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PSYCHIATRY > PSYCHOSIS - schizo > Flashcards

PSYCHOSIS - schizo Flashcards

1
Q

what is psychosis?

A

mental d.o but not a DX

  • Qualitatively diff. from normal experiences
  • inability to distinguish subjective internal exper. from objective reality
  • lack insight
  • harmful to individual’s functioning and interpersonal relations
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2
Q

What psychotic experiences may one have?

A
  • HALLUCINATIONS
  • DELUSIONS
  • formal thought d.o
  • thought interference
  • passivity phenomena
  • loss of insight
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3
Q

How do sensory organs impair reality?

A
  • they are fallible
  • brain is therefore limited in processing capabilities
  • why there is NO direct interface when interpreting reality
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4
Q

What does it mean when a innocuous/coincidental events will be ascribed a significant meaning by the person?

A

Ideas of Reference

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5
Q

What is Primary delusions?

A
  • arise FULLY formed in consciousness WITHOUT the need of an explanation
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6
Q

What becomes impaired in Psychosis?

A
  • embodiment
  • volition (movement of the body
  • time
  • memory
  • consciousness
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7
Q

How does a hallucination occur?

A
  • aberrant brain PROCESSING without an external stimulus triggers perception.
  • sleep deprivation may trigger hallucinations
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8
Q

What about hallucinations makes it seem so real? (3)

A
  • holds the SAME qualities as NORMAL perception
    (vivid, solid, compelling)
  • not subject to conscious manipulation
  • can occur in any sensory modality
  • experienced as originating in REAL space (NOT just in thoughts)
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9
Q

Provide examples of ideas of reference?

A
  • pt thinks there are MESSAGES in the newspaper about them
  • think the tv is talking TO them/ commenting on their life
  • radio station songs trying to tell you something
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10
Q

What does it mean to have persecutory beliefs?

A
  • pt believes that someone is OUT to harm them
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11
Q

What is self-referential experiences?
How varied in intensity may the thoughts be self-referential experiences?
Give an example.

A
  • belief that external events are related to oneself
  • brief thought
  • frequent, INTRUSIVE thoughts> delusional intensity

= feeling that others are talking about them

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12
Q

What are delusions?

A
  • fixed, FALSELY held belief
  • held with unshakeable conviction
  • —can’t accept evidence to the contrary
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13
Q

What may delusions be a/w?

A
  • with the usual social, cultural and educational background of the pt.
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14
Q

Distinguish between primary and secondary delusion.

A

Primary: arises SPONTANEOUSLY without any precedent cause

Secondary : arises based on some logical extension (external factors)—-ATTEMPTS to EXPLAIN anomalous experiences (hallucinations)—-“because of mafia”

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15
Q

What is Nihilistic delusion?

A
  • the fear that they LOST everything
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16
Q

What are the 2 ways in which Misidentification delusion may take form as?

A
  • Capgrass

- Fregoli (diff. people are in fact the same single person –wearing other clothes)

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17
Q

Name 5 diff. forms of delusions.

A
  • paranoid
  • persecutory
  • grandiose
  • misidentification
    -Nihilistic (nothing is nothing)
  • guilt
  • reference
    jealousy/love/poverty/ sin
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18
Q

Why do delusions change from person to person?

A
  • the delusional content is usually culturally defined

(evil spirits/ISIS/devil/spies)

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19
Q

How to pick up on presence of thought d.o?

A
  • inferred from the pts’ speech
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20
Q

How does Clanging thought d.o sound like?

A
  • non-sensical rhyming #
  • “ding dong bell. Got to hell”
    > seen in BPD and Schizophrenia
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21
Q

How does circumstantial thought processing appear?

A
  • person talks in circles (A LOT of excessive detail)

- they get to the point

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22
Q

How does tangential thinking appear?

A
  • person moves from one thought to another

- never gets to the point

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23
Q

How does loosening of associations appear as a thought pattern?

A
  • Severe thought disorder

- thoughts LOOSE connection from one another

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24
Q

What are neologisms?

A

-made-up words

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25
Q

What are 4 ways in which thoughts may be interfered?

