Psychosis Flashcards
1
Q
What are hallucinations?
A
Internal perception not perceived as internal
2
Q
What is a simple hallucination?
A
Bangs etc
3
Q
What is a complex hallucination?
A
Voices etc
4
Q
What are delusions?
A
Firmly held incorrect belief
5
Q
What are primary delusions?
A
Fully formed in consciousness without need for explanation. No way to understand.
6
Q
What are secondary delusions?
A
Understandable in light of previous experiences. Attempt to explain things.
7
Q
What is a capgras delusion?
A
Imposter syndrome, feel others have been replaced with imposters
8
Q
What is a Fregoli delusion?
A
Think one person is multiple
9
Q
What is a paranoid delusion?
A
Thinks things refer to themselves- hidden messages etc
10
Q
What are persecutory delusions?
A
About others, feel harm may come to others
11
Q
WHat are delusions of sin usually about?
A
Paedophilia
12
Q
What are nihilistic delusions about?
A
Think they are already dead
13
Q
What is a delusion of grandeur?
A
Think one is important
14
Q
What is a religious delusion?
A
Think god is speaking to them or are god themselves
15
Q
What are delusions of guilt of?
A
Think a bad person etc
16
Q
What is a delusion of love/ De Clerambault syndrome?
A
Feel someone loves them. Often leads to stalking.
17
Q
What is a delusion of jealousy/Othello syndrome?
A
Thinks partner cheating etc. Can lead to murder.
18
Q
What are illusions?
A
Misinterpretation of info
19
Q
What are ideas of reference?
A
Thought that coincidence etc are linked or referring to them/seeing hidden messages to them. Paranoia.
20
Q
What is passivity?
A
Feel like being controlled
21
Q
Give some examples of thought interference
A
Insertion
Withdrawal
Broadcasting
Blocking
22
Q
What is thought insertion?
A
Someone giving them thoughts
23
Q
What is thought withdrawal?
A
Someone taking their thoughts away
24
Q
What is thought broadcasting?
A
Others can hear thoughts
25
What is thought blocking?
Mind goes blank mid thought
26
What is a thought disorder?
Disorder of content of thought
27
Give some examples of thought disorders
```
Neologisms
Circumstantiality/Tangentiality
Clanging and punning
Loosening of associations
Knight's move thinking
Verbigeration/Word Salad
```
28
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.
29
What do people with psychosis tend to lack?
Insight
30
Give some examples of psychosis symptoms?
Hallucinations
Delusions
Disorders of form of thought
31
What are some forms of psychosis?
Psychosis
Affective
Organic
Pharmacological
32
What kind of things can cause a pharmacological delusion?
Drugs
Alcohol
Withdrawal
33
Do you need to be intoxicated to suffer from pharmacological psychosis
No- can last past intoxication
34
What causes organic psychosis?
Damage to part of the world that interpreters reality (temporal lobe).
35
What things can cause organic psychosis?
```
Temporal lobe epilepsy
Temporal lobe damage
Sleep deprivation
Stroke
Delirium
Dementia
```
36
What is affective psychosis?
Psychosis associated with affective/mood disorder
37
What are some symptoms of unipolar depression psychosis?
Persecutor delusions
Self-blame delusions
Worthlessness delusions
2nd person hallucinations- accusing/insulting/threat
38
What are some symptoms of bipolar psychosis?
Delusions of grandeur
Religiosity
Special abilities
39
What is the main condition in paranoid psychosis?
Schizophrenia
40
What is schizophrenia?
A broad range of perceptual, cognitive and behavioural disturbances.
41
What is the patho of schizophrenia?
No specific cause
| Neurodevelopmental disconnection
42
What can cause the neurodevelopmental disconnection in schizophrenia?
Genetics
| Environmental factors affecting brain development.
43
What is a risk factor for schizophrenia?
Daily cannabis use
44
What are some signs of schizophrenia?
Enlarged ventricles
| Mesolimbic DAR upreg
45
Describe the onset of schizophrenia symptoms?
Any age
Rare before puberty
Peak in 20s
46
What are the first rank symptoms of schizophrenia used for?
