Psychosis and the MSE Flashcards

1
Q

Define delusion

A

A stubborn belief that cannot be shaken despite contradiction from reality

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2
Q

Define hallucination

A

Seeing things that don’t exist

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3
Q

What is the difference between a delusion and a hallucination?

A

Hallucinations involve external stimuli whereas delusions arise internally

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4
Q

Are delusions or hallucinations present in schizophrenia?

A

Both

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5
Q

What are the positive symptoms of schizophrenia?

A

Hallucinations

Delusions

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6
Q

What are the negative symptoms of schizophrenia?

A

Alogia
Avolition
Anhedonia
Affective flattering

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7
Q

What is alogia?

A

Poverty of speech

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8
Q

What is avolition?

A

Poor self care eg hygiene, lack of motivation etc

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9
Q

What is affective flattering?

A

Unchanged facial expressions and no expressive gestures

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10
Q

At what ages is psychosis most likely to develop?

A

Transition from childhood and adolescence

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11
Q

What are main components of a psych history?

A
History of presenting concern
Past psych history
Background history (family, personal, social)
Past medical history
Medications
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12
Q

Which medicine can be brought over the counter for depression and can interfere with other medication?

A

St John’s wort

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13
Q

What acronym is used to remember the mental state exam?

A
ASEPTIC
Appearance and behaviour
Speech
Emotion/mood
Perceptions
Thoughts
Insight
Cognition
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14
Q

What is examined in the appearance and behaviour section of the MSE?

A

General appearance
Facial expressions (depression, anxiety)
Posture (hunched shoulders? head looking down? gripping the chair?)
Movements (overactive, restless, immobile, slow, mannerisms etc)
Social behaviour
Eye contact

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15
Q

What is examined in the speech section of the MSE?

A

Quantity
Rate
Spontaneity
Volume

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16
Q

What is examined in the thoughts section of the MSE?

A
Stream
Form
Content
Preoccupations
Morbid thought- always ask if they are suicidal
Delusions
17
Q

What is folie a deux?

A

When 2 people play into the delusion

18
Q

What is examined in the perceptions section of the MSE?

A

Illusions
Hallucinations
Distortions

19
Q

Define illusion?

A

Misperception of an external stimulus

20
Q

Define pseudo hallucination

A

When there is self awareness about the hallucination

21
Q

What is examined in the cognition section of the MSE?

A
Consciousness
Orientation
Attention and concentration
Memory
Language functioning
22
Q

What is examined in the insight section of the MSE?

A

Awareness of whether they are presenting with something other people would consider abnormal
Do they accept that this abnormal behaviour is caused by mental illness
Do they accept specific treatment options

23
Q

What are the different types of delusions?

A
Persecutory
Control
Reference
Mind reading
Grandiosity
Religious
Guilt/sin
Somatic
Thought broadcasting
Thought insertion
Thought withdrawal
24
Q

What is congreuncy?

A

Whether things match up eg do their facial expressions match their speech, does their body language match their thoughts

25
Q

What is lability?

A

How often they change eg their tone of speech, their body language, their flow of thoughts

26
Q

What are the 2 types of hallucinations?

A

Visual and auditory

27
Q

What are some risk factors in developing psychosis?

A
Family history of schizophrenia
Childhood trauma
Previous psychiatric history of conditions eg anxiety
Cannabis use
Prenatal and birth complications
Socioeconomic deprivation
28
Q

What are some of the prodromal symptoms of psychosis?

A

Change in social behaviour

Impairments in functioning

29
Q

What are some other sources for patient information you may use?

A
Family 
Friends
Workplace
Place of eduction
GP records
Mental health service records
30
Q

What is the main underlying pharmacology of anitpsychotics?

A

They are usually dopamine receptor antagonists or partial agonists, they work because psychosis is caused by excess dopamine in the brain

31
Q

What neurotransmitter causes psychosis and what level of it?

A

High levels of dopamine

32
Q

What are the EPSEs of dopamine blockade?

A

Parkinsonism:
Rigidity
Slow/shuffling gait
Lack of arm swing
Dystonia= increased motor tone that can occur shortly after starting medication, is frightening
Tardive dyskinesia= repeated oral/facial/buccal/lingual movements
Akathisia= inner restlessness where you feel compelled to move but moving doesn’t alleviate anything, most commonly affects the legs

33
Q

What do ESPEs stand for in terms of psychosis?

A

Extra pyramidal side effects (that are caused by dopamine blockade)

34
Q

How are ESPEs avoided?

A

By giving atypical antipsychotics as first line treatment instead of dopamine antagonists

35
Q

What are other side effects of antipsychotics besides ESPEs?

A

Gastrointestinal eg constipation
Haematological eg agranulocytosis and neutropenia
Metabolic eg increased appetite, weight gain, diabetes
Pituitary eg increased prolactin release (release is usually suppressed by dopamine)
Cardiac eg dysrhythmia

36
Q

What does psychological management for psychosis involve?

A

CBT and new therapies like avatar therapy

37
Q

What does social support for psychotic patients involve?

A

Supportive environments, housing, benefits, support with budgeting and employment