A
  • thought INSERTION
  • thought WITHDRAWAL
  • thought BROADCASTING
  • thought BLOCKING “can’t think of anything for a while”
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26
Q

What is meant by passivity of volition?

A
  • pt believes his actions are under the control of external forces
  • he feels like he is the passive observer in his own body
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27
Q

What is meant by passivity of affect?

A
  • pt experiences FEELINGS that are not his own
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28
Q

What is somatic passivity like ?

A
  • pt experiences BODILY sensations as being produced by an external force
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29
Q

How may a pt react to passivity of impulse?

A
  • surprised as they believe the impulse to carry out an action was not his own
30
Q

What may the thought processing behind loss of insight be? And why?

A
  • pt feels as though everything seems as real as it always did
  • the filtering of information about the world around us (and interpreting its relevance) is impaired
31
Q

What are important points to collate when diagnosing Psychosis?

A
  • nature of psychotic experiences
  • associated Psychiatric symptoms
  • natural hx of symptoms
32
Q

Which conditions present with Visual hallucinations?

A
  • substance misuse

- delerium/ dementia

33
Q

What 2 conditions present with auditory 2nd or 3rd person hallucinations?

A
  • schizo

- substance misuse

34
Q

The passivity phenomena occurs in 2 conditions. What are they?

A
  • Schizo

- Substance Misuse

35
Q

When does formal thoughts disorder manifest?

A
  • Schizo

- Mania

36
Q

Name all the symptoms of Schizophrenia.

A
  • formal thought d.o
  • self-referential delusions
  • grandiose delusions
  • Persecutory delusions
  • passivity phenomena
  • auditory hallucinations (2nd and 3rd)
37
Q

What to keep in mind for suspected drug-induced psychosis?

A
  • some underlying co-morbidities

schizo and BPD

38
Q

How does depressive psychosis present as?

A
  • delusions of WORTHLESSNESS/ guilt/ hypochondriasis/poverty

- hallucinations of acusing/ insulting/ threatening voices (in 2nd person)

39
Q

How does mania with psychosis present as?

A
  • delusions of grandeur/ special ability/ persecution/ religiosity
  • auditory hallucinations
  • flight of ideas
40
Q

What is delirium?

What meds cause delirium?

A
  • acute, transient DISTURBANCE
  • steroids, digoxin, diuretics, anticholinergics
  • withdrawal from benzodiazepines!
41
Q

What other conditions may cause delirium?

A
  • septicaemia
  • organ failure
  • hypoglycemia
  • post-op hypoxia, post-ictal, SOL, encephalitis
42
Q

What are the symptoms of Delirium?

A

-Change in consciousness (subtle drowsiness-> unresponsive)
- disorientated
- lucid intervals (fluctuations)
- worse at night
- impaired conc./memory
(ESP. new info.)

43
Q

What may delirious pts experience?

A
  • visual hallucinations/illusions +/- auditory hallucinations
  • persecutory delusions
  • psychomotor distrubance
    (agitation, retardation)
  • insomnia
44
Q

What are the core psychotic symptoms of Schizo?

A
  • delusions
  • hallucinations
  • thought interference
  • passivity
45
Q

What are the subtypes of Schizophrenia?

A
  1. Paranoid - most common form
  2. Hebephrenic (disorganized schizo)
  3. Catatonic – more movement d.o
  4. others: simple, residual, undifferentiated
46
Q

Name 4 other paranoid psychosis.

A
  1. Persistent Delusional d.o
  2. Schizotypical d.o
  3. acute and transient psychotic disorder
  4. Schizoaffective d.o
47
Q

What are the demographics like in the schizo patients?

A

M:F is 1.4:1

  • peak incidence in men: 15-25 years
  • 25-35 years in women

Higher incidence in Lower socioeconomic class

48
Q

Do genetics play a role in schizo?

A
  • 40-60% chance is MZ twins
  • 15% if one parent
  • 50% chance is BOTH parents have it
  • some mutations’
  • higher rates in some ehtnic gr. (african-caribeean)
49
Q

What birth complications may arise in a schizophrenic pt?

