Psychosis Flashcards
is psychosis a differential
no its a description of symptom
do people with psychosis have insight
no
what is the most significant consequence of psychosis
impairment of normal function, cant deal with reality
which area of the brain is hyper stimulated in psychosis
subcortical dopamine
in schizophrenia they often have negative symptoms as well as the positive psychosis symptoms, which part of the brain causes this
mesocortical dopamine hypoactivity
are the symptoms in psychosis positive or negative
all positive
hallucination definition
brain creating the perception of something in the absence of an external stimulus
are hallucinations vivid (life like) or in their thoughts (and they know this)
vivid
hepatic hallucination definition
internal organs are moving about
something has been inserted inside you
2nd person hallucinations
can hear someone talking to you
3rd person hallucinations
can hear people talking about you (not to you)
running commentary
what are 3rd person hallucinations characteristic of
schizophrenia
can hear someone talking about you in London (out of hearing range)
extracampine hallucination
delusion definition
fixed and falsely held assumptions
a belief that is maintained despite proof that its wrong (they always have a reason)
delusion examples in depression
nilhilistic delusions
poverty
guilt
delusion examples in schizophrenia
persecution
religion
delusion examples in mania
grandiosity
paranoid
religion - eg gods voice
passivity phenomena definition
3 categories
parts of them are under the control of others
thoughts, actions or feelings being controlled
which category of passivity phenomena is most common
thought interference
‘someone is putting ideas into my head’
thought insertion
‘people can hear my thoughts’
‘everyone has access to my thoughts’
thought broadcasting
‘thoughts are being taken out of my head’
thought withdrawal
‘thoughts just dry up half way through thinking’
thought blocking
coincidental events that the person thinks are significant to them (self referential) or about something else
eg TV is transmitting messages
eg there are hidden messages in the newspaper about them
ideas of reference
what does ideas of reference result in
paranoia
examples of formal thought disorder (4)
neologism
knights move thoughts
flight of ideas
rhyming and punning
what is rhyming and punning characteristic of
mania
tangential thought process where each sentence doesn’t seem to be connected (don’t know how they got from A to B)
knights move thoughts
rapid change of topics when speaking but it makes sense how they got from A to B
flight of ideas
when people make up words that they assume you would know
neologisms
what is knights order thoughts characteristic of
schizophrenia
what is flight of ideas characteristic of
mania (bipolar)
what are the 3 differentials for visual hallucinations
delirium
substance misuse
lewy body dementia - not threatening hallucinations
how does passivity phenomena differ from formal thought disorder
formal thought disorder - neologisms (making up words), knights move thoughts, fight of ideas, rhyming and punning
passivity phenomena - thought insertion/withdrawal/broadcasting/blocking
hepatic hallucinations are characteristic of
depressive psychosis
hallucinations about internal organs moving, stuff inside you etc
risk factors for schizophrenia (4)
genetics/family history
2nd trimester viral illness (winter/spring birth)
cannabis use
large ventricles, reduced frontal lobe grey matter
typical age of onset of schizophrenia
15-25 males
25-35 females
what chemical is in excess in schizophrenia
dopamine
which drug can release dopamine = cause psychosis
amphetamine
brain changes in schizophrenia
reduced frontal lobe grey matter
enlarged ventricles
educed grey matter in temporal cortex
3rd person auditory hallucinations
give example
what condition are they characteristic of
can hear people taking about them, but not to their face
schizophrenia
as well as psychosis, what other symptoms do people with schizophrenia have
negative symptoms - reduced speech, reduced motivation
which positive symptoms (psychosis) do people with schizophrenia have
delusions - religious, persecutory
hallucinations - 3rd person
formal thought disorder - neologisms, knights move thoughts
passivity phenomena - thought insertion/withdrawal/broadcasting/blocking
how many symptoms of schizophrenia do you need for diagnosis
just 1!
or 2 if formal thought disorder
what is catatonic schizophrenia
schizophrenia with unusual posture (movement disorder)
what investigation can you do to rule a cause of psychosis when diagnosing schizophrenia
toxicology - for drug cause of psychosis (though usually present differently with visual hallucinations)
treatment of aggressive behavior in schizophrenia
lorazepam and haloperidol
first line treatment of schizophrenia
second generation atypical antipsychotics
how do second generation atypical antipsychotics work in treating schizophrenia
block serotonin receptor
examples of second generation atypical antipsychotics for schizophrenia (3)
risperidone
olanzepine
quetiapine
side effects of second generation atypical antipsychotics for schizophrenia
metabolic syndrome ( high BP, hyperglycaemia, high cholesterol) = weight gain sedation long QT syndrome
contraindications for second generation atypical antipsychotics for schizophrenia
type 2 diabetes (bc of metabolic syndrome SE)
indications for second generation atypical antipsychotics for schizophrenia
parkinsons (bc first generation typicals have extrapyramidal side effects)
which second generation atypical antipsychotic is first line in schizophrenia
risperidone
how do first generation typical antipsychotics work in treating schizophrenia
block dopamine receptor
alternative to second generation antipsychotics in schizophrenia
first generation typical antipsychotics
examples of first generation typical antipsychotics for schizophrenia (2)
haloperidol
chlorpromazine
main side effect of first generation typical antipsychotics for schizophrenia (1)
how does this present (6)
extra pyramidal side effects eg parkinsonism
rolling pin tremor bradykinesia wide based gait tremor slurred speech loss of coordination
contraindications for first generation typical antipsychotics for schizophrenia
parkinsons (bc they cause extra pyramidal side effects)
indications for first generation typical antipsychotics for schizophrenia
type 2 diabetes
obesity
other than parkinsonism, what are the other side effects of first generation typical antipsychotics for schizophrenia (5)
tardive dyskinesia akathisia - restless dystonia - muscle spasms long QT syndrome hyperprolactinaemia - sexual dysfunction
what is tardive dyskinesia (SE of first generation typical antipsychotics)
involuntary movement of tongue/mouth
develops over years
which first generation typical antipsychotic is used most in schizophrenia
haloperidol
third line treatment of schizophrenia after second generation atypical antipsychotics (risperidone) and first generation typical antipsychotics (haloperidol)
clozapine
last line
if clozapine is best, why isn’t it first line in schizophrenia
v bad side effects
side effects of clozapine (3)
agranulocytosis!!!
myocarditis
weight gain
what safety netting do you need to do if you prescribe clozapine
tell them to stop it and get help if they get a sore throat
= risk of agranulocytosis
what is the suicide risk in schizophrenia
10%
must follow up after a hospital discharge
how many people with schizophrenia get better
1/3
how many people with schizophrenia get better but aren’t fully functioning
1/3
how many people with schizophrenia don’t get better with drugs
1/3
suicide likely
how to monitor ?agranulocytosis with someone on clozapine
FBC
STOP the clozapine1
