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Psychiatry > Psychosis > Flashcards

Psychosis Flashcards

1
Q

4 language features of psychosis?

A

Word salad
Derailment - Knights move
Neologism
Alogia - lack of speech

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2
Q

Difference between a belief and delusion?

A

Belief is when someone believes something with absolute certainty with or without evidence
Delusion is when someone believes something with aboslute certainty despite contradictory evidence

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3
Q

Anhedonia?

A

Lack of enjoyment

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4
Q

Avolition?

A

diminished motivation

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5
Q

Environmental factors that could contribute to development of schizophrenia?

A

Birth trauma, urban living, trauma, moves in childhood, famine, urban living, cannabis

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6
Q

How do structural brain alterations occur in schizophrenia?

A

Abberant DNA methylation
HPA axis dysregulation
Pro inflammatory state
brain alterations

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7
Q

Mechanism of chlorpromazine?

A

Binds to postsynaptic dopamine receptors, feedback to presynaptic, more dopamine released, more metabolites in synapse

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8
Q

3 phases of schizophrenia management?

A

Acute phase, stabilization phase, stable phase

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9
Q

Drug treatment choice of schizophrenia?

A

Chlorpromazine

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10
Q

What is used in treatment resistant schizophrenia?

A

Clozapine

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11
Q

First generation antipsychotics?

A

“azines”
chlorpromazine

Haloperidol

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12
Q

6 second generation anti-psychotics?

A 
Quitiapine
Clozapine
Respiridone 
Olanzapine
Aripiprazole
Ziprazidone
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13
Q

First generation antipsychotics tend to have what 4 side effects?

A

tardive dyskinesia
increased prolactin
Weight gain
Sedation

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14
Q

What specific side effects do first generation antipsychotic Thiorazine come with?

A 
usual:
Tardive dyskinesia
Prolactin increase
Weight gain
Sedation

Specific:
Qtc prolongation
Hypotension
Anticholinergic

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15
Q

Main 6 side effects of clozapine?

A

Weight gain
Glucose abnormalities
Lipid abnormalities

Hypotension
Sedation
Anticholinergic SE

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16
Q

Which class of antipsychotic should be used when someone has sensitivity to extrapyramidal SE?

A

second gen

Not high risperidone

17
Q

Which class of antipsychotic should be used when someone has sensitivity to prolactin increase?

A

Second gen

Not risperidone

18
Q

Which class of antipsychotic should be used when someone has sensitivity to weight gain and hyperglycaemia?

A

Aripiprazole

Ziprasidone

19
Q

Blood tests for schizophrenia/ psychosis?

A 
FBC
U&E
B12
Folate
TFTs
Glucose/HbA1c
Serum calcium
Cholesterol
LFTs
20
Q

Investigations into psychosis

A

ECG - antipsychotic prolonged qtc
ct brain - organic cause
EEG - temporal lobe epilepsy
Urine drug test - temporal lobe epilepsy

21
Q

What antipsychotics are used first line in schizophrenia?

A

atypical - olanzapine, risperidone

22
Q

When is ECT used in schizophrenia?

A

Catatonic or treatment resistant

23
Q

Schizophrenia support groups?

A

SANE

Rethink

24
Q

Causes of challenging behaviour developing?

A 
Drugs - not managing pain, SE, withdrawal
Psychotic illness
Learning disability 
Hypoxia
Infection
Personality disorder
Substance abuse or withdrawal
Head injury
25
Q

What do you need to know in order to manage someones acutely disturbed behaviour?

A 
When did it start?
Has it happened before? How was it managed?
Any precipitants?
Any changes to medication?
Why were they admitted?
26
Q

How do you approach an acutely disturbed patient?

A

Calmly, eye level, know your exits, safe environment, not alone, clear communication

27
Q

What training do staff need in order to provide physical intervention for acutely disturbed patients?

A

MAPA

28
Q

What is the stepwise management plan of managing an acutely disturbed patient?

A

De-escalate verbally
MAPA trained staff provide physical restraint
Pharmacological intervention

29
Q

What benzodiazepine is chosen to be administered to patients experiencing an acute psychotic episode? adverse effects of drug on patients who are suffering what?

A

Flumazenil - adverse effects on those with anxiety or panic

30
Q

When should antipsychotics not be given to a patient suffering an acute psychotic episode?

A

When the cause if delirium tremens as it lowers the seizure threshold

31
Q

After IM sedatives are given to treat an acutely disturbed patient, how often do obs need to be recorded?

A

5-10 minutes for first hour

Every half hour till they are ambulatory again

32
Q

What is oral medication and doses given to an acutely disturbed patient?

A

Lorazepam 250-500mcg PO up to 2mg daily
Risperidone 250mcg to 500mcg PO up to 2mg daily
(Can give Haloperidol or Olanzapine 2.5-5mg PO daily up to 5mg)

33
Q

If oral medication is refused in an acutely unwell patient, what IM medications can be administered?

A

IM Lorazepam 0.5-1mg IM up to 2mg a day
IM Haloperidol 0.5mg IM up to 2mg a day
(Can give olanzapine 2.5-5mg IM up to 5mg a day)

34
Q

What is a form 5?

A

Document that doctors fill out in order to ensure patient stays in hospital to be assessed properly

Psychiatry (17 decks)

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