Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

psychiatry > psychosis > Flashcards

psychosis Flashcards

1
Q

define psychosis

A

set of Sx - “losing contact w reality”

realitu is greatly distorted

lack of insight is a key component

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Sx of psychosis

A

-> hallucinations
-> delusions
thought interference
passivity
formal thought disorder
other Sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are hallucinations

A

“a perception in the absence of a stimulus”
- most commonly auditory (2nd - voices talking diorectly to them or 3rd person - voices speaking about them, command, thought echo, running commentary)
M/F
voices outside from the head

  • visual more likely ot be delirium
  • olfactory indicates possible frontal lobe pathology
  • true hallucinations are perceived as real and we may be able to observe behaviour that confirms or refutes this
  • pseudo-hallucinations - hearing voices in my head
  • illusions and distortions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are delusions

A

‘a fixed, false belief that is maintained despite contradictory evidence and which is not explained by the person’s culture or religion

  • persecutory, grandiose, nilhillistic, religious
  • person is 100% sure of belief and will behave as if it is real
  • stable over time
  • ask “how did u come to this conclusion
  • overvalued ideas - person pursues past the point of reason
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Types of delusion

A

.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is thought interference/thought alienation

A
  • SIGNIFICANT IN DIAGNOSIS OF SCHIZO
    1. thought insertion - thoughts being put into the mind
    2. thought withdrawal - thought being taken/ “stolen” from the mind
    3. thought broadcasting - thoughts are available to others in the vicinity

OBJECTIVE Sx
thought blocking - thought just top, nothing there, will stop talking (often considered as part of formal thought disorder.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are passivity Sx

A

SIGNIFICANT IN SCHIZO

  • made Action - actions/movements are being controlled externally “like a puppet”
  • made Affect - emotions are being controlled externally
  • made Impulse - urges are being controolled externally
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is formal thought disorder

A

disorganised thought which manifest as speech which is hard to follow or in severe forms make no sense at all

types

  • knight’s move thinking - no discernible links
  • circumstantially - explain something so excessively
  • derailment
  • thought blocking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Sx of catatonic schizo

A
  • stupor
  • excitement
  • negativism
  • mutism
  • posturing
  • wavy flexibility
    stereotypy
  • echolalia
  • verbigeration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

DD for psychosis

A 
drug intoxication
delirium
epilepsy
brain injury
thyrotoxicosis
hyper PTH
encephalitis
huntingtons
demnetia
cushings
Wilson
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Ix for psychosis, schizo

A

physical esp neuro exam
FBC, U&Es, Ca, TFTs, LFTs, ESR
urine drug screen

consider
CT head
EEG
ANA
STI testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

baseline Ix for antipsychotic

A 
BMI
ECG
U&Es
LFTs
HbA1c
Lipid profile
Prolcatin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is functional psychosis

A
  • brief psychotic episode <1 month
  • schizophrenia
  • schizoaffective disorder
  • depression or mania w psychotic Sx
  • Drug induced psychosis
  • persistent delusional disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

attenuated “borderline” or psuedopsychotic conditions

A
  • Schizotypal disorder
  • borderline (or emotionally unstable) personality disorder
  • paranoid personality disorder
  • treated psychotic conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

non-organic causes of psychosis

A 
schizophrenia
schizotypical disorder
schizoaffective disorder
acute psychotic episode
mood disorders w psychosis
drug induced psychosis
delusional disorder
induced delusional disorder
puerperal psychosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

organic causes of psychosis

A 
drug induced psychosis
iatrogen (medication)
complex partial epilepsy
delirium
dementia
Huntington's disease
SLE
Syphillis
Endocrine disturbances ie cushing
Metabolic disorders - vit B12 deficiency and porphyria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is shizotypal disorder

characteristics

A

Another name latent schizophrenia

chracterised by

  • eccentric behaviour
  • suspiciousness
  • unusual speech
  • deviations of thinking

DO NOT SUFFER FROM HALLUCINATIONS/DELUSIONS

increased risk if they have first-degree relatives w schizophrenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is acute and transient psychotic disorders

A

a psychotic episode presenting very similaryly to schizophrenia <1 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

characteristics of schizoaffective disorder

criteria

A

schizophrenia and a mood disorder in the same episode of illness

mood Sx should meet the criteria for either a depressive illness or a manic episode

AND

one or two typical Sx of schizophrenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is persistent delusional disorder

