psychosis + schitzophrenia Flashcards
what is psychosis?
Psychosis refers to a group of symptoms that impairs perception of reality
-hallucinations
-disorganised thought
-delusion
what is a hallucination?
-a perception which occurs in the absence of an external stimulus
-has the same qualities as a normal perception
-is not subject to conscious manipulation
-can occur in any sensory modality
what is passivity phenomena?
-phenomena where they think someone is controlling what they do, their emotions or thoughts
-they made me think/ do/ feel this
what is thought interference?
-thought interference refers to thought broadcasting, insertion, blocking or withdrawal
Thought insertion - “There are thoughts being put into my head that don’t belong to me - I haven’t thought them.”
Thought withdrawal - “They can extract the information from me using the internet, they take my thoughts out of my head”
Thought broadcasting - “It’s like everyone can know what I am thinking - my sky dish is beaming what I am thinking to the neighbours, they all know!”
Thought blocking - “It’s like I get halfway through thinking something and the thoughts just dry up, and I can’t think anything for a while.”
what is loss of insight?
you can think you’re fine and everything is normal, don’t realise that you are ill
what are delusions?
A firm fixed belief based on inadequate grounds
presentation of hebephrenic schitzophrenia?
-affective symptoms are prominent delusions and hallucinations, feeling and fragmentary, behaviour irresponsible and unpredictable, and mannerisms common
-The mood is shallow and inappropriate, thought is disorganised, and speech is incoherent
-Early negative symptoms
-a lot of disorderd speech/thought
what are examples of negative symptoms?
- Reduced amount of speech
- Reduced motivation/drive
- Reduced interest/ pleasure
- Reduced social interactions
- Blunting of affect
when are negative symptoms typically seen?
during the predromal phase
what are examples of positive symptoms?
- Hallucinations
- Delusions
- Passivity Phenomena
- Disorder of the form of thought
what is the dopamine theory regarding psychosis?
Dopamine dysregulation causes psychosis
Dopamine regulates salience of external events and internal representations
Dopamine theory- what causes positive schitzophrenia symptoms?
subcortical dopamine hyperactivity
(mesolimbic pathway VTa> Nucleus accumbens)
dopamine theory- what causes negative schitzophrenia symptoms?
frontal dopamine hypoactivity
(mesocortical pathway VTA> frontal cortex)
risks for developing schitzophrenia?
it has a polygenetic inheritence
RISKS:
-Viral illness in 2nd trimester in utero
-Long term cannabis use
-FH
what can make schitzophrenia worse?
amphetamines
what changes are made to the brain structure in schitzophrenia?
-enlarged ventricles
-reduced fronto temporal volume
-reduced frontal lobe grey matter
-Reduced activation of prefrontal areas on specific tasks
-Poor neuronal activity
presentation of catatonic scitzophrenia?
Movement disorder predominates, alternating between stupor and hyperkinesis
Automatic obedience, posturing and waxy flexibility
what is used to treat positive symptoms?
antipsychotics
what is a long prodromal stage associated with?
-poor prognosis
what is an acute schitzoprenic episode like?
-this is usually their first psychotic episode
-more positive symptoms dominate
how does chronic schitzophrenia typically present?
negative symptoms dominate
what is a self referential experience?
The sense than external events are connected to oneself in some way
TV/Radio are transmitting signals aimed at me
what is knights move thinking?
AKA loosening of associations
unexpected illogical connections between ideas
-will jump from idea to idea with increasingly more fragmented connections
what is flight of ideas?
-quick erratic speech where the person is jumping from ideas
-no apparent association between the ideas
what are neologisms?
-made up words
what is verbigerism?
AKA word salad
words dont match up AKA jesus leather
what is circumferentially?
-when they work around the point and eventually get back to it
what is tangiability?
-when they go on a tangent and don’t get back to the point
managment of scitzophrenia?
CBT
1st= 2nd generation antipsychotic drug e.g. olanzapine, quetiapine, risperidone, paliperidone, lurasidone, assess over 2-3 weeks
2nd= try a different 2nd generation antipsychotic or switch to a 1st generation
3rd= check diagnosis, consider psychological input, optimise social supports, check compliance (consider depot?)
4th= consider combining two antipsychotics, consider clozapine
examples of second generation anti psychotics?
-olanzapine
-risperidone
-clozapine
-quetiapine
-paliperidone
-lurasidone
examples of first generation anti psychotics?
-Chlorpromazine
-Haloperidol
-Zuclopenthixol
-Flupentixol
-Trifluoperazine
-Prochlorperazine
SE of dopamine (D2) antagonists?
-extrapyramidal SE
-hyperprolactinaemia
SE of histamine receptor antagonists?
-weight gain
- sedation
SE of muscarinic receptor antagonists?
-anticholinergic effects (dry mouth, sedation, constipation)
SE of adrenoceptor receptor antagonists?
-hypotension
what is associated with poor prognosis of scitzophrenia?
-long predromal phase
-low IQ
-Strong family history
-Lack of obvious precipetent