Diagnosis?
47
How do you diagnose schizophrenia?
Presence of the first rank symptoms
48
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
49
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
```
50
What are NOT some symptoms of schizophrenia?
Visual hallucinations- Can occasionally occur
Altered consciousness
Memory disturbances
51
What are the two categories of symptoms in schizophrenia?
Type 1/positive
| Type 2/negative
52
What are positive symptoms?
Things present in patient that are not in normal people
53
What are negative symptoms?
Patient lacks things seen in normal people
54
Give some features of positive symptoms
```
Acute onset
Prominent delusions and hallucinations
Normal brain structure
Involves dopaminergic transmission
Good response to neuroleptics
Better outcome
```
55
How rapidly do positive symptoms come on?
Acutely
56
What are the main symptoms of positive symptoms?
Prominent delusions and hallucinations
57
How do positive symptoms react to treatment?
Well
58
Between postivie and negative symptoms which has the better response to treatment?
Positive has better outcome
59
What are some features of negative symptoms?
```
Slow insidious onset
Absence of acute symptoms
Apathy
Social withdrawal
Lack of motivation
Brain structure abnormalities
```
60
Describe the onset of negative symptoms?
Slow insidious onset
61
What are some symptoms of negative symptoms?
Apathy
Social withdrawal
Lack motivation
62
How do negative symptoms respond to treatment?
Not very well
63
What are the four main subtypes of schizophrenia?
Paranoid
Hebephrenic/disorganised
Catatonic
Undifferentiated
64
What is the commonest form of schizophrenia?
Paranoid
65
What are the main symptoms of paranoid schizophrenia?
Hallucinations- 3rd person auditory
| Delusions- Persecutory or grandiose, Jealousy, Religiosity
66
How does personality change in paranoid schizophrenia?
Doesn't change
67
What's the prognosis for disorganised schizophrenia?
Poor
68
What is the normal age of onset of disorganised schizophrenia?
15-25
69
What are some symptoms of disorganised schizophrenia?
Changes in mood prominent with fleeting fragmented delusions and hallucinations
Thought disorder
Flat affect
70
How does personality change in disorganised schizophrenia?
Premorbid schizoid or schizotypal personality
71
What are some symptoms of catatonic schizophrenia?
Stupor, excitement, posturing, waxy flexibility and negativism
Agitated, purposeless movement
72
How common is catatonic schizophrenia?
Rare
73
What is undifferentiated schizophrenia?
Mixture of all types.
74
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
75
How do you diagnose schizophrenia?
Symptoms for >6m
Symptoms present for most days of 1m
Marked impairment in work or home functioning
76
What is the best treatment for schizophrenia?
Pharma and social combo best
77
What psychotherapy can be used for schizophrenia?
Reasurrance
CBT
No intensive or exploratory psychotherapy
78
What social therapy can be used for schizophrenia?
Family education
| Sheltered employment
79
What are the two categories of pharmacological treatment for schizophrenia?
Typical antipsychotics
| Atypical antipsychotics
80
What are neuroleptics?
Antipsychotic drugs
81
How do typical antipsychotic work?
Block D1 and D2 receptors
82
What are typical antipsychotics best used for?
Acute postivie symptoms
| Not good for chronic symptoms
83
How long can typical antipsychotics take to work?
Complete control can take up to 3 months
84
What can typical antipsychotics be good for?
Limited use in maintenance due to side effects
| Symptom control
85
What are the two categories of typical antipsychotics?
Phenothiazines
| Butyrophenones
86
Give some examples of phenothiazines?
Clopromazine- 100-1000mg daily
Trifluoperazine- Less sedation
Fluphenazine decanoate
87
What is the benefit of clopromazine?
Good for treatment resistant
88
What are some major side effects of clopromazine?
Severe extra-pyramidal SE.
89
What is Fluphenazine decanoate used for?
Prophylaxis (IM 1-4 weeks)
90
What are some benefits of butyrophenones?
Good for acute psychosis and mania.
| Less sedating than phenothiazines
91
Give an example of butyrophenones?
Haloperidol
92
What is haloperidol really useful for
Acute treatment
93
What is the dose of haloperidol?
