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Psychiatry > Psychosis > Flashcards

Psychosis Flashcards

1
Q

What are hallucinations?

A

Internal perception not perceived as internal

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2
Q

What is a simple hallucination?

A

Bangs etc

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3
Q

What is a complex hallucination?

A

Voices etc

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4
Q

What are delusions?

A

Firmly held incorrect belief

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5
Q

What are primary delusions?

A

Fully formed in consciousness without need for explanation. No way to understand.

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6
Q

What are secondary delusions?

A

Understandable in light of previous experiences. Attempt to explain things.

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7
Q

What is a capgras delusion?

A

Imposter syndrome, feel others have been replaced with imposters

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8
Q

What is a Fregoli delusion?

A

Think one person is multiple

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9
Q

What is a paranoid delusion?

A

Thinks things refer to themselves- hidden messages etc

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10
Q

What are persecutory delusions?

A

About others, feel harm may come to others

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11
Q

WHat are delusions of sin usually about?

A

Paedophilia

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12
Q

What are nihilistic delusions about?

A

Think they are already dead

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13
Q

What is a delusion of grandeur?

A

Think one is important

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14
Q

What is a religious delusion?

A

Think god is speaking to them or are god themselves

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15
Q

What are delusions of guilt of?

A

Think a bad person etc

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16
Q

What is a delusion of love/ De Clerambault syndrome?

A

Feel someone loves them. Often leads to stalking.

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17
Q

What is a delusion of jealousy/Othello syndrome?

A

Thinks partner cheating etc. Can lead to murder.

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18
Q

What are illusions?

A

Misinterpretation of info

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19
Q

What are ideas of reference?

A

Thought that coincidence etc are linked or referring to them/seeing hidden messages to them. Paranoia.

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20
Q

What is passivity?

A

Feel like being controlled

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21
Q

Give some examples of thought interference

A

Insertion
Withdrawal
Broadcasting
Blocking

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22
Q

What is thought insertion?

A

Someone giving them thoughts

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23
Q

What is thought withdrawal?

A

Someone taking their thoughts away

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24
Q

What is thought broadcasting?

A

Others can hear thoughts

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25
Q

What is thought blocking?

A

Mind goes blank mid thought

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26
Q

What is a thought disorder?

A

Disorder of content of thought

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27
Q

Give some examples of thought disorders

A 
Neologisms
Circumstantiality/Tangentiality
Clanging and punning
Loosening of associations
Knight's move thinking
Verbigeration/Word Salad
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28
Q

What is psychosis?

A

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.

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29
Q

What do people with psychosis tend to lack?

A

Insight

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30
Q

Give some examples of psychosis symptoms?

A

Hallucinations
Delusions
Disorders of form of thought

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31
Q

What are some forms of psychosis?

A

Psychosis
Affective
Organic
Pharmacological

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32
Q

What kind of things can cause a pharmacological delusion?

A

Drugs
Alcohol
Withdrawal

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33
Q

Do you need to be intoxicated to suffer from pharmacological psychosis

A

No- can last past intoxication

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34
Q

What causes organic psychosis?

A

Damage to part of the world that interpreters reality (temporal lobe).

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35
Q

What things can cause organic psychosis?

A 
Temporal lobe epilepsy
Temporal lobe damage
Sleep deprivation
Stroke
Delirium
Dementia
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36
Q

What is affective psychosis?

A

Psychosis associated with affective/mood disorder

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37
Q

What are some symptoms of unipolar depression psychosis?

A

Persecutor delusions
Self-blame delusions
Worthlessness delusions
2nd person hallucinations- accusing/insulting/threat

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38
Q

What are some symptoms of bipolar psychosis?

A

Delusions of grandeur
Religiosity
Special abilities

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39
Q

What is the main condition in paranoid psychosis?

A

Schizophrenia

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40
Q

What is schizophrenia?

A

A broad range of perceptual, cognitive and behavioural disturbances.

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41
Q

What is the patho of schizophrenia?

A

No specific cause

Neurodevelopmental disconnection

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42
Q

What can cause the neurodevelopmental disconnection in schizophrenia?

A

Genetics

Environmental factors affecting brain development.

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43
Q

What is a risk factor for schizophrenia?

A

Daily cannabis use

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44
Q

What are some signs of schizophrenia?

A

Enlarged ventricles

Mesolimbic DAR upreg

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45
Q

Describe the onset of schizophrenia symptoms?

A

Any age
Rare before puberty
Peak in 20s

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46
Q

What are the first rank symptoms of schizophrenia used for?

A

Diagnosis?

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47
Q

How do you diagnose schizophrenia?

A

Presence of the first rank symptoms

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48
Q

What are the first rank symptoms of schizophrenia?

A
  • 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
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49
Q

What are some other symptoms of schizophrenia?

