Psychosis Flashcards
1
Q
Psychosis
A
A state in which there is a loss of contact with reality Includes: Delusions Hallucinations Formal thought disorder
2
Q
Prevlance psychosis
A
1/100
3
Q
When is the peak incidence of psychosis in males?
A
23 y/o
4
Q
When is the peak incidence of psychosis in females?
A
26
2nd peak 30-40
5
Q
Biological aetiology schizophrenia (2)
A
FHx
Idenitcal twins - 46%
Obstetric complication
6
Q
Psychological aetiology schizophrenia
A
Congitive errors
Premorbid personality - schizotypal disorder
7
Q
Social aetiology schizophrenia (4)
A
Urban living
Migration
Life events incl physical + sexual abuse
Ethnicity - Afro-Caribbean
8
Q
Prodrome
A
Period of time when the individual = gradually developing Sx but has not yet met criteria for diagnosis
9
Q
What is the average DUP?
A
> 1
10
Q
Good prognostic factors psychosis (8)
A
Female Married FHx affective disorder Acute onset Good premorbid personality Early Tx prominent mood Sx good response to Tx
11
Q
Poor prognostic factors psychosis (6)
A
FHx schizophrenia High expressed emotion Substance misuse Prominent negative Sx Early onset Lack of insight/non-compliance
12
Q
What are the 3 groups of schizophrenia symptoms?
A
Positive
Negative
Motor/catatonic
13
Q
E.g.s of positive schizophrenia Sx (3)
A
Formal thought disorder
Hallucination
Delusion
14
Q
E.g.s of negative schizophrenia sx (7)
A
Anhedonia Blunting of affect Apathy Lack of volition - under control Poverty of thought Poor self-care Cognitive deficits
15
Q
E.g.s of motor/catatonic schziophrenia Sx (7)
A
Rigidity Posturing Mutism Waxy flexibility Negativism Stereotypies Tics
16
Q
What is rigidity
A
Maintaining a fixed position and rigidly resisting all attempts to be moved
17
Q
What is posturing
A
Adopting an unusual position that is then maintained for some time
18
Q
What is waxy flexibility
A
patients can be moulded like wax into a position that is then maintained
19
Q
What is negativisim
A
A seemingly motiveless resistance to all instructions/attempts to be moved
20
Q
What is stereotypies
A
A complex movement that does not appear to be goal-directed e.g. rocking
21
Q
Perception
A
The process of making sense of the physical information we receive from our 5 sensory modalities
22
Q
Illusions
A
Misperceptions of real external stimuli
23
Q
Delusion
A
A fixed, usually false unshakable belief which is out of keeping with patients educational, cultural and background + held despite all evidence to contrary
24
Q
Persecutory delusion
A
Delusional belief that one’s life is being interfered with in a harmful way
25
Delusion of reference
Delusional belief that external events have been arranged so that a messaged is conveyed
26
Grandiose delusions
Delusional belief that the patient has special powers
27
Primary delusions
Do not occur in response to any previous psychopathologies state
28
Mood congruent delusions
Contents are appropriate to patients mood
29
De-Clerambault's syndrome
Delusion where the patient believes another individual is in love with them and they are destined to be together
30
Capgras syndrome
Patient is replaced by an identical double' who is not the real person
31
Cotard syndrome
Psychotic depressive presentation with nihilistic delusions and hypochondriacal disorder
32
Fergoli syndrome
Strangers have been replaced by one familiar person who changes appearance or takes on disguises
33
Nihilistic delusion
Patient believes they have died or no longer exists or the world has ended
34
Delusion perception
A real percept that leads immediately to a delusional belief - the traffic lights turned red and I knew I was the King of England'
35
Overvalued ideas
Ideas that are understandable and reasonable in themselves come to dominate the patients life
36
Typical disorders that feature overvalued ideas (5)
```
Anorexia nervosa
Hypochondriacal disorder
Dysmorphophobia
Paranoid personality disorder
Morbid jealous
```
37
The more simple the auditory hallucination...
The more likely the cause is to be organic
38
When does a Hypnopomic hallucination occur?
Upon waking
39
When does a hypnagogic hallucination occur?
Upon falling asleep
40
Conditions where visual hallucinations are more common (5)
```
Dx withdrawal
Some dementias
Encephalitis
Epilepsies
Occipital lobe tumours
```
41
What is a visceral tactile delusion
False perception of inner organns
42
What is Ekbom's syndrome
False belief that one = infested with small but visible organisms
43
Auditory pseudohallucinations
A perceptual experience which differs from hallucination in that it appears to arise in the subjective inner space of the mind
44
How can auditory pseudohallucinations be explained?
Internalisation of past aggressor/abuser
| E.g. in EUPD
45
Features of formal thought disorder (5)
```
Loosening of association
Flight of ideas
Circumstantial thoughts
Tangential thoughts
Thought block
```
46
What is Knight's move thinking
Patients train of thought shifts suddenly from 1 v loosely unrelated idea --> next
--> 'word salad'
47
Thought block
Pt experience a sudden cessation to their flow of thought, often mid sentance.
