Psychosis Flashcards
What are hallucinations?
Internal perception not perceived as internal
What is a simple hallucination?
Bangs etc
What is a complex hallucination?
Voices etc
What are delusions?
Firmly held incorrect belief
What are primary delusions?
Fully formed in consciousness without need for explanation. No way to understand.
What are secondary delusions?
Understandable in light of previous experiences. Attempt to explain things.
What is a capgras delusion?
Imposter syndrome, feel others have been replaced with imposters
What is a Fregoli delusion?
Think one person is multiple
What is a paranoid delusion?
Thinks things refer to themselves- hidden messages etc
What are persecutory delusions?
About others, feel harm may come to others
WHat are delusions of sin usually about?
Paedophilia
What are nihilistic delusions about?
Think they are already dead
What is a delusion of grandeur?
Think one is important
What is a religious delusion?
Think god is speaking to them or are god themselves
What are delusions of guilt of?
Think a bad person etc
What is a delusion of love/ De Clerambault syndrome?
Feel someone loves them. Often leads to stalking.
What is a delusion of jealousy/Othello syndrome?
Thinks partner cheating etc. Can lead to murder.
What are illusions?
Misinterpretation of info
What are ideas of reference?
Thought that coincidence etc are linked or referring to them/seeing hidden messages to them. Paranoia.
What is passivity?
Feel like being controlled
Give some examples of thought interference
Insertion
Withdrawal
Broadcasting
Blocking
What is thought insertion?
Someone giving them thoughts
What is thought withdrawal?
Someone taking their thoughts away
What is thought broadcasting?
Others can hear thoughts
What is thought blocking?
Mind goes blank mid thought
What is a thought disorder?
Disorder of content of thought
Give some examples of thought disorders
Neologisms Circumstantiality/Tangentiality Clanging and punning Loosening of associations Knight's move thinking Verbigeration/Word Salad
What is psychosis?
Mental disorder in which the thoughts, affective response or ability to recognise reality, and the ability to communicate and relate to others, are sufficiently impaired to interfere grossly with the capacity to deal with reality.
What do people with psychosis tend to lack?
Insight
Give some examples of psychosis symptoms?
Hallucinations
Delusions
Disorders of form of thought
What are some forms of psychosis?
Psychosis
Affective
Organic
Pharmacological
What kind of things can cause a pharmacological delusion?
Drugs
Alcohol
Withdrawal
Do you need to be intoxicated to suffer from pharmacological psychosis
No- can last past intoxication
What causes organic psychosis?
Damage to part of the world that interpreters reality (temporal lobe).
What things can cause organic psychosis?
Temporal lobe epilepsy Temporal lobe damage Sleep deprivation Stroke Delirium Dementia
What is affective psychosis?
Psychosis associated with affective/mood disorder
What are some symptoms of unipolar depression psychosis?
Persecutor delusions
Self-blame delusions
Worthlessness delusions
2nd person hallucinations- accusing/insulting/threat
What are some symptoms of bipolar psychosis?
Delusions of grandeur
Religiosity
Special abilities
What is the main condition in paranoid psychosis?
Schizophrenia
What is schizophrenia?
A broad range of perceptual, cognitive and behavioural disturbances.
What is the patho of schizophrenia?
No specific cause
Neurodevelopmental disconnection
What can cause the neurodevelopmental disconnection in schizophrenia?
Genetics
Environmental factors affecting brain development.
What is a risk factor for schizophrenia?
Daily cannabis use
What are some signs of schizophrenia?
Enlarged ventricles
Mesolimbic DAR upreg
Describe the onset of schizophrenia symptoms?
Any age
Rare before puberty
Peak in 20s
What are the first rank symptoms of schizophrenia used for?
Diagnosis?
How do you diagnose schizophrenia?
Presence of the first rank symptoms
What are the first rank symptoms of schizophrenia?
- Primary delusion (arising out of nothing- often persecutory
- Delusional perception
- Auditory hallucinations in the third person, and/or voices commenting on their behaviour
- Thought interference- Thought withdrawal, insertion and broadcast
- Somatic passivity and feelings – patients believe that thoughts, feelings or acts are controlled by other
What are some other symptoms of schizophrenia?
