Psychosis Flashcards
what is psychosis?
difficulty perceiving and interpreting reality
list psychotic disorders
schizoaffective disorder bipolar I schizophrenia delusional disorder substance related due to another medical condition depression w/ psychotic features
symptom domains in psychosis
positive symptoms
negative symptoms
disorganisation
examples of positive symptoms
hallucinations
delusions
what are hallucinations?
Percepts in absence of a stimulus
what are delusions?
Fixed, false beliefs, out of keeping with social/cultural background
types of hallucinations
Auditory Voices commenting on you Voices talking to each other Visual Somatic/tactile Olfactory (rare)
types of delusions
Persecutory Control Reference Mind reading Grandiosity Religious Guilt/sin Somatic
Thought broadcasting
Thought insertion
Thought withdrawal
examples of negative symptoms
alogia
avolition/apathy
anhedonia/asociality
affective flattening
what is alogia?
poverty of speech
Paucity of speech, little content
Slow to respond
signs of avolition/apathy
Poor self-care
Lack of persistence at work/education
Lack of motivation
signs of anhedonia/asociality
Few close friends
Few hobbies/interests
Impaired social functioning
signs of affective flattening
Unchanging facial expressions Few expressive gestures Poor eye contact Lack of vocal intonations Inappropriate affect
examples of disorganisation symptoms
bizarre behaviour
thought disorder
signs of bizarre behaviour
Bizarre social behaviour
Bizarre clothing/appearance
Aggression/agitation
Repetitive/stereotyped behaviours
signs of thought disorder
Derailment Circumstantial speech Pressured speech Distractibility Incoherent/illogical speech
onset of psychosis
Can occur at any age
Peak incidence in adolescence/early 20s
Peak later in women
course of psychosis
Often chronic & episodic
Very variable
morbidity of psychosis
Substantial, both from disorder itself and increased risk of common health problems e.g. heart disease, significant impact on education, employment and functioning
mortality of psychosis
Substantial
All-cause mortality 2.5x higher, ~15 years life expectancy lost
High risk of suicide in schizophrenia – 28% of excess mortality
outline the psychiatric history
History of Presenting Concern Past Psychiatric History Background History (Family, Personal, Social) Past Medical History and Medicines Corroborative History
what is corroborative history?
history from informants e.g. relatives, friends, authority
NEED FOR CONSENT!
what is included in the mental state examination?
Appearance and Behaviour Speech Mood Thoughts Perceptions Cognition Insight
what to look for in appearance and behaviour?
General appearance Facial expression Posture Movements Social behaviour
what to look for in speech?
Quantity
Rate
Spontaneity
Volume
what to look for in mood?
Subjective Objective Predominant mood Constancy Congruity
what to look for in thoughts?
Stream Form Content Preoccupations Morbid thoughts, suicidality Delusions, overvalued ideas Obsessional symptoms
what to look for in perceptions?
Illusions
Hallucinations
Distortions
what to look for in cognition?
Consciousness Orientation Attention and concentration Memory Language functioning Visuospatial functioning
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
psychosis is often preceded by what?
prodromal symptoms
what are pharmacological treatment options for psychosis?
Antipsychotic medications
Often mainstay of treatment
what are psychological treatment options for psychosis?
CBT for psychosis
Newer therapies like avatar therapy
what are social support options for psychosis?
Supportive environments, structures and routines
Housing, benefits
Support with budgeting /employment
What neurotransmitter system is most implicated in the mechanism of antipsychotics?
dopamine
most antipsychotics are what drug class?
dopamine antagonists
drug class of aripirazole
partial agonist
what type of drug used to treat Parkinson’s can cause psychotic symptoms?
dopamine agonist
what are extrapyramidal side effects of anti-psychotics?
Parkinsonism
Acute Dystonia
Tardive Dyskinesia
Akathisia
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)
what is Parkinsonism?
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:
what is dystonia?
Increased motor tone -> sustained abnormal posture
Can be acute, frightening, painful, even fatal
how can dystonia be fatal?
laryngeal dystonia
what is tardive dyskinesia?
repeated oral/ facial/ buccal/ lingual movements
Initially subtle – can progress to tongue involvement, lip smacking
what brings an increased risk of tardive dyskinesia?
female
long term antipsychotics
what is akathisia?
Inner restlessness
Feel compelled to move, but does little to alleviate
Can lead to overt, relentless movement
Legs most commonly affected
What makes something a ‘typical’ versus an ‘atypical’ antipsychotic?
‘Typical’ antipsychotics commonly cause extrapyramidal side effects at therapeutic doses.
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
list other side effects of anti-psychotics
sedation, agranulocytosis, neutropenia, constipation, ^prolactin, ^ appetite, weight gain, diabetes, dysrhythmia, Long QTc
