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BRS 2 > Psychosis > Flashcards

Psychosis Flashcards

1
Q

What is psychosis?

A

A group of mental illnesses that features a difficulty perceiving and interpreting reality

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2
Q

Which type of mental illnesses are associated wit psychosis?

A 
Schizoaffective disorder
Bipolar I
Schizophrenia (1%) 
Delusional disorder
Depression with psychotic features 
Due to other medical condition 
Substance related
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3
Q

What are the three domains of psychosis symptoms?

A

Positive symptoms
Negative symptoms
Disorganisation

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4
Q

What are the two main positive symptoms of psychosis?

A

Hallucinations

Delusions

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5
Q

What are hallucinations in psychotic patients?

A 
Percepts in absence of a stimulus
Auditory
Voices commenting on you 
Voices talking to each other
Visual
Somatic/tactile
Olfactory
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6
Q

What are delusions in psychotic patients?

A

Fixed, false beliefs, out of keeping with social/cultural background.

Persecutory
Control
Reference
Mind reading
Grandiosity
Religious
Guilt/sin
Somatic

Thought broadcasting
Thought insertion
Thought withdrawal

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7
Q

What are the four main negative symptoms of psychosis?

A

Alogia
Avolution/apathy
Anhedonia
Affective flattening

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8
Q

What term describes a poverty of speech?

A

Alogia

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9
Q

What is alogia?

A

Is concerned with paucity of speech, little content and the individual is slow to respond.

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10
Q

What is avolution/apathy?

A

Poor self-care
Lack of persistence at work/education
Lack of motivation

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11
Q

What is anhedonia/asociality?

A

Disengaged interest and pleasure within conducting activities.

  • Few close friends
  • Few hobbies/interests
  • Impaired social functioning
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12
Q

What is affective flattening?

A 
Unchanging facial expressions
Few expressive gestures
Poor eye contact
Lack of vocal intonations
Inappropriate affect
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13
Q

What are the two main forms of disorganisation symptoms?

A

Bizarre behaviour

Thought disorder

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14
Q

What is bizarre behaviour?

A

Bizarre social behaviour
Bizarre clothing/appearance
Aggression/agitation
Repetitive/sterotyped behaviours

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15
Q

What is thought disorder?

A 
Derailment
Circumstantial speech
Pressured speech
Distractibility
Incoherent/illogical speech
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16
Q

What is the peak onset of psychosis?

A

Peak incidence in adolescence/early 20s.

Peak later in women

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17
Q

What is taken in a psychiatric history?

A
  • History of presenting concern- nature, severity, onset, worsening factors, and treatment received
  • Past psychiatric history (diagnosis, treatment, community team, previous admissions?)
  • Background history (family, personal, social- abuse, alcohol/drug misuse)
  • Past medical history and medicine
  • Corroborative history

(Educational, occupational history, relationships, separation, childhood illness)

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18
Q

What things are considered when conducting a social history?

A
  • Living arrangements
  • Financial issues
  • Alcohol and illicit drug use
  • Forensic history
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19
Q

What type of history requires consent?

A

Corroborative history

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20
Q

What 7 key features are assessed in a mental state examination?

A 
Appearance and behaviour 
Speech
Mood
Thoughts
Perceptions
Cognition 
Insight
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21
Q

How can appearance change in patients with psychosis?

A

Neglect : Alcoholism, drug addiction, dementia, depression and schizophrenia

Weight loss: Anorexia nervosa, depression, cancer, hyperthyroidism, financial issues/homelessness.

Facial: Depressive, anxious, wooden Parkinsonian

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22
Q

What type of movements are assessed in psychosis patients?

A

Overactive, restless- manic

Inactive, slow - depressive

Immobile, mute - stupor

Tremors, ticks, choreiform movements, dystonia, tardive dyskinesia
Mannerisms, stereotypes

23
Q

What four factors are assessed when looking at speech?

A

Quantity - less, more, mutism
Rate- slow, fast, pressure of speech.
Spontaneity - latency
Volume - quiet, loud

24
Q

What are primary delusions?

A

Occurs suddenly

25
Q

What are secondary delusions?

A

Arises from previous abnormal idea/experience

26
Q

What is an illusion?

A

Misperception of a real external stimulus

27
Q

What is a hallucination?

A

= perception in the absence of external stimulus
true perception + 2) coming from outside the head
pseudohallucination = 1) OR 2)

hypnagogic, hypnopompic

auditory – second person, third person
visual – Charles Bonnet syndrome
olfactory
gustatory
tactile, of deep sensation
28
Q

What features are assessed when considering mood in individuals with suspected pyschosis?