A

development of a single or set of delusions for a period of at least 3 months

content of delusion is often persecutory, grandiose or hypochondriacal

Sx respond well to antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is puerperal psychosis

A

acute onset of a manic or psychotic episode shortly after childbirth (first 2 weeks following birth)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is late paraphrenia

A

late onset schizophreia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

delusion of reference

A

perceive things have special meaning. referring to you

there is a connection between them

ie. personal messages from television and newspapers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

delusional percepetion

A

see a red car outside but now u think thats gonna kill their mum

theres no connection between them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

negative Sx of schizo

A

Avolition (reduced motivation)

Asocial behaviour - loss of drive for any social engagements

Anhedonia

Alogia (poverty of speech)

Affect blunted - diminished or absent capacity to express feelings

Attention - cognitiv deficits
poverty of speech

apathy- lack of motivation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is schizophrenia and the phases

A 
most common psychotic condition
characterised by 
- hallucinations
- deusions
- thought disorders

leading to functional impairment

  • prodromal
  • acute psychotic
  • maintenance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

RFs of schizo

A

increased likelihood
- positive family history

dopamine hypothesis - secondary to over-activity of mesolimbic dopamine pathways

obstetric complications
fetal inuury
low birth weight

adverse life events
psychological stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

predisposing biological RFs of schizo

precipitating

perpetuating

A

PREDISPOSING
Genetic

Neurochemical - increased dopamine, reduced glutamate, serotonin, GABA

Neurodevelopmental: intrauterine infection
premature birth
fetal brain injury
obstetric complications

Age 15-35

extremes of parental age
<20 or >35
cannabis

PRECIPITATING
- smoking cannabis or psychostimulants

PERPETUATING

  • substance misuse
  • poor compliance to medication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

predisposing PSYHCOLOGICAL RFs of schizo

precipitating

perpetuating

A

PREDISPOSING
closer the family member is the higher the risk

childhood abuse

PRECIPITATING

  • adverse life events
  • poor coping style

PERPETUATING
- adverse life events

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

predisposing
precipitating
perpetuating
SOCIAL RFs of schizo

A

substance misuse
low socioeconomic status
migrants

PRECIPITATING
- adverse life events

PERPETUATING

  • decreased social support
  • expressed emotion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

peak onset age of schizophrenia

A

15-35 years

32
Q

define what is meant by positive symptoms

A

acute syndrome when there is the appearance of hallucinations and delusions

33
Q

define what is meant by negative symptoms

A

chronic syndrome refers to loss of function

34
Q

what are the positive Sx of schizo

A 
Delusions 
Held - Hallucinations
Firmly - formal thought disorder
Think - Thought interference
Psychosis - passivity phenomenon
35
Q

classification of schizophrenia

A 
Paranoid - Paranoid schizophrenia
Psychotic - Postschizophrenic depression
Humans - Hebephrenic schizophrenia
Can't - catatonic schizophrenia
Supply - Simple schizophrenia Understandable - Undifferentiated schizophrenia
Reasoning - residual schizophrenia
36
Q

what is parnaoid schizophrenia

A

most common

dominated by positive symptoms (hallucinations and delusions)

37
Q

what is postschizophrenic depression

A

depression predominates with schizophrenic illness in the past 12 months with some schizophrenia Sx present

38
Q

what is hebephrenic schizophrenia

A

thought disorganisation predominates

onset of illness is earlier (15-25) and has poorer prognosis

39
Q

what is catatonic schizophrenia

A

one or more catatonic symptoms

40
Q

what is simple schizophrenia

A

rare form where negative symptoms develop without psychotic symptoms

41
Q

what is Undifferentiated schizophrenia

A

meets diagnostic criteria for schizophrenia but does not conform to any of the other subtypes

42
Q

what is residual schizo

A

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

43
Q

ICD-10 criteria for schizophrenia

A

at least one very clear symptoms from Group A

  • thought echo, control, withdrawal, broadcasting
  • delusions
  • hallucinatory voices giving a running commentary on pts behaviour or discussing the pt amongst themselves
  • culturally inappropriate or implausible persistent delusions

or two or more from Group B for at least 1 month or more

  • persistent hallucinations
  • breaks of interpolations in the train of thought
  • catatonic behaviour
  • negative symptoms
44
Q

