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Psychiatry > Psychosis and Schizophrenia > Flashcards

Psychosis and Schizophrenia Flashcards

1
Q

What is the definition of psychosis

A

a mismatch between the events in a persons mind and the events in real life

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2
Q

what is the difference between neurosis and psychosis

A

neurosis is excess contact with reality with hyperexaggerated versions of normal emotions (depression/anxiety)

Psychosis is losing contact with reality with the presence of abnormal perceptions (hallucinations) and thoughts (delusions) (schizophrenia)

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3
Q

What is the definition of a delusion

A

an unshakable belief outside of the cultural norms of the society the person is in

the person should not be able to be persuaded against their delusion

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4
Q

whats the definiton of ertomania

A

the deliusion that someone famous is in love with them

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5
Q

what is cotard’s delusion and where is it often seen

A

the delusion that you are dead/dying/rotting from the inside/have no blood/organs, often with feelings of persecution and guilt - 55% feel they are immortal

seen more commonly in psychotic depression, as opposed to bipolar/schizophrenia

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6
Q

what diseases may cause psychosis

A 
schizophrenia 
affective disorder
neurodegenerative disorders 
substance use 
brain injury
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7
Q

what are the +ve and -ve symptoms of schizophrenia

A

+ve
reality distortion
disorganisation

-ve
psychomotor poverty
anhedonia
avolution (reduced motivation to complete tasks with an end goal - e.g. paying bills)
alogia - malformed speech
affective flattening - very low emotional range

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8
Q

what are the first rank symptoms for schizophrenia 8)

A 
3rd person auditory hallucinations 
thought echo - person hears their thoughts out loud
running commentary 
passivity (someone is controlling them)
somatic hallucination 
thought broadcast 
thought insertion/withdrawal
delusional perception (real life perception with an attached delusion belie)
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9
Q

what part of the brain are auditory hallucinations associated with

A

frontotemporal

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10
Q

What is the neuro-pharmacology of psychosis

A

dopamine exacerbates psychosis, and it is seen as a dopaminergic disease. this makes amphetamines particularly dangerous as they increase dopamine release

however serotonin agonists (LSD) and glutaminergic blockers (ketamine) can cause reality distortion

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11
Q

what are the behavioural and cognitive symptoms of schizophrenia

A

formal thought disorder
bizarre behaviour - catatonia, mutism, posturing, ticks
inappropriate affect
attention + memory impairments
decreased social cognition - empathy, reading emotion
therefore major interpersonal relationship difficulty

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12
Q

what is the aetiology of schizophrenia

A 
genetics
early childhood trauma
birth complications
maternal complications + infections
migration 
ethnic minority
early cannabis use 2.5x (6x in heavy users)
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13
Q

what are some factors that predict poor outcome in psychosis

A 
Male 
Single
Young age at onset
family history
substance misuse
poor premorbid adjustment 
insidious onset
disorganized subtype
negative symptoms
cognitive impairment 
lack of affective symptoms 
poor insight 
high expressed emotion 
poor adherence
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14
Q

What is the treatment for schizophrenia

A

BIO
oral antipsychotic

PSYCHO
family therapy
psychoeducation
CBTp (CBT for psychosis) - only if chronically psychotic

SOCIAL
financial help
accomodation
employment

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15
Q

how do you investigate schizophrenia

A

full history, MSE, risk assessment

ECG - for antipsychotics

bloods - FBC, U+E, TFT, fasting glucose, lipid profile, CA2+, LFT

urine drug screen

this is to assess suitablility for medication as well as reversible causes for psychosis

collateral history

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16
Q

does schizphrenia affect sleeping pattern

A

yes - interrupts the circadian rhythm

17
Q

what are the side effects of clozapine

A 
neutropenia(3%) agranulocytosis (1%) 
weight gain
hyperprolactinemia 
reduced seizure threshold
constipation
hypersalivation 
myocarditis 
increased risk of stroke/VTE
18
Q

what does smoking cessation do to clozapine levels in the blood

A

smoking induces certain cytochrome p450 enzymes, so stopping smoking suddenly causes a reduction in their metabolic rate meaning clozapine is broken down less effectively

19
Q

Lifetime prevalence of schizophrenia

A

1%

20
Q

What happens if clozapine has not been taken for >48 hours

A

it must be restarted at the 12.5mg starting dose and titrated up again

21
Q

what medication is used when a schizophrenic patient is resistant to two atypical antipsychotics (the first-line treatments)

A

clozapine

22
Q

what is fregoli syndrome

A

the delusional belief that a single person is impersonating lots of different people

23
Q

what is capgras syndrome

A

delusional belief that someone you know has been replaced by an identical imposter

24
Q

what is ekbom syndrome

A

delusional belief that a patients body is infested by insects or animals when it isn’t

25
Q

what is the matchbox sign in ekbom syndrome

A

a patient will bring a contained filled with pieces of fluff or first that signify that there is an infestation

26
Q

what is de clerambault syndrome

A

delusional belief that someone (usually of higher social status) is in love with them, and that they communicate to them through oblique ways

27
Q

what is othello syndrome

A

delusional belief that a partner is being unfaithful

28
Q

what are the subtypes of schizophrenia

A 
Paranoid
Simple
Hebephrenic
Catatonic
Cenesthopathic 
residual
persistent delusional disorder
undifferentiated
29
Q

what is the most common subtype of schizophrenia

A

paranoid

30
Q

what is hebephrenic schizophrenia

A

schizophrenia with mainly prominent affective symptoms, such as disordered behaviour and speech, with a shallow affect and inappropriate laughter

31
Q

what is catatonic schizophrenia

A

prominent motor symptoms (waxy flexibility ,posturing)

32
Q

what is residual schizophrenia

A

chronic stage of schizophrenia where the patient develops prominent negative symptoms after previous episodes of delusions and hallucinations

33
Q

what is cenesthopathic schizophrenia

A

form of schizophrenia characterized by bizarre or bothersome bodily sensations (referred to as cenesthopathy), typically without a real, physical cause

34
Q

what is undifferentiated schizophrenia

A

subtype of schizophrenia in which the individual exhibits prominent psychotic features, such as delusions, hallucinations, disorganized thinking, or grossly disorganized behavior, but does not meet the criteria for any of the other subtypes of the disorder.

Psychiatry (13 decks)

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