A 
Subjective
Objective
Predominant mood 
Constancy
Congruity (Cheerful while describing sad events).

Emotional lability/incontinence/reduced reactivity/blunting/flattening/irritability.

29
Q

What features of thought are examined when assessing thoughts in individuals with suspected psychosis?

A 
Stream
Form
Content
Preoccupations
Morbid thoughts, suicidality
Delusions, overvalued ideas
Obsessional symptoms
30
Q

What is insight in terms of assessing a patient’s mental state?

A

Awareness of onself as presenting phenomena that other people consider abnormal

Recognition that these phenomena are abnormal

Acceptance that these abnormal phenomena are caused by mental illness

Awareness that treatment is required

31
Q

What type of symptoms typically precede psychosis?

A

Prodromal symptoms

Changes in social behaviour, social withdrawal and impairments in functioning

32
Q

What are the environmental risk factors for psychosis?

A

Cannabis and drug use

Maternal infections
Migrant status
Socioeconomic deprivation Childhood trauma
Prenatal/birth complications

33
Q

What are the genetic risk factors for psychosis?

A

Schizophrenia is highly heritable

Highly polygenic

34
Q

What additional sources of information are available to support a diagnosis of psychosis?

A

Collateral history from family, friends and work.

Healthcare records: GP, Mental health services.

35
Q

What difficulties are encountered when treating someone with very poor insight into their psychosis?

A

Concordance with treatment
Attendance at follow-up
Would not stay in hospital

36
Q

What are the differentials for psychosis?

A 
Delirium
Schizophrenia
Personality disorder
Dementia
Drugs
Encephalitis (behavioural changes)
37
Q

What are the three types of psychosis management?

A

Pharmacological
Psychological (CBT and avatar therapy)
Social support

38
Q

Which neurotransmitter system is most implicated in the mechanism of antipsychotics?

A

Dopamine

39
Q

Which hormone activity is increased in psychosis?

A

Increased dopamine activity is implicated in causing reality distortion in psychosis

post-mortem studies reveal elevated presynaptic dopamine in striatum.

40
Q

How do most antipsychotics work?

A

They are dopamine antagonists.

Aripirazole is a partial agonist

41
Q

Why can Parkinson’s be a risk factor for psychosis?

A

Dopamine agonists which are used in the treatment can cause psychotic symptoms.

42
Q

What are the common side effects associated antipsychotic medication?

A

Extrapyramidal side effects

  • Parkinsonism
  • Acute dystonia
  • Tardive dyskinesia
  • Akathisia

Antipsychotics can cause post-synaptic dopamine blockade in the extrapyramidal system

Parkinsonism is a common effect

43
Q

What parkinsonism features are associated with antipysychotic drug use?

A

Rigidity- Characteristic cog-wheeling
Slow and shuffling gait
Lack of arm swing in gait- early sign

Pill rolling tremor - slow movement of the thumb across other fingers

44
Q

What is acute dystonia?

A

Increased motor tone –> Sustained abnormal posture

Can occur shortly after taking dopamine antagonist

45
Q

What is tardive dyskinesia?

A

Repeated oral/facial/buccal/lingual movements.

Initially subtle- can progress to tongue involvement, lip smacking.

increased risk: Long term antipsychotics, female

46
Q

What is akathisia?

A

Inner restlessness (hand streotypy)
Feel compelled to move, but does little to alleviate
Can lead to overt, relentless movement.
Legs most commonly affected

47
Q

What are ‘typical’ antipsychotics?

A

Commonly cause extrapyramidal side effects at therapeutic doses, definition is NOT based on pharmacology/drug target.

48
Q

What is the main difference between atypical and typical antipsychotics?

A

Atypical drugs are less likely to cause ESPEs.

49
Q

What is the management of extra-pyramidal side effects in patients receiving antipsychotics?

A

Avoid them in the first place: Atypical antipsychotics usually first-line.

Change medication, anticholinergic medications can help e.g procyclidine.

50
Q

What are the haematological side effects of antipsychotics?

A

Agranulocytosis

Neutropenia

51
Q

What are the metabolic side effects of antipsychotics?

A

Increased appetite
Weight gain
Diabetes

52
Q

What are the cardiac side effects of antipsychotics?

A

Dysrhythmia

Long QTc,

53
Q

What are the pituitary side effects of antipsychotics?

A

Increased prolactin release

54
Q

What are the gastrointestinal side effects of antipsychotics?

A

Constipation

BRS 2 (62 decks)

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