

A

Less EPSEs, more metabolic SEs Good mood stabiliser Good for psychosis in dementia

35
Q

Hyperprolactinaemia cause, S+S

A

DA inhibits prolactin release S+S: sexual dysfunction, reductions in bone mineral density, menstrual disturbances, breast growth, increase in risk of breast ca

36
Q

Weight gain with antipsychotics - why, which APs are high + moderate risk

A

Due to serotonin antagonism + hyperprolactinaemia High risk: clozapine + olanzapine Moderate risk: risperidone, quetiapine, paliperidone, chlorpromazine

37
Q

QT prolongation - why, which drugs

A

Block cardiac K+ channels Risk factor for ventricular arrhythmia + torsades de pointes High risk: TCAs, SSRIs, haloperidol

38
Q

APs with high risk of sexual dysfunction

A

Haloperidol, risperidone, chlorpromazine

39
Q

APs with high risk of diabetes

A

Olanzapine, clozapine

40
Q

APs causing anti-adrenergic SE

A

Clozapine, chlorpromazine

41
Q

TCAs - action, SE

A

Serotonin + noradrenaline reuptake inhibition Anticholinergic + antihistaminergic effects QT prolongation, ST elevation Postural hypotension + sedation (due to alpha adrenergic blockage)

42
Q

MAOis - action, SE, complications

A

Inhibit MAO-A (noradrenaline, serotonin + tyramine) + B (dopamine, tyramine) Postural hypotension, restlessness, oedema, nausea, sexual dysfunction Risk of hypertensive crisis

43
Q

MAOis cheese reaction - what happens, S+S, tyramine foods

A

Tyramine causes catecholamine release = tachycardia, sweating, HTN, arrhythmias, stroke Tyramine foods = cheese, yeast, hung game, red wine, pickled herring

44
Q

Mirtazapine - type, action, SE

A

NASSA Enhances NA transmission Causes weight gain + sedation No CV + anticholinergic side effects

45
Q

Antidepressant discontinuation symptoms

A

Flu like, insomnia, agitation, irritability, shock-like sensations, vivid dreams

46
Q

Carbamazepine - action, SE

A

Blocks sodium channels - reduces glutamate release + decreases turnover of DA + NA Hepatic enzyme inducer SE: dizziness, diplopia, drowsiness, ataxia, blood dyscrasias

First line for partial seizures

47
Q

Sodium valproate - action, SE, contraindications

A

Inhibits catabolism of GABA Can reduce aggression SE: blood dyscrasias, weight gain, hair loss, pancreatitis, sedation Major human teratogen - strong caution in women of child bearing age

48
Q

Benzodiazepine receptors (+ effects)

A

omega 1 = hypnotic omega 2 = anxiolytic omega 3 = myorelaxant

49
Q

Benzo withdrawal effects

A

Anxiety, tremor, pain, fatigue, psychosis, seizures, abnormal sensations

50
Q

Z drug action

A

Zopiclone = anxiolytic + hypnotic Zolpidem + zaleplon = only hypnotic

51
Q

Types of visual hallucination

A

Lilliputian = hallucination where subjects appear smaller (micropsia) = common in delirium Elementary = flashes of light Extracampine = seeing things outside your visual field ie someone standing behind you Reflex = sensory stimulus causes a hallucination in another modality (bright lights cause auditory hallucinations)

52
Q

Charles Bonnet syndrome

A

Intact cognition Ocular pathology Visual hallucinations Affects people with visual loss (usually due to macular degeneration) - often see animals in the corner of the room

53
Q

Auditory illusion

A

When auditory stimulus is misheard or misinterpreted

54
Q

Schneiders first rank symptoms

A

Delusions Auditory hallucinations Thought disorder Passivity experience

55
Q

Opisthotonus

A

Excessive spine extension

56
Q

Oculogyric crisis

A

Painful superolateral deviation of the eyes

57
Q

Buccolingual crisis

A

Bizarre grimacing/ facial expressions

58
Q

Autochthonous delusion

A

Delusion that comes out of nowhere ‘light bulb’

59
Q

De Clerambault delusion

A

Delusion that a famous person is in love with you

60
Q

Delusional mood

A

When someone feels like something around them is going on but not sure what

61
Q

Risk of developing schizophrenia (general population, twin, sibling or parent with schizophrenia)

A

Monozygotic twin has schizophrenia = 50% Parent has schizophrenia = 10-15% Sibling has schizophrenia = 10% No relatives with schizophrenia = 1%

62
Q

Hypnogogic + Hypnopompic hallucinations

A

Hypnogogic = occur as falling to sleep Hypnopompic = occurs as you wake up, continues as you open your eyes

Psychiatry (13 decks)

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