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Psychiatry > Psychosis > Flashcards

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
Q

what to look for in speech?

A

Quantity
Rate
Spontaneity
Volume

26
Q

what to look for in mood?

A 
Subjective
Objective
Predominant mood
Constancy		
Congruity
27
Q

what to look for in thoughts?

A 
Stream
Form
Content
Preoccupations 
Morbid thoughts, suicidality 
Delusions, overvalued ideas
Obsessional symptoms
28
Q

what to look for in perceptions?

A

Illusions
Hallucinations
Distortions

29
Q

what to look for in cognition?

A 
Consciousness 
Orientation
Attention and concentration
Memory
Language functioning
Visuospatial functioning
30
Q

what to look for in insight?

A

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
Q

psychosis is often preceded by what?

A

prodromal symptoms

32
Q

what are pharmacological treatment options for psychosis?

A

Antipsychotic medications

Often mainstay of treatment

33
Q

what are psychological treatment options for psychosis?

A

CBT for psychosis

Newer therapies like avatar therapy

34
Q

what are social support options for psychosis?

A

Supportive environments, structures and routines
Housing, benefits
Support with budgeting /employment

35
Q

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

A

dopamine

36
Q

most antipsychotics are what drug class?

A

dopamine antagonists

37
Q

drug class of aripirazole

A

partial agonist

38
Q

what type of drug used to treat Parkinson’s can cause psychotic symptoms?

A

dopamine agonist

39
Q

what are extrapyramidal side effects of anti-psychotics?

A

Parkinsonism
Acute Dystonia
Tardive Dyskinesia
Akathisia

40
Q

how do anti-psychotics cause extrapyramidal side effects?

A

can cause post-synaptic dopamine blockade in the extrapyramidal system (parts of the brain that enable us to maintain posture and tone)

41
Q

what is Parkinsonism?

A

rigidity - characteristic‘cog-wheeling’
slow and shuffling gait
Lack of arm swingin gait – early sign
‘pill-rolling’ tremor- slow (4-6Hz) movement of the thumb across the other fingers:

42
Q

what is dystonia?

A

Increased motor tone -> sustained abnormal posture

Can be acute, frightening, painful, even fatal

43
Q

how can dystonia be fatal?

A

laryngeal dystonia

44
Q

what is tardive dyskinesia?

A

repeated oral/ facial/ buccal/ lingual movements

Initially subtle – can progress to tongue involvement, lip smacking

45
Q

what brings an increased risk of tardive dyskinesia?

A

female

long term antipsychotics

46
Q

what is akathisia?

A

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

47
Q

What makes something a ‘typical’ versus an ‘atypical’ antipsychotic?

A

‘Typical’ antipsychotics commonly cause extrapyramidal side effects at therapeutic doses.

48
Q

management of extrapyramidal side effects?

A

Avoid them in the first place: atypical antipsychotics usually first-line
Change medication
Anticholinergic medications can help e.g. procyclidine

49
Q

list other side effects of anti-psychotics

A

sedation, agranulocytosis, neutropenia, constipation, ^prolactin, ^ appetite, weight gain, diabetes, dysrhythmia, Long QTc

Psychiatry (9 decks)

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