Lack of insight Social withdrawal Apathy Lack of conversation Anhedonia Psychomotor retardation Self-neglect Cognitive impairment Secondary delusions Blunting of mood
What are NOT some symptoms of schizophrenia?
Visual hallucinations- Can occasionally occur
Altered consciousness
Memory disturbances
What are the two categories of symptoms in schizophrenia?
Type 1/positive
Type 2/negative
What are positive symptoms?
Things present in patient that are not in normal people
What are negative symptoms?
Patient lacks things seen in normal people
Give some features of positive symptoms
Acute onset Prominent delusions and hallucinations Normal brain structure Involves dopaminergic transmission Good response to neuroleptics Better outcome
How rapidly do positive symptoms come on?
Acutely
What are the main symptoms of positive symptoms?
Prominent delusions and hallucinations
How do positive symptoms react to treatment?
Well
Between postivie and negative symptoms which has the better response to treatment?
Positive has better outcome
What are some features of negative symptoms?
Slow insidious onset Absence of acute symptoms Apathy Social withdrawal Lack of motivation Brain structure abnormalities
Describe the onset of negative symptoms?
Slow insidious onset
What are some symptoms of negative symptoms?
Apathy
Social withdrawal
Lack motivation
How do negative symptoms respond to treatment?
Not very well
What are the four main subtypes of schizophrenia?
Paranoid
Hebephrenic/disorganised
Catatonic
Undifferentiated
What is the commonest form of schizophrenia?
Paranoid
What are the main symptoms of paranoid schizophrenia?
Hallucinations- 3rd person auditory
Delusions- Persecutory or grandiose, Jealousy, Religiosity
How does personality change in paranoid schizophrenia?
Doesn’t change
What’s the prognosis for disorganised schizophrenia?
Poor
What is the normal age of onset of disorganised schizophrenia?
15-25
What are some symptoms of disorganised schizophrenia?
Changes in mood prominent with fleeting fragmented delusions and hallucinations
Thought disorder
Flat affect
How does personality change in disorganised schizophrenia?
Premorbid schizoid or schizotypal personality
What are some symptoms of catatonic schizophrenia?
Stupor, excitement, posturing, waxy flexibility and negativism
Agitated, purposeless movement
How common is catatonic schizophrenia?
Rare
What is undifferentiated schizophrenia?
Mixture of all types.
What is the differential for schizophrenia?
Organic mental disorders (e.g. partial complex epilepsy)
Mood (affective) disorders (e.g. mania)
Drug psychoses (e.g. amfetamine psychosis)
Personality disorders (schizotypal).
Older patients, any acute or chronic brain syndrome can present in a schizophrenia-like manner
Schizoaffective psychosis
How do you diagnose schizophrenia?
Symptoms for >6m
Symptoms present for most days of 1m
Marked impairment in work or home functioning
What is the best treatment for schizophrenia?
Pharma and social combo best
What psychotherapy can be used for schizophrenia?
Reasurrance
CBT
No intensive or exploratory psychotherapy
What social therapy can be used for schizophrenia?
Family education
Sheltered employment
What are the two categories of pharmacological treatment for schizophrenia?
Typical antipsychotics
Atypical antipsychotics
What are neuroleptics?
Antipsychotic drugs
How do typical antipsychotic work?
Block D1 and D2 receptors
What are typical antipsychotics best used for?
Acute postivie symptoms
Not good for chronic symptoms
How long can typical antipsychotics take to work?
Complete control can take up to 3 months
What can typical antipsychotics be good for?
Limited use in maintenance due to side effects
Symptom control
What are the two categories of typical antipsychotics?
Phenothiazines
Butyrophenones
Give some examples of phenothiazines?
Clopromazine- 100-1000mg daily
Trifluoperazine- Less sedation
Fluphenazine decanoate
What is the benefit of clopromazine?
Good for treatment resistant
What are some major side effects of clopromazine?
Severe extra-pyramidal SE.
What is Fluphenazine decanoate used for?
Prophylaxis (IM 1-4 weeks)
What are some benefits of butyrophenones?
Good for acute psychosis and mania.
Less sedating than phenothiazines
Give an example of butyrophenones?
