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Phase 2 Psychiatry > Psychosis and Schizophrenia > Flashcards

Psychosis and Schizophrenia Flashcards

1
Q

Define the following:

  1. illusion
  2. hallucination
  3. pseudo-hallucination
  4. delusion
  5. delusional perception
  6. thought insertion
  7. thought withdrawal
  8. thought broadcast
  9. thought echo
  10. thought blocking
  11. concrete thinking
  12. catatonia
  13. flight of ideas
  14. depersonalisation
  15. derealisation
A
  1. false interpretation of a real perception
  2. false sensory perception in the absence of a real external stimulus. Located in objective space
  3. A form of imagery arising in the subjective inner space of the mind and lacking the substantiality of normal perceptions (perceived from inside the mind)
  4. A false personal belief based on incorrect inference about external reality and firmly sustained in spite of what almost everyone else believes and obvious evidence to the contrary
  5. A new and delusional interpretation is attached to a familiar and real perception without any logical reason.
  6. delusional belief that thoughts are being put into one’s mind
  7. delusional belief that thoughts are being removed from one’s mind
  8. delusional belief that thoughts are being read by or transmitted to others
  9. A form of auditory hallucination in which the patient hears his thoughts spoken out loud either simultaneously with them thinking it or a moment or two afterwards.
  10. A sudden interruption in the train of thought occurs, leaving a blank, after which what was being said cannot be recalled.
  11. lack of abstract thinking
  12. a state of increased muscle tone affecting extension and flexion and abolished by voluntary movement
  13. speech consists of a stream of accelerated thoughts, with abrupt changes from topic to topic and no central direction
  14. illusion whereby the patient feels they are altered or not real in some way
  15. illusion whereby the surroundings do not seem real
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2
Q
  1. What is psychosis?

2. What is schizophrenia?

A
  1. severe mental disorder involving gross disturbance of perception and/or thought content, derangement of personality and loss of contact with external reality
  2. mental illness characterised by relapsing episodes of psychosis
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3
Q
  1. What is the mean age of onset of schizophrenia?
  2. How does schizophrenia affect men and women differently?
  3. In which areas is prevalence of schizophrenia higher?
  4. In which populations is the prevalence of schizophrenia higher?
A
  1. late adolescence/early adulthood (uncommon first presentation >45)
  2. earlier onset in men (28 compared to 32); affects men more severely
  3. urban areas
  4. migrant populations (particularly second generation immigrants)
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4
Q

Describe risk factors for the development of schizophrenia

A
  1. family history (genetics is an aetiological factor as shown by twin and adoption studies)
  2. obstetric complications, premature birth, IUGR, low birth weight
  3. mixed handedness, late milestones
  4. adverse life events (particularly in month prior to onset of acute symptoms)
  5. expressed emotion
  6. adult factors - urban areas, immigration, substance use
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5
Q

Describe the anatomical course and the function of the following dopaminergic pathways

  1. mesolimbic
  2. mesocortical
  3. nigrostrital
  4. tuberinfundibular
A
  1. from ventral tegemental area to the ventral striatum. Involved in reward related cognition
  2. from ventral tegemental area to the prefrontal cortex; involved in executive functions such as selecting and successfully monitoring behaviors that facilitate the attainment of chosen goals
  3. from the substantia nigra to the striatum. Involved in motor function, associative learning and reward related cognition
  4. from arcuate nucleus to the hypothalamus. Inhibits the release of prolactin
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6
Q
  1. Describe the dopamine hypothesis of schizophrenia?
  2. which dopaminergic pathway is implicated in causing positive symptoms?
  3. which dopaminergic pathway is implicated in causing negative symptoms?
  4. What is the implication of the use of dopaminergic antagonists on symptoms of schizophrenia?
A
  1. schizophrenia results from increased levels of dopamine in the brain
  2. dopamine overactivity in the mesolimbic system (increased D2 receptor activation)
  3. dopamine underactivity in the mesocortical system (decreased D1 receptor activation)
  4. decrease positive symptoms and increase negative symptoms (and cause extrapyramidal side effects)
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7
Q

Describe the glutamate hypothesis of schizophrenia

A

hypoglutaminergic state may be a predisposing factor for schizophrenia

  • thought to decrease dopaminergic activity in the mesocortical pathway leading to negative symptoms
  • thought to increase dopaminergic activity in the mesolimbic pathway leading to positive symptoms
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8
Q

What are the clinical features of the prodromal phase of schizophrenia?

