Psychosis and Schizophrenia

Question 1

what is psychosis?

Answer 1

thoughts, affective response and ability to recognise reality and communicate that with others is impaired

Question 2

what is psychosis characterised by?

Answer 2

lack of insight

Question 3

classification of psychosis

Answer 3

1. schizophrenia
2. manic depressive psychosis
3. organic conditions
4. substance use

Question 4

what is manic depressive psychosis split into?

Answer 4

unipolar depression

bipolar

Question 5

organic conditions that can cause psychosis

Answer 5

delirium
dementia
brain injury
stroke

Question 6

types of substance use that can cause psychosis

Answer 6

acute intoxication
withdrawal
DTs

Question 7

psychotic presentation

Answer 7

hallucinations
delusions
ideas of reference
formed thought disorder
thought interference
passivity phenomena

Question 8

themes of delusions in psychosis

Answer 8

paranoid
grandiose
religious
misidentification
jealousy (RED FLAG for murder)

Question 9

formed thought disorders in psychosis

Answer 9

clanging and punning
loosening of association
Knight's move thinking
neologisms
word salad/ verbigeration

Question 10

thought interference in psychosis

Answer 10

insertion
withdrawal
broadcasting
blocking

Question 11

passivity phenomena in psychosis

Answer 11

volition
affect
impulses

Question 12

cause of schizophrenia

Answer 12

78% inheritability
polygenetic
environment= 2nd trimester viral illness, obstetric problems, childhood CNS infection, substance misuse (cocaine, amphetamines, cannabis)

Question 13

ICD-10 schizophrenia criteria

Answer 13

one of:

• thought echo, insertion, withdrawal or broadcasting
• delusions of control
• hallucinations= 3rd person
• persistent delusions culturally inappropriate

or at least two of:

• persistent hallucinations (everyday for at least 1 month)
• neologisms
• catatonic behaviour
• negative syndromes

Question 14

what are negative syndromes

Answer 14

reduced speech
reduced interest
blunting of emotion responses
apathy

Question 15

positive syndromes in schizophrenia

Answer 15

presence of hallucinations

delusions

Question 16

types of schizophrenia

Answer 16

paranoid schizophrenia
hebephrenic/ disorganised
catatonic
others e.g. specific, undifferentiated, residual, other, unspecified

Question 17

examples of paranoid psychoses

Answer 17

schizophrenia (paranoid)
persistent delusional disorder
schizotypal disorder

Question 18

management of schizophrenia

Answer 18

antipsychotics

Question 19

action of antipsychotics

Answer 19

dopamine antagonists

want to block the mesolimbic pathway
60-80% of dopamine receptors in therapeutic

Question 20

side effects of antipsychotics

Answer 20

• extra-pyramidal side effects (EPSE)
• neuroleptic malignant syndrome (NMS)
• hyperprolactinaemia
• akathisia/ restless legs
• anticholinergic, 5-HT2, anti-adrenergic
• hepatotoxicity
• prolonged QT
• photosensitivity

Question 21

what are the extra-pyramidal side effects?

Answer 21

• acute dystonic reaction
• parkinsonism
• tardive dyskinesia

Question 22

what is the acute dystonic reaction?

Answer 22

within minutes there is increased muscle tone, hot, sweaty, torticolla (muscles of neck cause head to tilt), oculogyrio crisis (eye rolling) and tongue protrusion

Question 23

features of parkinsonism

Answer 23

TRAP

Question 24

what is tardive dyskinesia?

Answer 24

long-term involvuntary, repetitive oro-facial movements (blinking, grimacing, lip-smacking)

Question 25

management of EPSE

Answer 25

procyclidine trihexyphenidyl orphenadrine antimuscarinics

Question 26

what is neuroleptic malignant syndrome NMS?

Answer 26

hours there is autonomic instability > malignant hyperpyrexia and increasing tone the changing BP/pulse causes rhabdomyolysis > ARF > coma > death

Question 27

diagnosis of NMS

Answer 27

measure CK

Question 28

management of NMS

Answer 28

``` stop antipsychotic rapid cooling renal support dantrolene bromocriptine (dopamine agonist) ```

Question 29

why do antipsychotics cause high prolactin?

Answer 29

dopamine inhibits release so blockage causes it to increase

Question 30

what is akathisia/ restless legs?

Answer 30

days-weeks there is pacing, rocking, inability to sit still, sleep disturbance

Question 31

risk in akathisia

Answer 31

suicide risk

Question 32

management of akathisia?

Answer 32

``` beta blockers (1st line) BZDs (2nd line) ```

Question 33

5-HT2 side effects

Answer 33

weight gain | DM

Question 34

anti-adrenergic side effects

Answer 34

postural hypotension

Question 35

first generation antipsychotics side effects

Answer 35

EPSE

Question 36

second generation antipsychotics side effects

Answer 36

weight gain and sedation

Question 37

examples of first generation antipsychotics

Answer 37

``` chlorpromazine haloperidol zuclopenthixol flupentixol trifluperazine prochlorperazine erphenazine sulpiride ```

Question 38

examples of second generation antipsychotics

Answer 38

``` clozapine olanzapine quetiapine risperidone paliperidone lurasidone ```

Question 39

when is clozapine used?

Answer 39

when other antipsychotics have failed

Question 40

side effects of clozapine

Answer 40

agranulocytosis (neutropenic sepsis) myocarditis constipation (gastroparesis, obstruction, perforation)

Question 41

brain changes in schizophrenia

Answer 41

enlarged lateral ventricles reduced fronto-temporal volume reduced activation of prefrontal areas on specific tasks (stroop test) neurotransmitter change (serotonin, dopamine, glutamate)

Question 42

dopamine hypothesis of schizophrenia

Answer 42

D2 receptor agonists such as amphetamines produce a psychotic state so assumed it is overactivity in these pathways

Question 43

dopamine pathway overactivity

Answer 43

``` nigrostriatal= extrapyramidal motor system mesolimbic/cortical= motivation/ reward tuberoinfundibular= prolactin release control ```

Question 44

what does hypoactivity in the dopamine pathways lead to?

Answer 44

negative syndromes