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Yr4 - Psych > Psychosis > Flashcards

Psychosis Flashcards

1
Q

Define psychosis

A

Individual experiencing a reality different to everyone else

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2
Q

Symptoms of psychosis

A

Hallucinations
Delusions
Formal thought disorder
Fragmentation of boundaries of self

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3
Q

Define hallucinations

A

Perception of an object in the absence of external stimulus

  • can be any of 5 modalities
  • auditory most common
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4
Q

Define delusions

A

Fixed, firmly held belief than is usually false
Cannot be reasoned away
That is held despite evidence to the contrary
Out of keeping with person’s sociocultural norms

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5
Q

Types of delusions

A 
Persecutory - someone/thing is after you
Grandiose - you are powerful
Reference - everything is about you
Erotomanic - someone loves you
Hypochondrial - have x illness
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6
Q

Define formal though disorder

A

Problem of speech which means that each word/sentence does not follow on from next

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7
Q

Define disorders of the self

A

Individual can no longer distinguish between oneself and the world

  • broadcast - everyone can hear your thoughts
  • passivity phenomena - physical movement controlled by someone/thing else
  • thought insertion - someone places thought in your head
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8
Q

Define schizophrenia

A

Group of disorders characterised by psychotic episodes (positive symptoms) and negative symptoms

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9
Q

Features of general schizophrenia

A

At least one
- thought echo, ingestion, broadcasting or withdrawal
- delusions of control, influence of passivity
- hallucinatory voices
- persistent delusions
Or at least 2 of
- persistent hallucinations of any modalities
- neologisms or breaks in train of thought
- catatonic behaviour
- negative symptoms

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10
Q

Define neologisms

A

A new word or phrase of patients own making

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11
Q

Define catatonic behaviour

A

Significant decrease in reactivity to environment

  • negativism
  • mutism
  • stupor
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12
Q

Diseases associated with psychosis

A

Schizophrenia - most common
Bipolar disorder
Severe depression
Severe anxiety

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13
Q

Incidence of psychosis

A

31.7 per 100 000

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14
Q

Causes of psychosis

A 
Non-organic
- schizophrenia
- acute psychotic episode
- mood disorders with psychosis
- drug-induced psychosis
- puerperal psychosis
Organic causes
- drug-induced psychosis
- iatrogenic - levodopa, methyldopa, steroids, antimalarials
- delirium
- dementia
- Huntington's
- SLE
- syphilis
- Cushing's
- vit B12 deficiency
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15
Q

Define schizophrenia

A

Most common psychotic condition

Characterised by hallucinations, delusions and thought disorders -> functional impairment

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16
Q

Predisposing factors for schizophrenia

A 
Biological 
- genetic - positive family history
- neurochemical - increased dopamine, decreased glutamate, serotonin and GABA
- neurodevelopmental - obstetric complications, foetal injury and low birth weight
- age 15-35
Psychological
- FH 
- childhood abuse
Social
- substance misuse
- low socioeconomic status
- migrants
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17
Q

Features of dopamine hypothesis for schizophrenia

A

Schizophrenia is secondary to over-activity of mesolimbic dopamine pathways in the brain
- antipsychotics block dopamine receptors

18
Q

Features of expressed emotion theory for schizophrenia

A

Those with relatives that are over involved or that make hostile or excessive critical comments are more likely to relapse

19
Q

Features of stress-vulnerability model for schizophrenia

A

Predicts that schizophrenia occurs due to environmental factors interacting with a genetic predisposition
- patients have different vulnerabilities and so different individuals need to be exposed to different levels of environmental factors to become psychotic

20
Q

Precipitating factors for schizophrenia

A 
Biological
- smoking cannabis or using psychostimulants
Psychological
- adverse life events
- poor coping skills
Social
- adverse life events
21
Q

Perpetuating factors for schizophrenia

A 
Biological
- substance misuse
- poor compliance to medication
Psychological
- adverse life events
Social
- reduced social support
- expressed emotion
22
Q

Define first rank symptoms of schizophrenia

A

Symptoms which is one or more is present are strongly suggestive of schizophrenia
- alternative tool to ICD-10 for diagnosis

23
Q

What are the first rank symptoms of schizophrenia

A

Delusional perception - new delusion that forms in response to a real perception without any logical sense
Third person auditory hallucinations - usually a running commentary
Thought interference - thought insertion, withdrawal or broadcast
Passivity phenomenon