A

subtle and non-specific problems in language, cognitive ability and behaviour that result in loss of function

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9
Q
  1. Name 2 positive symptoms of schizophrenia
  2. name 8 negative symptoms of schizophrenia
  3. Name 3 disorganised symptoms of schizophrenia
A
  1. hallucinations
    delusions
2. affective flattening
    apathy
    avolition (lack of motivation)
    anergy (lack of energy)
    anhedonia
    alogia (poverty of words and thoughts)
    asociality
    attentional impairment
  1. disorganised thinking/speech
    disorganised behaviour
    inappropriate affect
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10
Q
  1. When are positive symptoms of schizophrenia most prominent?
  2. When are disorganised symptoms often detectable?
  3. When are negative symptoms of schizophrenia present?
A
  1. during acute psychotic phase
  2. present in the prodromal phase before the onset of positive symptoms
  3. more subtle but more persistent symptoms
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11
Q

According to ICD-10, how long do symptoms need to be present for a diagnosis of schizophrenia to be made?

A

at least one month, and present for most of the time

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12
Q

Describe the rule of thirds relating to disease course after an acute psychotic episode

A
  • 1/3 will have a single episode and recover completely

-

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13
Q
  1. Name 3 important causes of death which are more likely in an individual with schizophrenia
  2. name 10 poor prognostic factors of schizophrenia
A
  1. suicide; accidents; cardiovascular disease
2. family history
    personal hx of any psychiatric disorder
    eccentric/shy personality
    poor social and psychosexual adjustment
    single
    unstable work record
    young age
    insidious onset
    blunted affect
    prolonged episode
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14
Q
  1. Why do typical antipsychotics worsen negative symptoms of psychzophrenia
  2. name the 4 extrapyramidal side effects of typical antipsychotics
  3. name other off target effects of typical antipsychotics
A
  1. because they antagonise D1 which is already under-activated by decreased DA activity in the mesocortical pathway
    • acute dystonia
    • parkinsonism
    • akatisia (motor restlessness)
    • tardive dyskinesia
  3. adrenergic and muscarinic antagonism
    • hypotension
    • dry mouth
    • urinary retention
    • constipation
    • blurred vision
      Galactorrhoea due to hyperprolactinaemia occurs due to inhibition of dopamine release in the tubuloinfundibular pathway
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15
Q

Name 2 typical antipsychotics used in the management of schizophrenia

A
  • chlorpromazine

- haloperidol

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16
Q
  1. Why do atypical antipsychotics cause fewer extrapyramidal side effects?
  2. Why do atypical antipsychotics worsen negative symptoms to a lesser degree than typical antipsychotics
A
  1. block D2
17
Q

Name 5 atypical antipsychotics

A
  1. risperidone
  2. olanzapine
  3. clozapine
  4. quetiapine
  5. aripiprazole
18
Q
  1. Which atypical antipsychotic is useful in the treatment of resistant schizophrenia?
  2. What is a potentially fatal side effect if this drug?
  3. What drug monitoring needs to be performed when first initiating treatment of this drug?
A
  1. clozapine
  2. agranulocytosis - risk of infection
  3. dose should be titrated slowly and WCC monitored weekly for 18 weeks (and then fortnightly for the remainder of treatment)
19
Q
  1. What are depot preparations?
  2. What are the indications of depot injection of antipsychotics?
  3. Name 4 antipsychotics that are available as a depot preparation
A
  1. long acting intramuscular injections of antipsychotic medication
  2. patient choice due to convenience
    poor adherence to oral treatment
  3. risperidone
    haloperidol
    olanzapine
    aripiprazole
20
Q

What psychosocial management approaches are available for those with schizophrenia?

A
  • psychological therapy involving reassurance, support and good therapeutic relationship
  • CBTp
  • treatment for substance abuse and other comorbid problems
  • social treatment
21
Q

What physical monitoring needs to be performed for those receiving treatment for schizophrenia? (6)

A
  1. weight
  2. waist circumference
  3. pulse and BP
  4. fasting blood glucose, HbA1c, lipids and prolactin
  5. assessment of any movement disorders
  6. assessment of nutritional status, diet and level of physical activity
22
Q

What is schizotypal disorder?

A

personality disorder characterised by eccentricities in behaviour, appearance and speech and cognitive and perceptual distortions, unusual beleiefs and discomfort with/reduced capacity for interpersonal relationships

symptoms are not of sufficient intensity or duration to meet the diagnostic requirements of schizophrenia

23
Q

What is schizoaffective disorder?

A

characterised by prominent affective and schizophrenic symptoms in the same episode of depressive illness
- diagnostic requirements of schizophrenia and a manic, mixed, or moderate or severe depressive episode are met within the same episode of illness, either simultaneously or within a few days of each other

24
Q

What is persistent delusional disorder?

A

development of a single set of delusions that persist for at least 3 months
other psychopathology is characteristically absent

25
Q

What is schizophreniform disorder?

A

characterised by comparatively stable psychotic symptoms that don’t fulfil the diagnostic criteria for schizophrenia

26
Q

What is induced delusional disorder?

A

rare delusional disorder shared by 2 or more people in a close and dependent relationships

Phase 2 Psychiatry (11 decks)

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