Ix for schizophrenia

A

Blood tests

urine drug test: illicit drugs can cause and exacerbate psychosis

ECG: antipsychotics cause prolonged QT interval

CT scan: to rule out organic causes such as SOL

EEG: to rule out temporal lobe epilepsy as possible causes of psychosis

45
Q

what blood tests are done schizophrenia

A
  • FBC
  • TFTs
  • HbA1c -> atypical antipsychotics can cause metabolic syndrome
  • serum calcium -> hypercalcaemia can present with psychosis
  • U&Es
  • LFTs - assess renal and liver function before giving antipsychotics
  • cholestrol - atypical antipsychotics cause metabolic syndrome
  • vitamin B12
  • folate
46
Q

Biological Mx of schizophrenia

A

FIRST LINE - Atypical
antipsychotics ie. risperidone + olanzapine 10mg nocte
aripiprazole 10 mg OD
Depot formulations

adjuvants - benzodiapezines, antidepressants and lithium can be used to augment antipsychotics

ECT - resistant to pharmacological agents. Effective catatonic schizophrenia

47
Q

what is used for treatment-resistant schizophrenia (failure to respond to two other antipsychotics)

A

clozapine

48
Q

when are benzodiazepines used for

A

Adjuvants

- benzodiazepines -> provide short-term relief of behavioural disturbance, insomnia, aggression and agitation

49
Q

Psychological Mx of schizophrenia

A

REFER TO CPN

CBT - strongly recommended. Reduces residual symptoms

family intervention - psychoeducation helps families reduce

art therapy - alleviation of negative symptoms in young ppl.

social skills training - uses a behavioural approach to help pts improve interpersonal, self-care and coping skills needed in everyday life

50
Q

Social Mx of schizophrenia

A

support groups - Rethink and SANE can help facilitate successul rehabilitation back into the community

peer support - delivered by a peer support worker who has recovered from psychosis or schizophrenia and remains stable

supported employment programmes

finance

51
Q

Which risks are considered when assessing someone under the Mental Health Act

A
  • Risk to themselves – malnutrition, poor personal hygiene leading to infection, suicide,vulnerability
  • Risks to others – hurt others, unsafe driving
  • Risks of further deterioration of mental health ie refusing treatment
52
Q

signs seen on examination in NMS

A 
Lead-pipe type muscular rigidity
Hyperthermia (above 38degrees)
Tachycardia
Hypotension/Hypertension – Fluctuating BP usually. 
Incontinence.
53
Q

bloods seen in NMS q

A 
CK elevated. 
U&Es may show metabolic disturbance (due to AKI or acidosis).
Bone profile may show hypercalcaemia.
FBC may show leucocytosis.
LFTs may be deranged and LDH raised. 
ABG may show metabolic acidosis.
54
Q

Mx of NMS

A 
Stop the medications 
Consider PRN benzodiazepines
Transfer urgently to a medical ward for 
Aggressive hydration
Treatment of hyperthermia
Medications – bromocriptine mesylate (dopamine agonist) & dantrolene sodium, a muscle relaxant that works by inhibiting calium release, antipyretics
55
Q

class of drug of olanzapine

A

SECOND GENERATION ANTIPSYCHOTIC Atypical antipsychotic

56
Q

key side effects of olanzapine

A

Sedation, weight gain, metabolic changes such as insulin dysregulation.

Akathisia and parkinsonism are more associated with First Generation Antipsychotics (such as Haloperidol), although akathisia has been noted with Aripiprazole (which is a SGA).

57
Q

What monitoring is required when prescribing olanzapine, both at baseline and ongoing?

A

Baseline bloods

  • FBC
  • U&E
  • LFTs
  • Lipid profile
  • Glucose
  • HbA1c

Metabolic baselines – as well as the blood tests mentioned above

  • a baseline weight/BMI
  • waist circumference should be performed. Repeat at 3 months, 6 months and yearly.

Cardiac baselines – heart rate/blood pressure, and ECG (particularly to monitor QTc interval). Repeat at dose/drug changes and yearly.

58
Q

what is the difference between section 2 and 3

A

Section 2 is for assessment whereas section 3 allows treatment for a known mental health condition

59
Q

what type of drug is clozapine

A

second generation antipsychotic

60
Q

when is clozapine prescribed

A

treatment resistant schizophrenia

It can be offered to patients who have not responded to two other antipsychotics, at least one of which should be a non-clozapine second generation antipsychotic, at adequate dosage. Due to it being an oral medication it requires agreement from the patient.