24
Q

Positive symptoms of schizophrenia

A 
Delusions Firmly Held Think Psychosis
- Delusions
- Hallucinations
Formal thought disorder
Thought interference
Passivity phenomenon
25
Q

Define passivity phenomenon

A

Actions, feelings or emotions being controlled by an external force

26
Q

Negative symptoms of schizophrenia

A

Avolition - reduced motivation
Asocial behaviour - loss of drive for social engagements
Anhedonia - loss of enjoyment
Alogia - decrease in speech
Affect blunted - diminished or absent capacity to express feelings
Attention deficits

27
Q

Features of a schizophrenic prodrome

A 
Reserved
Anxious
Suspicious
Irritable
Disturbance in normal everyday functioning
28
Q

Features of paranoid schizophrenia

A

Most common

Dominated by positive symptoms - hallucinations and delusions

29
Q

Features of postschizophrenic depression

A

Depression predominates with schizophrenic illness in past 12 months with some schizophrenia symptoms still present

30
Q

Features of hebephrenic schizophrenia

A

Thought disorganisation predominates
Onset of illness earlier - 15-25
Prognosis poorer

31
Q

Features of catatonic schizophrenia

A

Rare

Characterised by one or more catatonic symptoms

32
Q

Features of simple schizophrenia

A

Rare

Negative symptoms develop without psychotic symptoms

33
Q

Features of undifferentiated schizophrenia

A

Meets diagnostic criteria for schizophrenia but does not conform to any other subtypes

34
Q

Features of residual schizophrenia

A

1 year of chronic negative symptoms preceded by a clear cut psychotic episode

35
Q

ICD-10 criteria for schizophrenia

A

At least one very clear symptom from group A or 2 or more from group B for at least 1 month
Without presence of organic brain disease
Group A
- thought echo/insertion/withdrawal/broadcast
- delusions of control, influence or passivity phenomenon
- running commentary auditory hallucinations
- bizarre persistent delusions
Group B
- hallucinations in other modalities that are persistent
- thought disorganisation
- loosening of associations, neologisms, incoherence
- catatonic symptoms
- negative symptoms

36
Q

Questions to help identify schizophrenia

A

Have you ever had the experience of hearing voices/noises when there is nobody else around?
How many voices are there?
Do they speak directly to you?
Do they make comments on what you are doing?
Are you afraid someone is trying to harm you?
Do you have any special abilities?
Have you ever felt that thoughts are being taken out of your mind?
Has anyone ever put thoughts into your head?
Have you felt under the control of an outside force?

37
Q

Investigations for schizophrenia

A 
Bloods
- FBC, TFT, glucose/HbA1c, serum calcium, U+Es, LFTs, cholesterol, vitamin B12 and folate
Urine drug test
ECG
- antipsychotics can prolong QT interval
CT
- rule out organic causes
EEG
- rule out temporal lobe epilepsy
38
Q

Management of schizophrenia

A

Risk assessment and use of mental health act if refuse informal admission
For 1st presentation of psychosis early intervention in psychosis team should be involved
Assess social circumstances and involve family

39
Q

Poor prognostic factors for schizophrenia

A 
Strong family history
Gradual onset
Reduced QI
Premorbid history of social withdrawal
No obvious precipitant
40
Q

Biological management of schizophrenia

A

Antipsychotics
- atypical first line - risperidone and olanzapine
- depot formulation if prefer or refusing oral
- clozapine - most effective and used for treatment-resistant schizophrenia
Adjuvants
- benzodiazepines provide short term relief of behavioural disturbance, insomnia, aggression and agitation
- antidepressant and lithium
ECT
- patients who are resistant to pharmacological agents
- effective for catatonic schizophrenia

41
Q

Psychological management of schizophrenia

A

CBT
- strongly recommended by NICE
- reduces residual symptoms
Family intervention
- psychoeducation helps families reduce high levels of expressed emotion - reduced relapse
Art therapy
- alleviation of negative symptoms in young people
Social skills training
- behavioural approach to help patients improve interpersonal, self-care and coping skills

42
Q

Social management of schizophrenia

A 
Support groups
- national groups - rethink and SANE 
Peer support
- delivered by peer support worker who has recovered form psychosis or schizophrenia
Supported employment programmes

Yr4 - Psych (13 decks)

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