A 
Lack of insight
 Social withdrawal 
 Apathy
 Lack of conversation
 Anhedonia 
 Psychomotor retardation 
 Self-neglect 
 Cognitive impairment  
Secondary delusions
Blunting of mood
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50
Q

What are NOT some symptoms of schizophrenia?

A

Visual hallucinations- Can occasionally occur
Altered consciousness
Memory disturbances

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51
Q

What are the two categories of symptoms in schizophrenia?

A

Type 1/positive

Type 2/negative

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52
Q

What are positive symptoms?

A

Things present in patient that are not in normal people

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53
Q

What are negative symptoms?

A

Patient lacks things seen in normal people

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54
Q

Give some features of positive symptoms

A 
Acute onset
Prominent delusions and hallucinations
Normal brain structure
Involves dopaminergic transmission
Good response to neuroleptics
Better outcome
55
Q

How rapidly do positive symptoms come on?

A

Acutely

56
Q

What are the main symptoms of positive symptoms?

A

Prominent delusions and hallucinations

57
Q

How do positive symptoms react to treatment?

A

Well

58
Q

Between postivie and negative symptoms which has the better response to treatment?

A

Positive has better outcome

59
Q

What are some features of negative symptoms?

A 
Slow insidious onset
Absence of acute symptoms
Apathy
Social withdrawal
Lack of motivation
Brain structure abnormalities
60
Q

Describe the onset of negative symptoms?

A

Slow insidious onset

61
Q

What are some symptoms of negative symptoms?

A

Apathy
Social withdrawal
Lack motivation

62
Q

How do negative symptoms respond to treatment?

A

Not very well

63
Q

What are the four main subtypes of schizophrenia?

A

Paranoid
Hebephrenic/disorganised
Catatonic
Undifferentiated

64
Q

What is the commonest form of schizophrenia?

A

Paranoid

65
Q

What are the main symptoms of paranoid schizophrenia?

A

Hallucinations- 3rd person auditory

Delusions- Persecutory or grandiose, Jealousy, Religiosity

66
Q

How does personality change in paranoid schizophrenia?

A

Doesn’t change

67
Q

What’s the prognosis for disorganised schizophrenia?

A

Poor

68
Q

What is the normal age of onset of disorganised schizophrenia?

A

15-25

69
Q

What are some symptoms of disorganised schizophrenia?

A

Changes in mood prominent with fleeting fragmented delusions and hallucinations
Thought disorder
Flat affect

70
Q

How does personality change in disorganised schizophrenia?

A

Premorbid schizoid or schizotypal personality

71
Q

What are some symptoms of catatonic schizophrenia?

A

Stupor, excitement, posturing, waxy flexibility and negativism
Agitated, purposeless movement

72
Q

How common is catatonic schizophrenia?

A

Rare

73
Q

What is undifferentiated schizophrenia?

A

Mixture of all types.

74
Q

What is the differential for schizophrenia?

A

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
Q

How do you diagnose schizophrenia?

A

Symptoms for >6m
Symptoms present for most days of 1m
Marked impairment in work or home functioning

76
Q

What is the best treatment for schizophrenia?

A

Pharma and social combo best

77
Q

What psychotherapy can be used for schizophrenia?

A

Reasurrance
CBT
No intensive or exploratory psychotherapy

78
Q

What social therapy can be used for schizophrenia?

A

Family education

Sheltered employment

79
Q

What are the two categories of pharmacological treatment for schizophrenia?

A

Typical antipsychotics

Atypical antipsychotics

80
Q

What are neuroleptics?

A

Antipsychotic drugs

81
Q

How do typical antipsychotic work?

A

Block D1 and D2 receptors

82
Q

What are typical antipsychotics best used for?

A

Acute postivie symptoms

Not good for chronic symptoms

83
Q

How long can typical antipsychotics take to work?

A

Complete control can take up to 3 months

84
Q

What can typical antipsychotics be good for?

A

Limited use in maintenance due to side effects

Symptom control

85
Q

What are the two categories of typical antipsychotics?

A

Phenothiazines

Butyrophenones

86
Q

Give some examples of phenothiazines?

A

Clopromazine- 100-1000mg daily
Trifluoperazine- Less sedation
Fluphenazine decanoate

87
Q

What is the benefit of clopromazine?

A

Good for treatment resistant

88
Q

What are some major side effects of clopromazine?

A

Severe extra-pyramidal SE.

89
Q

What is Fluphenazine decanoate used for?

A

Prophylaxis (IM 1-4 weeks)

90
Q

What are some benefits of butyrophenones?

A

Good for acute psychosis and mania.

Less sedating than phenothiazines

91
Q

Give an example of butyrophenones?

A

Haloperidol

92
Q

What is haloperidol really useful for

A

Acute treatment

93
Q

What is the dose of haloperidol?

A

2-30mg

94
Q

Why are atypical antipsychotics used instead of typical?

