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Psychosis and schizophrenia Flashcards

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1
Q

What is the prodromal period prior to psychosis characterised by

A

Transient, low-intensity psychotic symptoms

Reduced interest in daily activities

Problems with mood, sleep, memory, concentration, communication, affect, motivation

Anxiety, irritability or depressive features

Incoherent or illogical speech

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2
Q

Hallmark symptoms of psychotic illness

A

Delusions
Hallucinations
Thought disorder
Lack of insight

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3
Q

First rank symptoms

A 
Lack of insight 
Auditory hallucinations 
Thought insertion 
Thought broadcasting 
Delusional perceptions 
External control of emotions 
Somatic passivity
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4
Q

Negative symptoms of schizophrenia

A 
Under activity - which also affects speech 
Low motivation 
Social withdrawal 
Emotional flattening 
Self-neglect
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5
Q

Typical appearance and behaviour in an individual with schizophrenia

A

Withdrawal, suspicion, or(rarely) stereotypical behaviours and mannerisms

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6
Q

Typical speech in schizophrenia

A

Interruptions to the flow of thought(thought blocking), loosening of associations/loss of normal thought structure(knight’s move thinking)

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7
Q

Typical mood/affect in schizophrenia

A

Flattened, incongruous or ‘odd’

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8
Q

Organic disorders which may give rise to psychotic symptoms

A 
Drug-induced psychosis 
Temporal lobe epilepsy 
Encephalitis 
Alcoholic hallucinosis 
Dementia 
Delirium 
Cerebral syphilis
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9
Q

Management of someone at risk of psychosis in primary care

A

Determine the level of risk to the person

Assess the person’s risk of unintentional harm to themselves

Determine risk of harms to others

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10
Q

Social factors in management of schizophrenia

A

Rates of homelessness, poverty and economic deprivation are increased in psychosis

Use of recovery action plan should be promoted

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11
Q

Features of psychological support for schizophrenia and psychosis

A

Education
Voluntary organisations and support groups
Family therapy
CBT
Art therapy for alleviation of negative symptoms

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12
Q

First-line pharmacological treatment for schizophrenia

A

Atypical antipsychotics eg. risperidone and olanzapine

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13
Q

When should depot formulations be considered

A

If patient prefers it after an acute episode or if there is non-compliance with medication

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14
Q

When is clozapine advised for management of schizophrenia

A

If symptoms have not responded to adequate doses of at least two different antipsychotics used sequentially for 6-8 weeks

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15
Q

When is ECT advised in management of schizophrenia

A

May be appropriate in patients resistant to pharmacological therapy

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16
Q

Which medications can cause psychosis

A 
Adrenergic agents 
Anticholinergic(antihistamines) 
Benzodiazepines 
Corticosteroids 
Dopamine agonists
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17
Q

Why does an affective presentation of psychosis have a better prognosis than a non-affective presentation of schizophrenia

A

Lower likelihood of progression to schizophrenia

18
Q

Main receptor targeted by antipsychotics

A

Dopamine receptor

19
Q

Which set of symptoms are antipsychotics more effective at treating in schizophrenia

A

Alleviation of positive symptoms than negative symptoms

20
Q

General advice regarding prescribing more than one antipsychotic drug at a time

A

Should be avoided in exceptional circumstances(e.g. clozapine augmentation or when changing meds during titration) because of the increased risk of adverse effects

21
Q

How do first-generation antipsychotic drugs generally work

A

Act predominantly by blocking dopamine D2 receptors in the brain

22
Q

Examples of 1st gen antipsychotics

A

Chlorpromazine hydrochloride

Haloperidol

23
Q

Which side effects are 1st gen antipsychotics more likely to cause

A

Acute EPS symptoms and hyperprolactinaemia

24
Q

Examples of extrapyramidal side effects

A

Dystonia
Akathisia
Parkinsonism characteristic symptoms such as rigidity, bradykinesia, tremor and tardive dyskinesia

25
Q

What is tardive dyskinesia

A

Irregular, jerky movements

26
Q

What is oculogyric crisis and which drug causes it as a side effect commonly

A

Acute dystonic reaction that involves the prolonged involuntary upward deviation of the eyes

Haloperidol

27
Q

Management of extra-pyramidal symptoms

A

Anticholinergic agents such as IV procyclidine

28
Q

Why should antipsychotics be prescribed with care in the elderly

A

Small increased risk of mortality and an increased risk of stroke or TIA

Furthermore, elderly patients are particularly susceptible to postural hypotension

29
Q

Recommendations for use of antipsychotics in the elderly

A

Should not be used in patients with dementia unless at risk of harm to themselves or others

Lowest effective dose should be used for the shortest period of time

Treatment should be reviewed regularly(every 6 weeks)

30
Q

Clinical symptoms of hyperprolactinaemia

A 
Sexual dysfunction 
Reduced bone mineral density 
Menstrual disturbances 
Breast enlargement 
Galactorrhoea 
Possible increased risk of breast cancer
31
Q

Which antipsychotics are more likely to cause symptomatic hyperprolactinaemia

A

Risperidone
Amisulpride
First gen antipsychotic drugs

32
Q

Which antipsychotics are more likely to cause sexual dysfunction

A

Risperidone
Halperidol
Olanzapine

33
Q

Cardiovascular side-effects associated with antipsychotics

A

Tachycardia
Arrhythmias
Hypotension
QT-interval prolongation

34
Q

What type of antipsychotic usage increases risk of QT-interval prolongation in patients

A

IV antipsychotic drug usage

Doses exceeding maximum

35
Q

Which second-generation antipsychotics are most likely to cause postural hypotension

A

Clozapine

Quetiapine

36
Q

Link between schizphrenia and diabetes

A

Associated with insulin resistance and diabetes

37
Q

Which antipsychotics are linked with weight gain

A

Clozapine and olanzapine

38
Q

Symptoms of neuroleptic malignant syndrome

A 
Hyperthermia 
Fluctuating GCS
Muscle rigidity 
Autonomic dysfunction with fever 
Tachycardia 
Labile blood pressure 
Sweating
39
Q

Pharmacological interventions in NMS

A

Bromocriptine

Dantrolene

40
Q

Clozapine side effects

A 
Agranulocytosis 
Weight gain 
Hypersalivation 
Myocarditis 
Constipation
41
Q

Monitoring of patient parameters for clozapine

A

WCC monitoring weekly for 18 weeks, then fortnightly for up to one year, and then monthly

Psych (9 decks)

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