2-30mg
94
Why are atypical antipsychotics used instead of typical?
Just as good but less side effects
95
What are the five main categories of typical antipsychotic side effects?
```
Motor
Autonomic
Antimuscarinic
Metabolic
Other
```
96
What are some motor side effects of typical antipsychotics?
```
Extra-pyramidal symptoms
Acute dystonia
Parkinsonism
Akathisia- Restlessness
Tardive dyskinesia
```
97
What are some autonomic side effects of typical antipsychotics?
Hypotension
| Sexual dysfunction in men
98
What are some antimuscarinic side effects of typical antipsychotics?
- Dry mouth
- Urinary retention
- Constipation
- Blurred vision
99
What is the metabolic side effects of typical antipsychotics?
Weight gain
100
What are some 'other' side effects of typical antipsychotics?
```
Precipitation of glaucoma
Galactorrhoea (due to hyperprolactinaemia)
Amenorrhoea
Cardiac arrhythmias
Seizures
```
101
What is a serious side effect of typical antipsychotics?
Neuroleptic malignant syndrome
102
What drug is Neuroleptic malignant syndrome commonly associated with?
Haloperidol
103
How long do symptoms start to come on in Neuroleptic malignant syndrome?
Days to weeks
104
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
```
105
How do you treat Neuroleptic malignant syndrome?
Stop antipsychotic
| Resuscitation
106
How do atypical antipsychotics work?
Block D1 more than D2R.
107
What is the first line treatment for schizophrenia?
Atypical antipsychotics
108
Give five examples of atypical antipsychotics?
```
Risperidone
Olanzapine
Clozapine
Quetiapine
Zuclopentixol
```
109
What is the dose of risperidone?
6-10mg
110
What are some major side effects of risperidone?
Sedation/daytime sleepiness
Low extra-pyramidal SE
Cardio abnormalities
111
What is the dose of olanzapine?
5-15mg
112
What are some major side effects of olanzapine?
Weight gain- Diabetes mellitus
Sedation/daytime sleepiness
Cardio abnormalities
113
What is the dose of clozapine?
25mg daily at start
| 150-300mg maintenance
114
What is clozapine good for?
Antipsychotic
| Good for aggression and suicidal intent
115
What are some side effects of clozapine?
Agranulocytosis
Weight gain- Diabetes Mellitus
Sialorrhoea
116
How does clozapine work?
Mainly blocks limbic DR therefore less extra-pyramidal side effects.
117
What is clozapine good for?
Both postivie and negative symptoms
| Chronic symptoms
118
What is Zuclopentixol good for?
For those with diabetes mellitus
119
What are some major side effects of most antipsychotics?
```
Extra-pyramidal
DSH
Acute dystonia- Torticollis
Akathisia
Amenorrhoea
Galactorrhoea
Postural hypotension
Delirium
```
120
How do extra-pyramidal side effects present?
Parkinsonism
121
What is acute dystonia and torticollis?
AD- Body parts contract uncontrollable causing twisting
| Torticollis- Abnormally twisted head/neck
122
What is akathisia?
Motor restlessness, most commonly affecting the legs. It is similar to the restless legs syndrome, but apparent during the day
123
How many previous antipsychotics need to have failed before you get clozapine?
2
124
What is Agranulocytosis?
Severe lowering of neutrophil levels
125
What kind of delusions are usually seen in schizophrenia?
Primary
126
What kind of delusions are normally seen in mood disorders?
Secondary
127
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.
128
What is a predisposing factor for brief psychotic disorders?
Personality disorder
129
How long does a brief psychotic disorder tend to last?
1 day - 1 month
130
What happens on resolution of a brief psychotic disorder?
Returns to normal
131
How does frontal lobe volume correlate with severity of schizophrenia?
Less volume more severe
132
What neurochemistry leads to psychosis?
Subcortical Dopamine hyperactivity
133
What neurochemistry causes the negative and cognitive symptoms of schizophrenia?
Mesocortical Dopamine hypoactivity
134
How does efficacy differ between antipsychotics?
Clozapine best then all others equal