A

Just as good but less side effects

95
Q

What are the five main categories of typical antipsychotic side effects?

A 
Motor
Autonomic
Antimuscarinic
Metabolic
Other
96
Q

What are some motor side effects of typical antipsychotics?

A 
Extra-pyramidal symptoms
Acute dystonia
Parkinsonism
Akathisia- Restlessness
Tardive dyskinesia
97
Q

What are some autonomic side effects of typical antipsychotics?

A

Hypotension

Sexual dysfunction in men

98
Q

What are some antimuscarinic side effects of typical antipsychotics?

A
  • Dry mouth
  • Urinary retention
  • Constipation
  • Blurred vision
99
Q

What is the metabolic side effects of typical antipsychotics?

A

Weight gain

100
Q

What are some ‘other’ side effects of typical antipsychotics?

A 
Precipitation of glaucoma
Galactorrhoea (due to hyperprolactinaemia) 
 Amenorrhoea
 Cardiac arrhythmias
 Seizures
101
Q

What is a serious side effect of typical antipsychotics?

A

Neuroleptic malignant syndrome

102
Q

What drug is Neuroleptic malignant syndrome commonly associated with?

A

Haloperidol

103
Q

How long do symptoms start to come on in Neuroleptic malignant syndrome?

A

Days to weeks

104
Q

What are some symptoms of Neuroleptic malignant syndrome?

A 
Hyperthermia
Muscle rigidity
Autonomic instability- Tachycardia, labile BP, pallor
Fluctuating consciousness 
Raised CK
Raised WCC
Abnormal liver function
105
Q

How do you treat Neuroleptic malignant syndrome?

A

Stop antipsychotic

Resuscitation

106
Q

How do atypical antipsychotics work?

A

Block D1 more than D2R.

107
Q

What is the first line treatment for schizophrenia?

A

Atypical antipsychotics

108
Q

Give five examples of atypical antipsychotics?

A 
Risperidone
Olanzapine
Clozapine
Quetiapine
Zuclopentixol
109
Q

What is the dose of risperidone?

A

6-10mg

110
Q

What are some major side effects of risperidone?

A

Sedation/daytime sleepiness
Low extra-pyramidal SE
Cardio abnormalities

111
Q

What is the dose of olanzapine?

A

5-15mg

112
Q

What are some major side effects of olanzapine?

A

Weight gain- Diabetes mellitus
Sedation/daytime sleepiness
Cardio abnormalities

113
Q

What is the dose of clozapine?

A

25mg daily at start

150-300mg maintenance

114
Q

What is clozapine good for?

A

Antipsychotic

Good for aggression and suicidal intent

115
Q

What are some side effects of clozapine?

A

Agranulocytosis
Weight gain- Diabetes Mellitus
Sialorrhoea

116
Q

How does clozapine work?

A

Mainly blocks limbic DR therefore less extra-pyramidal side effects.

117
Q

What is clozapine good for?

A

Both postivie and negative symptoms

Chronic symptoms

118
Q

What is Zuclopentixol good for?

A

For those with diabetes mellitus

119
Q

What are some major side effects of most antipsychotics?

A 
Extra-pyramidal
DSH
Acute dystonia- Torticollis
Akathisia
Amenorrhoea
Galactorrhoea
Postural hypotension 
Delirium
120
Q

How do extra-pyramidal side effects present?

A

Parkinsonism

121
Q

What is acute dystonia and torticollis?

A

AD- Body parts contract uncontrollable causing twisting

Torticollis- Abnormally twisted head/neck

122
Q

What is akathisia?

A

Motor restlessness, most commonly affecting the legs. It is similar to the restless legs syndrome, but apparent during the day

123
Q

How many previous antipsychotics need to have failed before you get clozapine?

A

2

124
Q

What is Agranulocytosis?

A

Severe lowering of neutrophil levels

125
Q

What kind of delusions are usually seen in schizophrenia?

A

Primary

126
Q

What kind of delusions are normally seen in mood disorders?

A

Secondary

127
Q

What is a brief psychotic disorder?

A

A sudden, short-term display of psychotic behaviour. It may include hallucinations or delusions, and can occur following a stressful event.

128
Q

What is a predisposing factor for brief psychotic disorders?

A

Personality disorder

129
Q

How long does a brief psychotic disorder tend to last?

A

1 day - 1 month

130
Q

What happens on resolution of a brief psychotic disorder?

A

Returns to normal

131
Q

How does frontal lobe volume correlate with severity of schizophrenia?

A

Less volume more severe

132
Q

What neurochemistry leads to psychosis?

A

Subcortical Dopamine hyperactivity

133
Q

What neurochemistry causes the negative and cognitive symptoms of schizophrenia?

A

Mesocortical Dopamine hypoactivity

134
Q

How does efficacy differ between antipsychotics?

A

Clozapine best then all others equal

Psychiatry (22 decks)

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