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Psychosis Flashcards

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1
Q

is psychosis a differential

A

no its a description of symptom

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2
Q

do people with psychosis have insight

A

no

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3
Q

what is the most significant consequence of psychosis

A

impairment of normal function, cant deal with reality

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4
Q

which area of the brain is hyper stimulated in psychosis

A

subcortical dopamine

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5
Q

in schizophrenia they often have negative symptoms as well as the positive psychosis symptoms, which part of the brain causes this

A

mesocortical dopamine hypoactivity

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6
Q

are the symptoms in psychosis positive or negative

A

all positive

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7
Q

hallucination definition

A

brain creating the perception of something in the absence of an external stimulus

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8
Q

are hallucinations vivid (life like) or in their thoughts (and they know this)

A

vivid

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9
Q

hepatic hallucination definition

A

internal organs are moving about

something has been inserted inside you

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10
Q

2nd person hallucinations

A

can hear someone talking to you

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11
Q

3rd person hallucinations

A

can hear people talking about you (not to you)

running commentary

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12
Q

what are 3rd person hallucinations characteristic of

A

schizophrenia

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13
Q

can hear someone talking about you in London (out of hearing range)

A

extracampine hallucination

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14
Q

delusion definition

A

fixed and falsely held assumptions

a belief that is maintained despite proof that its wrong (they always have a reason)

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15
Q

delusion examples in depression

A

nilhilistic delusions
poverty
guilt

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16
Q

delusion examples in schizophrenia

A

persecution

religion

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17
Q

delusion examples in mania

A

grandiosity
paranoid
religion - eg gods voice

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18
Q

passivity phenomena definition

3 categories

A

parts of them are under the control of others

thoughts, actions or feelings being controlled

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19
Q

which category of passivity phenomena is most common

A

thought interference

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20
Q

‘someone is putting ideas into my head’

A

thought insertion

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21
Q

‘people can hear my thoughts’

‘everyone has access to my thoughts’

A

thought broadcasting

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22
Q

‘thoughts are being taken out of my head’

A

thought withdrawal

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23
Q

‘thoughts just dry up half way through thinking’

A

thought blocking

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24
Q

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

A

ideas of reference

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25
Q

what does ideas of reference result in

A

paranoia

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26
Q

examples of formal thought disorder (4)

A

neologism
knights move thoughts
flight of ideas
rhyming and punning

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27
Q

what is rhyming and punning characteristic of

A

mania

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28
Q

tangential thought process where each sentence doesn’t seem to be connected (don’t know how they got from A to B)

A

knights move thoughts

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29
Q

rapid change of topics when speaking but it makes sense how they got from A to B

A

flight of ideas

30
Q

when people make up words that they assume you would know

A

neologisms

31
Q

what is knights order thoughts characteristic of

A

schizophrenia

32
Q

what is flight of ideas characteristic of

A

mania (bipolar)

33
Q

what are the 3 differentials for visual hallucinations

A

delirium
substance misuse
lewy body dementia - not threatening hallucinations

34
Q

how does passivity phenomena differ from formal thought disorder

A

formal thought disorder - neologisms (making up words), knights move thoughts, fight of ideas, rhyming and punning

passivity phenomena - thought insertion/withdrawal/broadcasting/blocking

35
Q

hepatic hallucinations are characteristic of

A

depressive psychosis

hallucinations about internal organs moving, stuff inside you etc

36
Q

risk factors for schizophrenia (4)

A

genetics/family history
2nd trimester viral illness (winter/spring birth)
cannabis use
large ventricles, reduced frontal lobe grey matter

37
Q

typical age of onset of schizophrenia

A

15-25 males

25-35 females

38
Q

what chemical is in excess in schizophrenia

A

dopamine

39
Q

which drug can release dopamine = cause psychosis

A

amphetamine

40
Q

brain changes in schizophrenia

A

reduced frontal lobe grey matter
enlarged ventricles
educed grey matter in temporal cortex