A
  • prematurity
  • prolonged labor
  • fetal DISTRESS
  • hypoxia
50
Q

What is hypothesized to increase the risk of scizophrenia prenatally?

A
  • exposure to VIRAL infections (toxoplasmosis, chlamydia)
  • maternal stress (hemorrhage, pre-term labor)
  • malnutrition

(any maternal prenatal complications)

51
Q

What external factors are said to cause increased risk of schizophrenia developing?

A
  • heavy, regular CANNABIS use (^2-4x risk)
  • urban dwelling
  • social deprivation
52
Q

How may schizophrenia develop through out one’s life?

A
  • in childhood: subtle motor, cognitive and social deficits (becomes greater later)
  • delay in speech and walking
  • prodromal: -gradual onset/ odd ideas and experiences
  • eccentricity, altered affect and off behaviours
53
Q

What may suggest bad prognosis to schizophrenia?

A
  • insidious onset
  • early onset
  • cognitive impairment
  • enlarged Vs
  • long duration of untreated psychosis
54
Q

What may contribute to good prognosis?

A

= older age onset

  • F
  • marked MOOD disturbance (esp. elation)
  • family hx of MOOD disorder
55
Q

What is the rule of thirds in Schizo outcomes?

A
  • a third have a stand alone episode and would recover and return to their normal functioning
  • a thirds would hve a relapsing- remitting pattern
  • a third would have chronic residual symptoms; and they would progressively worsen.
56
Q

How are symptoms of psychosis categorized as?

A
  1. Positive Symptoms
  2. Negative Symptoms
  3. Mood Symptoms
57
Q

What is the diff. between ACUTE and CHRONIC schizophrenia?

A
  • Acute: presents with the sudden onset of positive symptoms (hallucinations, delusions and confused thoughts)
  • Chronic: characterized by negative symptoms
58
Q

What are Schneider’s 1st rank symptoms? (4)

A
  • hearing thoughts spoken ALOUD
  • 3rd person hallucination and hallucinations as running commentary
  • Thought withdrawal, insertion and broadcasting
  • Delusional perception
  • passivity
59
Q

What is schizophreniform d.o?

A
  • meets the dx of 1 or 2 symptoms display

- but lasts LESS than 6 MONTHS

60
Q

What is Schizoaffective d.o?

A
  • schizophrenia with Mania or Depression
  • BUT times with ONLY PSYCHOSIS alone

(diff. from mania or depression with psychotic episodes- they present psychotic episodes with mania or depression)

61
Q

What is a delusional disorder?

A
  • person has ISOLATED delusions
  • for one month or LONGER
  • Folie a Deux: person with delusional disorder shares the delusion with friend
62
Q

Who is usually predisposed to Postpartum Psychosis?

A
  • women with KNOWN psychiatric disorder
  • often BIPOLAR d.o
  • —or also schizoaffective d.o, depression with psychosis, schizophrenia
  • those who stopped MEDS before pregn.
63
Q

What occurs in Post-partum Psychosis?

A
  • delusions, halluc., disorganized thoughts

- delusions INVOLVES the baby

64
Q

How to manage Post-partum Psychosis?

A
  • women MUST be HOSPITALIZED
  • antipsychotic drugs
  • ECT (good for a pt who just delivered)
65
Q

MOst common hallucination in Schizophrenia?

A
  • AUDITORY hallucination
66
Q

Gustatory and Olfactory hallucinations are commonly seen in what condition?

A
  • Partial complex seizures
67
Q

What is seen in Schizotypical d.o?

A
  • eccentricity
  • social withdrawal
  • MAGICAL thinking
  • transient AUDITORY hallucinations
  • aloofness
68
Q

What is seen with persistent Delusional d.o?

A
  • systematised, FIXED delusions

only ft

69
Q

What occurs in Transient/Acute Psychotic d.o?

A
  • schizophrenia-like symptoms lasting <1month
70
Q

What neurological changes occur in a pt with Schizophrenia?

A
  • -enlarged Vs and thinnner cortices

- altered dopamine signalling

PSYCHIATRY (32 decks)

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