Haloperidol
What is haloperidol really useful for
Acute treatment
What is the dose of haloperidol?
2-30mg
Why are atypical antipsychotics used instead of typical?
Just as good but less side effects
What are the five main categories of typical antipsychotic side effects?
Motor Autonomic Antimuscarinic Metabolic Other
What are some motor side effects of typical antipsychotics?
Extra-pyramidal symptoms Acute dystonia Parkinsonism Akathisia- Restlessness Tardive dyskinesia
What are some autonomic side effects of typical antipsychotics?
Hypotension
Sexual dysfunction in men
What are some antimuscarinic side effects of typical antipsychotics?
- Dry mouth
- Urinary retention
- Constipation
- Blurred vision
What is the metabolic side effects of typical antipsychotics?
Weight gain
What are some ‘other’ side effects of typical antipsychotics?
Precipitation of glaucoma Galactorrhoea (due to hyperprolactinaemia) Amenorrhoea Cardiac arrhythmias Seizures
What is a serious side effect of typical antipsychotics?
Neuroleptic malignant syndrome
What drug is Neuroleptic malignant syndrome commonly associated with?
Haloperidol
How long do symptoms start to come on in Neuroleptic malignant syndrome?
Days to weeks
What are some symptoms of Neuroleptic malignant syndrome?
Hyperthermia Muscle rigidity Autonomic instability- Tachycardia, labile BP, pallor Fluctuating consciousness Raised CK Raised WCC Abnormal liver function
How do you treat Neuroleptic malignant syndrome?
Stop antipsychotic
Resuscitation
How do atypical antipsychotics work?
Block D1 more than D2R.
What is the first line treatment for schizophrenia?
Atypical antipsychotics
Give five examples of atypical antipsychotics?
Risperidone Olanzapine Clozapine Quetiapine Zuclopentixol
What is the dose of risperidone?
6-10mg
What are some major side effects of risperidone?
Sedation/daytime sleepiness
Low extra-pyramidal SE
Cardio abnormalities
What is the dose of olanzapine?
5-15mg
What are some major side effects of olanzapine?
Weight gain- Diabetes mellitus
Sedation/daytime sleepiness
Cardio abnormalities
What is the dose of clozapine?
25mg daily at start
150-300mg maintenance
What is clozapine good for?
Antipsychotic
Good for aggression and suicidal intent
What are some side effects of clozapine?
Agranulocytosis
Weight gain- Diabetes Mellitus
Sialorrhoea
How does clozapine work?
Mainly blocks limbic DR therefore less extra-pyramidal side effects.
What is clozapine good for?
Both postivie and negative symptoms
Chronic symptoms
What is Zuclopentixol good for?
For those with diabetes mellitus
What are some major side effects of most antipsychotics?
Extra-pyramidal DSH Acute dystonia- Torticollis Akathisia Amenorrhoea Galactorrhoea Postural hypotension Delirium
How do extra-pyramidal side effects present?
Parkinsonism
What is acute dystonia and torticollis?
AD- Body parts contract uncontrollable causing twisting
Torticollis- Abnormally twisted head/neck
What is akathisia?
Motor restlessness, most commonly affecting the legs. It is similar to the restless legs syndrome, but apparent during the day
How many previous antipsychotics need to have failed before you get clozapine?
2
What is Agranulocytosis?
Severe lowering of neutrophil levels
What kind of delusions are usually seen in schizophrenia?
Primary
What kind of delusions are normally seen in mood disorders?
Secondary
What is a brief psychotic disorder?
A sudden, short-term display of psychotic behaviour. It may include hallucinations or delusions, and can occur following a stressful event.
What is a predisposing factor for brief psychotic disorders?
Personality disorder
How long does a brief psychotic disorder tend to last?
1 day - 1 month
What happens on resolution of a brief psychotic disorder?
Returns to normal
How does frontal lobe volume correlate with severity of schizophrenia?
Less volume more severe
What neurochemistry leads to psychosis?
Subcortical Dopamine hyperactivity
What neurochemistry causes the negative and cognitive symptoms of schizophrenia?
Mesocortical Dopamine hypoactivity
How does efficacy differ between antipsychotics?
Clozapine best then all others equal