61
Q

which blood test is carried out prior to starting clozapine and frequently after initiation

why is it done

A

FBC - leucocyte count -> agranulocytosis, thrombocytopenia

Timing

  • weekly basis for 18 months
  • fortnightly until one year
  • monthly indefinitely
62
Q

common side effects of clozapine

A 
Constipation – this is important to be aware of as it can be fatal.
Sedation
Hypersalivation
Changes in BP
Tachycardia – usually benign, however be cautious and consider cardiology review as can be linked to Myocarditis (usually associated with fever, hypotension or chest pain). Clozapine has been linked to myocarditis and cardiomyopathy. ECG should be performed and consider echo/cardiology referral. 
Weight gain.
Fever.
Seizures.
GORD.
Nausea.
Nocturnal Enuresis.
63
Q

if pts refuse oral medication what can we administer

A

IM depot antipsychotic condition

64
Q

What is paliperidone

how is it initated

A
  • depot version of risperidone
  • through loading doses of IM injection Day 1 and Day 8 of treatment then monthly after

pt remains stable for at least four months on the monthlu dose of IM paliperidone - every 3 months

65
Q

what is CTO

A

This can be used to specify conditions to which the patient is subject to on discharge, and the patient may be recalled to hospital if the conditions are not met. For example, if the patient does not comply with their medication in the community, they can be recalled to hospital regardless of whether they would otherwise currently meet the required criteria for detention under a Section of the Mental Health Act – This means clinicians needn’t wait for the patient to relapse and become risky before re-admitting them to hospital, thus avoiding relapses and possible consequences of relapses.

66
Q

Initial Mx of psychosis

A 
take a detailed history
perform an examination and Ix
obtain collateral history
refer to psychiatric team
commence antipsychotic medication

lorazepam - acute agitation

67
Q

which antipsychotic does not cause weight gain or has no clashes with cardiac problems

A

aripriprazole

68
Q

biggest cause of death due to clozapine

A

constipation

69
Q

DDx for schizophrenia

A 
substance-induced psychotic disorder
psychotic episode
- mood disroders w psyhcotic features
- delusional disorder
- dementia/delirium
- paranoid personality disorder
- schizotypal PD
70
Q

prevalence of schizophrenia

A

lifetime risk 15-19 per 1000 population

2 and 7 per 1000

71
Q

the need for hospital admission schizo

A

• High risk of suicide or homicide.
• Other illness-related behaviour that endangers relationships, reputation, or assets.
• Severe psychotic, depressive, or catatonic symptoms.
• Lack of capacity to cooperate with treatment.
• Lack or loss of appropriate psychosocial supports.
• Failure of outpatient treatment.
• Non-compliance with treatment plan (e.g. depot medication) for patients detained under the MHA.
• Significant changes in medication for patient at high risk of relapse
• Need to address comorbid conditions (e.g. inpatient detoxication, physical problems, serious
medication side effects).

72
Q

monitoring antipsychotic medication

A
  • response to treatment,
  • side effects of treatment, taking into account overlap between certain side effects and clinical features of schizophrenia (for example, the overlap between akathisia and agitation or anxiety) and impact on functioning
  • the emergence of movement disorders
    weight, weekly for the first 6 weeks, then at 12 weeks, at 1 year and then annually (plotted on a chart)
  • waist circumference annually (plotted on a chart)
  • pulse and blood pressure at 12 weeks, at 1 year and then annually
  • fasting blood glucose, HbA1c and blood lipid levels at 12 weeks, at 1 year and then annually
  • adherence
  • overall physical health.
73
Q

in what conditions can hallucinations occur

A

illegal drugs/alcohol
schizophrenia
a progressive neurological condition, such as Alzheimer’s disease or Parkinson’s disease
charles bonnet

74
Q

what to ask when someone mentions voices

A
  • content - are they telling him to hurt himself or others
  • 2nd or 3rd person
  • running commentary
  • does if feel like the voice is your own thoughts or a different person speaking
75
Q

Poor prognostic factors of schizophrenia

A 
strong family history
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant
76
Q

ariprazole

A

less hyperporlcat
less appetite craving
less sedative
give it in morning

77
Q

risperidone

A

twice a day
shorter half life
higher protency given acutely

psychiatry (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions