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Psychiatry > Psychosis and Schizophrenia > Flashcards

Psychosis and Schizophrenia Flashcards

1
Q

Psychosis

A

Mental state in which reality is greatly distorted

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2
Q

What are delusions

A

a fixed false belief which is firmly held despite evidence to the contrary and goes against the individuals normal social and cultural belief system.

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3
Q

Hallucinations

A

A perception in the absence of an external stimulus

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4
Q

thought disorder

A

an impairment in the ability to form thoughts from logically connected ideas

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5
Q

Non-orgaic causes of psychosi

A
  • Schizophrenia
  • Schizoaffective disorder
  • Drug-induced psychosis
  • Delusional disorder
  • Mood disorders with psychosis
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6
Q

Organic causes of psychosis

A
  • Drug induced
  • Iatrogenic
  • Complex partial epilepsy
  • Delirium
  • Dementia
  • Huntingtons
  • SLE
  • Syphillis
  • Endocrine disturbance and metabolic disorders
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7
Q

Mneumonic for other causes of psychosis

A

Schizophrenia And Schizoaffective Persist For >1 Month, Paraphenia Presents Late

Schizotypal disorder
Acute and transient psychotic disorders
Schizoaffective disorder
Persistent delusional disorder
Folie a deux
Mood disorders with psychosis
Puerperal Psychosis
Late paraphrenia

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8
Q

Schizotypal disorder

A

eccentric behaviour, suspiciousness and unusual speech with deviations of thinking. Do no suffer from hallucinations or delusions. Inc risk in those with a first degree relative with schizophrenia.

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9
Q

Acute and transient psychotic disorders

A

< 1 month so not meeting criteria for schizophrenia.

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10
Q

Schizoaffective disorder

A

schizophrenia and mood disorder in the same episode of illness.

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11
Q

Persistent delusional disorder

A

> 3 months

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12
Q

Folie a deux

A

induced delusional disorder - shared paranoid disorder in two or more individuals. Folie imposee is the dominant person with the initial delusional belied and imposes it on a foil simultanee.

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13
Q

Mood disorders with psychosis

A

secondary to depression or mania

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14
Q

Puerperal Psychosis

A

onset first 2 weeks after childbirth

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15
Q

Late paraphrenia

A

late onset schizophrenia. Hallucinations and delusions are prominent and thought disorders and catatonic symptoms are rare.

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16
Q

Schizophrenia

A

Most common psychiatric condition, characterised by hallucinations, delusions and thought disorders, which lead to functional impairment. It occurs in absence of organic disease, alcohol or drug related disorders and it is not secondary to elevation or depression of mood.

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17
Q

Aetiology schizophrenia

A

24 million people worldwide

Peak age 15-35

Males and females equally affected.

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18
Q

Pathiphysiology

A
  • Dopamine hypothesis
  • Stress vulnerability model
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19
Q

Dopamine hypothesis schiz

A

schizophrenia is secondary to over activity of mesolimbic dopamine pathways in the brain.
Supported by conventional antipsychotics that act on D2 receptors dopamine receptors and block them.

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20
Q

Stress vulnerability model

A

Predicts schizo occurs due to environmental factors interacting with a genetic predisposition or brain injury. Patients have different vulnerabilities and so different individuals need to be exposed to different environmental factors to become psychotic.

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21
Q

Predisposing biological

A
  • Genetic
  • Neurochemical - inc dopamine or dec glutamate, serotonin and GABA
  • Neurodevelopment
  • Age 15-35
  • Extremes of parental age <20 or >35.
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22
Q

Precipitating biological

A

Smoking cannabis or using psychostimulants

23
Q

Perpetuating biological

A
  • Substance misuse
  • Poor compliance to medication
24
Q

Predisposing psychological

A
  • FHx
  • Childhood abuse
25
Q

Precipitating psychological

A
  • Adverse life events
  • Poor coping style
26
Q

Perpetuating psychological

A

Adverse life events

27
Q

Predisposing social

A
  • Substance misuse
  • Low SES
    Migrants - afrocarribbean
  • Urban area
  • Birth in late winter or early spring - controversial
28
Q

Precipitating social

A

Adverse life events

29
Q

Perpetuating social

A
  • Dec social support
  • Expressed emotion.
30
Q

Positive symptoms

A
  • Positive - acute syndrome
    • Delusions held firmly think psychosis
      • Delusions
      • Hallucinations
      • Formal thought disorder
      • Thought interference
      • Passivity phenomenon
31
Q

Negative symptoms

A
  • Negative - chronic syndrome
    • The 6A factor
      • Avolition - dec motivation
      • Asocial behaviour - loss of drive os social behaviour
      • Anhedonia - lack of pleasure in activities
      • Alogia - poverty of speech
      • Affect blunted - diminished or absent capacity to express feelings
      • Attention deficits - attention, language and memory.
32
Q

Onset of features prodrome

A

where the pt is reserved, anxious and irritable.

33
Q

ICD criteria

A

ICD-10 Criteria. At LEAST ONE very clear symptom from group A

OR

Two or more from group B

FOR

at least one month or more

WITHOUT

Organic brain disease

34
Q

Group A symptoms

A

Thought echo/ insertion / withdrawal / broadcast

Delusions of control, influence, or passivity phenomenon

Running commentary auditory hallucinations

Bizarre persistent delusions

35
Q

Group B symptoms

A

Hallucinations in other modalities that are persistent

Thought disorganisation

Catatonic symptoms

Negative symptoms

36
Q

Schneider’s first rank symptoms

A
  • delusional perception
  • Third person auditory hallucinations
  • Thought interference
  • Passivity phenomenon
37
Q

Types of schizo

A

Paranoid Psychotic Humans Can’t Supply Understandable Reasoning

Paranoid
Postschizophrenic
Hebenphrenic
Catatonic
Simple
Undifferentiated
Residual

38
Q

Paranoid

A

most common - positive symptoms

39
Q

Postschizophrenic

A

Depression predominates with schizophrenic illness in the past 12 months with some schizophrenia symptoms still present

40
Q

Hebenphrenic

A

Thought disorganisation predominates. Onset is earlier 15-25 - poorer prognosis

41
Q

Catatonic

A

rare form - one or more catatonic symptoms

42
Q

Simple schiz

A

Negative symptoms develop without psychotic symptoms

43
Q

Undifferentiated

A

Meets diagnostic criteria but does not conform to any other subtype

44
Q

Residual schiz

A

1 year of chronic negative symptoms preceded but a clear cut psychotic episodes.

45
Q

MSE findings

A

Appearance
Can be normal or inappropriate with poor self care

Behaviour
Preoccupied restless, noisy or suspicious. A few show sudden, unexpected changes in behaviour. withdrawn, poor eye contact and apathy

Speech
May reflect underlying thought disorder, interruptions to flow of thought and poverty of speech

Mood
Incongruity of affect or mood changes such as depression, anxiety or irritability. Flattened affect.

Thought Delusions, thought insertion, formal thought disorder, POSITIVE

Perception
Hallucinations

Cognition
Normal orientation. Attention and concentration often impaired. Cognitive deficits

Insight
Generally poor.

46
Q

Ix

A

BT - FBC - anaemia,
TFT(can present with psychosis),

Glucose HbA1c (atypical antipsychotics can cause metabolic syndrome) ,

serum calcium (hypercalcaemia can present with psychosis),

U+E,

LFT (assess renal and liver function before giving anti psychotics)

  • Urine drug test - illicit drugs
  • ECG - antipsychotics can cause prolonged QT interval
  • CT - To rule out organic causes such as space occupying lesions
  • EEG - to rule out temporal lobe epilepsy
47
Q

Treatment

A
  • RA and MHA
  • Primary and secondary care with mixture of in and outpatient care.
  • Care programme approach
  • Early intervention psychosis team
  • Bio-psychosocial approach
48
Q

Biological treatment

A
  • Antipsychotics - Typical and atypical
    - Atypical are first line - risperidone and olanzapine
      - Depot formulations should be considered if the patient prefers or if there is a problem with non-compliance.

  - Clozapine - most effective and is used for treatment resistant schizophrenia. used after failure to respond to two other.
    • Adjuvants
      • Benzodiazepines - short term relief from behavioural disturbance, insomnia, aggression and agitation
      • Antidepressants and lithium can be used to augment antipsychotics
    • ECT
      • May be appropriate in patients who are resistant to pharmacological agents. Effective for catatonic schizophrenia
49
Q

Psychological treatments

A
  • CBT
    • Reduces residual symptoms. Strongly recommended by NICE
  • Family Intervention
    • Persisting symptoms for family members. Reduce high levels of expressed emotion which reduces relapse
  • Art Therapy
    • Alleviation of negative symptoms in young people
  • Social skills training -
    • Behavioural approach to help patients improve interpersonal, self-care and coping skills.
50
Q

Social treatment

A
  • Support groups - Rethink and SANE
  • Peer Support - Peer support worker who has recovered from psychosis or schizophrenia and remains stable
  • Supported employment programmes - Recommended by nice for pt with schizophrenia who wish to find or return to work.
51
Q

Timeline of treatment

A

agree choice of antipsychotic
Titrate to minimum effective dose
Adjust dose according to response and tolerability
Assess over 2-3 weeks

If not effective - change drug and follow again - if still not then clozapine

If not tolerated or poor compliance is an issue instead
Discuss reasoning and change drug. If other reasoning then use early depot injection

52
Q

Poor prognostic factors:

A
  • Strong Fhx
  • Gradual onset
  • Low IQ
  • Premorbid history of social withdrawal
  • No obvious precipitant.

Psychiatry (17 decks)

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