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Psychosis Flashcards

1
Q

what is psychosis?

A

difficulty perceiving and interpreting reality

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2
Q

list psychotic disorders

A 
schizoaffective disorder
bipolar I
schizophrenia
delusional disorder
substance related
due to another medical condition
depression w/ psychotic features
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3
Q

symptom domains in psychosis

A

positive symptoms
negative symptoms
disorganisation

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4
Q

examples of positive symptoms

A

hallucinations

delusions

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5
Q

what are hallucinations?

A

Percepts in absence of a stimulus

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6
Q

what are delusions?

A

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

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7
Q

types of hallucinations

A 
Auditory
Voices commenting on you
Voices talking to each other
Visual
Somatic/tactile
Olfactory (rare)
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8
Q

types of delusions

A 
Persecutory
Control
Reference
Mind reading
Grandiosity
Religious
Guilt/sin
Somatic

Thought broadcasting
Thought insertion
Thought withdrawal

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9
Q

examples of negative symptoms

A

alogia
avolition/apathy
anhedonia/asociality
affective flattening

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10
Q

what is alogia?

A

poverty of speech
Paucity of speech, little content
Slow to respond

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11
Q

signs of avolition/apathy

A

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

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12
Q

signs of anhedonia/asociality

A

Few close friends
Few hobbies/interests
Impaired social functioning

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13
Q

signs of affective flattening

A 
Unchanging facial expressions
Few expressive gestures
Poor eye contact
Lack of vocal intonations
Inappropriate affect
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14
Q

examples of disorganisation symptoms

A

bizarre behaviour

thought disorder

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15
Q

signs of bizarre behaviour

A

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

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16
Q

signs of thought disorder

A 
Derailment
Circumstantial speech
Pressured speech
Distractibility
Incoherent/illogical speech
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17
Q

onset of psychosis

A

Can occur at any age
Peak incidence in adolescence/early 20s
Peak later in women

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18
Q

course of psychosis

A

Often chronic & episodic

Very variable

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19
Q

morbidity of psychosis

A

Substantial, both from disorder itself and increased risk of common health problems e.g. heart disease, significant impact on education, employment and functioning

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20
Q

mortality of psychosis

A

Substantial
All-cause mortality 2.5x higher, ~15 years life expectancy lost
High risk of suicide in schizophrenia – 28% of excess mortality

21
Q

outline the psychiatric history

A 
History of Presenting Concern
Past Psychiatric History
Background History (Family, Personal, Social)
Past Medical History and Medicines
Corroborative History
22
Q

what is corroborative history?

A

history from informants e.g. relatives, friends, authority

NEED FOR CONSENT!

23
Q

what is included in the mental state examination?

A 
Appearance and Behaviour
Speech
Mood
Thoughts
Perceptions
Cognition
Insight
24
Q

what to look for in appearance and behaviour?

A 
General appearance
Facial expression
Posture 
Movements 
Social behaviour
25
what to look for in speech?
Quantity Rate Spontaneity Volume
26
what to look for in mood?
``` Subjective Objective Predominant mood Constancy Congruity ```
27
what to look for in thoughts?
``` Stream Form Content Preoccupations Morbid thoughts, suicidality Delusions, overvalued ideas Obsessional symptoms ```
28
what to look for in perceptions?
Illusions Hallucinations Distortions
29
what to look for in cognition?
``` Consciousness Orientation Attention and concentration Memory Language functioning Visuospatial functioning ```
30
what to look for in insight?
Awareness of oneself 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 Acceptance of the specific treatment recommendations
31
psychosis is often preceded by what?
prodromal symptoms
32
what are pharmacological treatment options for psychosis?
Antipsychotic medications | Often mainstay of treatment
33
what are psychological treatment options for psychosis?
CBT for psychosis | Newer therapies like avatar therapy
34
what are social support options for psychosis?
Supportive environments, structures and routines Housing, benefits Support with budgeting /employment
35
What neurotransmitter system is most implicated in the mechanism of antipsychotics?
dopamine
36
most antipsychotics are what drug class?
dopamine antagonists
37
drug class of aripirazole
partial agonist
38
what type of drug used to treat Parkinson's can cause psychotic symptoms?
dopamine agonist
39
what are extrapyramidal side effects of anti-psychotics?
Parkinsonism Acute Dystonia Tardive Dyskinesia Akathisia
40
how do anti-psychotics cause extrapyramidal side effects?
can cause post-synaptic dopamine blockade in the extrapyramidal system (parts of the brain that enable us to maintain posture and tone)
41
what is Parkinsonism?
rigidity - characteristic ‘cog-wheeling’  slow and shuffling gait  Lack of arm swing in gait – early sign ‘pill-rolling’ tremor - slow (4-6Hz) movement of the thumb across the other fingers: 
42
what is dystonia?
Increased motor tone -> sustained abnormal posture | Can be acute, frightening, painful, even fatal
43
how can dystonia be fatal?
laryngeal dystonia
44
what is tardive dyskinesia?
repeated oral/ facial/ buccal/ lingual movements | Initially subtle – can progress to tongue involvement, lip smacking
45
what brings an increased risk of tardive dyskinesia?
female | long term antipsychotics
46
what is akathisia?
Inner restlessness Feel compelled to move, but does little to alleviate Can lead to overt, relentless movement Legs most commonly affected
47
What makes something a ‘typical’ versus an ‘atypical’ antipsychotic?
‘Typical’ antipsychotics commonly cause extrapyramidal side effects at therapeutic doses.
48
management of extrapyramidal side effects?
Avoid them in the first place: atypical antipsychotics usually first-line Change medication Anticholinergic medications can help e.g. procyclidine
49
list other side effects of anti-psychotics
sedation, agranulocytosis, neutropenia, constipation, ^prolactin, ^ appetite, weight gain, diabetes, dysrhythmia, Long QTc

Psychiatry (9 decks)

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