41
Q

3rd person auditory hallucinations

give example

what condition are they characteristic of

A

can hear people taking about them, but not to their face

schizophrenia

42
Q

as well as psychosis, what other symptoms do people with schizophrenia have

A

negative symptoms - reduced speech, reduced motivation

43
Q

which positive symptoms (psychosis) do people with schizophrenia have

A

delusions - religious, persecutory
hallucinations - 3rd person
formal thought disorder - neologisms, knights move thoughts
passivity phenomena - thought insertion/withdrawal/broadcasting/blocking

44
Q

how many symptoms of schizophrenia do you need for diagnosis

A

just 1!

or 2 if formal thought disorder

45
Q

what is catatonic schizophrenia

A

schizophrenia with unusual posture (movement disorder)

46
Q

what investigation can you do to rule a cause of psychosis when diagnosing schizophrenia

A

toxicology - for drug cause of psychosis (though usually present differently with visual hallucinations)

47
Q

treatment of aggressive behavior in schizophrenia

A

lorazepam and haloperidol

48
Q

first line treatment of schizophrenia

A

second generation atypical antipsychotics

49
Q

how do second generation atypical antipsychotics work in treating schizophrenia

A

block serotonin receptor

50
Q

examples of second generation atypical antipsychotics for schizophrenia (3)

A

risperidone
olanzepine
quetiapine

51
Q

side effects of second generation atypical antipsychotics for schizophrenia

A 
metabolic syndrome ( high BP, hyperglycaemia, high cholesterol) = weight gain 
sedation 
long QT syndrome
52
Q

contraindications for second generation atypical antipsychotics for schizophrenia

A

type 2 diabetes (bc of metabolic syndrome SE)

53
Q

indications for second generation atypical antipsychotics for schizophrenia

A

parkinsons (bc first generation typicals have extrapyramidal side effects)

54
Q

which second generation atypical antipsychotic is first line in schizophrenia

A

risperidone

55
Q

how do first generation typical antipsychotics work in treating schizophrenia

A

block dopamine receptor

56
Q

alternative to second generation antipsychotics in schizophrenia

A

first generation typical antipsychotics

57
Q

examples of first generation typical antipsychotics for schizophrenia (2)

A

haloperidol

chlorpromazine

58
Q

main side effect of first generation typical antipsychotics for schizophrenia (1)

how does this present (6)

A

extra pyramidal side effects eg parkinsonism

rolling pin tremor 
bradykinesia 
wide based gait 
tremor 
slurred speech 
loss of coordination
59
Q

contraindications for first generation typical antipsychotics for schizophrenia

A

parkinsons (bc they cause extra pyramidal side effects)

60
Q

indications for first generation typical antipsychotics for schizophrenia

A

type 2 diabetes

obesity

61
Q

other than parkinsonism, what are the other side effects of first generation typical antipsychotics for schizophrenia (5)

A 
tardive dyskinesia 
akathisia - restless 
dystonia - muscle spasms 
long QT syndrome 
hyperprolactinaemia - sexual dysfunction
62
Q

what is tardive dyskinesia (SE of first generation typical antipsychotics)

A

involuntary movement of tongue/mouth

develops over years

63
Q

which first generation typical antipsychotic is used most in schizophrenia

A

haloperidol

64
Q

third line treatment of schizophrenia after second generation atypical antipsychotics (risperidone) and first generation typical antipsychotics (haloperidol)

A

clozapine

last line

65
Q

if clozapine is best, why isn’t it first line in schizophrenia

A

v bad side effects

66
Q

side effects of clozapine (3)

A

agranulocytosis!!!
myocarditis
weight gain

67
Q

what safety netting do you need to do if you prescribe clozapine

A

tell them to stop it and get help if they get a sore throat

= risk of agranulocytosis

68
Q

what is the suicide risk in schizophrenia

A

10%

must follow up after a hospital discharge

69
Q

how many people with schizophrenia get better

A

1/3

70
Q

how many people with schizophrenia get better but aren’t fully functioning

A

1/3

71
Q

how many people with schizophrenia don’t get better with drugs

A

1/3

suicide likely

72
Q

how to monitor ?agranulocytosis with someone on clozapine

A

FBC

STOP the clozapine1

J Psych (14 decks)

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