Pt - no recall of what they were saying + continue to talk about different topic
48
Neoglisms
New word created by the patient
49
Idiosyncratic word use
Using recognised words by attributing them with non-recognised meaning
50
Perseveration
When an initially correct response is inappropriately repeated
51
Echolalia
Patients senselessly repeat words or phrases spoken around them by others = parrot
52
What are Schnider's 1st rank symptoms (ABCD)
Auditory hallucinations
Broadcasting of thought
Controlled thought - delusions of control
Delusional perception
53
Diagnostic criteria schizophrenia - ICD-10
```
>28 days
No organic cause
1st rank symptoms present
1 or > of: thought sx, delusion control/passivity, delusional perception, hallucinatory voices running commentary, bizarre delusions
May also have -ve and cognitive
```
54
Organic causes psychosis (6)
```
Delirium
Medication induced
Endocrine - Cushings, HypoT/hyperT
Neuro
Systemic - porphyria/SLE
Substances
```
55
Medications that can induce psychosis (3)
Corticosteroids
Stimulants
Dopamine agonists
56
DDx psychotic patient (6)
```
Schizoaffective disorder
Delusional disorder
Schizotypal disorder
Acute + transient psychotic disorder
Mood disorder
Substance misuse
```
57
Ix psychosis (7)
```
Neurological exam
BMI
Bloods
Urine - Dx screen
Syphillis screen
ECG
Collateral Hx
```
58
Common co-morbidity psychosis
Substance misuse
59
Reasons for non-compliance with antipsychotics (5)
```
Lack of insight
SE of medication
Delusions about medication/prescriber
Patient feels 'better' when ill
Pt gains remission + thinks meds no longer required
```
60
Physical health monitoring for psychosis patients (6)
```
Smoking/drinking status
P/FHx of DM/Coronary heart disease
BP
BMI
Bloods
ECG
```
61
Define treatment resistance schizophrenia
Lack of response to adequate doses of 2 different antipsychotics
62
What should you double check if you are about to diagnose someone with TRS (Tx-resistant schizophrenia)
Review diagnosis
Rule out co-morbid substance misuse
Ensure dose/duration + compliance prev Tx
63
Med used for TRS
Clozapine
64
SE clozapine (7)
```
Neutropenia
Fatal agranulocytosis
Hypersalivation
Cardiomyopathy
Myocarditis
DM
Seizures
```
65
Monitoring clozapine
FBC weekly for 1st 18w
Then every 2w for 1year
Then every 4 weeks
66
Psychological Tx schizophrenia
CBT ***
FIT (Family intervention therapy)
Psychoeducation
Coping stratergies
67
What is involved in psychoeducation for schizophrenics (4)
Relapse signs
Crisis plans
Relapse prevention
WRAP - Wellness, recovery + Action Plans
68
Conditions antipsychotics can be used for (10)
```
Psychosis
Delirium
Behavioural disturbance - dementia
Mood disorders
Severe agitation, anxiety + violent/impulsive behaviour
Insomnia
Rapid tranquillisation
N+V
Hiccups
Tics incl Tourette's
```
69
What are the 3 main aims of Tx in the use of antipsychotics in psychosis
Alleviate +ve Sx
Alleviate -ve Sx
minimise SE
70
1st gen antipsychotics (5)
```
Chlorpromazine
Haloperidol
Sulpiride
Flupentixol
Zuclopenthixol
```
71
2nd gen antipsychotics (5)
```
Clozapine
Olanzapine
Quetiapine
Risperidone
Amisulpride
```
72
SE 1st gen antipsychotics (12)
```
NMS
Seizure threshold lowered
Sedation
EPSE
BP/Temp changes
Hypersensitivity reactions - liver, bone marrow, skin
Raised prolactin
Apathy
Confusion
Depression
Arrhythmia
Metabolic syndrome
```
73
What is Akathisia
Subjective feelings of restlessness
74
Parkinsonism
Tremor, rigidity, bradykinesia
75
What is Acute dystonia
Involuntary mm spasms which prod briefly sustained abnormal postures.
Within 48hrs initiation
76
What is Tardive Dyskinesia
Abnormal involuntary hyperkinetic chewing, head nodding, grimacing, rocking movements
77
Features of metabolic syndrome (6)
```
Central obesity
Insulin resistance
Impaired glucose regulation
HTN
Raised plasma TG
Raised LDL cholesterol level
```
78
Mortality rate NMS
5-20%
79
Sx NMS (7)
```
Hyperthermia
Confusion
TachyC
Hyper/HoTN
Tremor
Raised CK
Low pH - metabolic acidosis
```
80
SE olanzapine
```
Sedation +
W gain ++++
Raised TG
Dizziness
AntiC SE
```
81
SE risperidone
W gain +
EPSE ++
Sexual dysfunction +
Sedation +
82
Quetiapine SE
Sedation ++
Weight gain ++
Possible QT prolongation
Lowest risk EPSE
83
SE Aripiprazole
Nausea
Restlessness
Insomnia
Exacerbates psychosis initially
84
What's great about Aripiprazole
Least W gain
| Minimal metabolic effect
85
Depot Antipsychotics (7)
```
Haloperidol
Flupentixol
Zuclopenthixol
Fluphenazine
Risperidone
Olanzapine
Aripiprazole
```
86
How long should schizophrenics continue their meds after recovering from an acute episode?
1-2 years at least
87
What psychosocial interventions should not be offered to schizophrenics (2)
Adherence therapy
| Social skills training
