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Psychosis & Schizophrenia Flashcards

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1
Q

What is psychosis?

A

Psychosis is a phenomenon where a person experiences a loss of perception or reality

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2
Q

What may features of psychosis look like?

A

Delusions
Disorganised Thoughts
Hallucinations

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3
Q

What manifestation of psychosis is expressed in speech by patient?

A

Delusions

NOTE: Expressed in speech by patient (content of the speech)

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4
Q

Types of delusions seen in psychosis

A
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5
Q

What is cotard delusion?

A

rare condition marked by the false belief that you or your body parts are dead, dying, or don’t exist.

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6
Q

Example of a persecutory delusion

A

Thinking someone is trying to kill you

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7
Q

Example of a somatic delusion

A

Thinking there are cockroaches on you

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8
Q

Example of a grandoise delusion

A

Thinking you are the prime minister

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9
Q

Example of a delusion of reference

A

Thinking someone/something is talking to you/is a sign meant for you

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10
Q

Example of an erotomaniac delusion

A

Thinking a celebrity is in love with yu

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11
Q

Example of a delusion of control

A

Thinking your body is in control by someone else

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12
Q

What manifestation of psychosis is shown by the pattern of the speech rather than the content?

A

Disorganised thoughts

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13
Q

Types of disorganised thoughts seen in psychosis

A

Alogia = poverty of speech (speak less)
Thought-blocking = sudden, abrupt stop while talking (say something then stop mid-sentence)
Loosening of association = jump from one idea to another
Tangentiality = diverging from one topic to another, usually there is a link e.g. how I feel, how the weather makes me feel, the weather yesterday
Clanging = use words that rhyme “The cow said wow”
Word salad = incoherence words that make no sense, might use neologisms
Perseveration = repeat words that don’t need to be repeated
Circumstantial speech = long, round-about answers to question, you will see that during rotation

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14
Q

What are the two most common types of disorganised thoughts?

A

Loosening of association and circumstantial speech

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15
Q

Alogia (disorganised thought seen in psychosis)

A

poverty of speech (speak less)

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16
Q

Thought-block (disorganised thought seen in psychosis)

A

sudden, abrupt stop while talking (say something then stop mid-sentence)

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17
Q

Loosening of association (disorganised thought seen in psychosis)

A

jump from one idea to another

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18
Q

Tangentiality (disorganised thought seen in psychosis)

A

diverging from one topic to another, usually there is a link e.g. how I feel, how the weather makes me feel, the weather yesterday

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19
Q

Clanging (disorganised thought seen in psychosis)

A

use words that rhyme “The cow said wow”

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20
Q

Word salad (disorganised thought seen in psychosis)

A

incoherence words that make no sense, might use neologisms

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21
Q

Perseveration (disorganised thought seen in psychosis)

A

repeat words that don’t need to be repeated

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22
Q

Circumstantial speech (disorganised thought seen in psychosis)

A

long, round-about answers to question

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23
Q

What are hallucinations?

A

Sensory perceptions without external stimuli

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24
Q

What psych condition are visual hallucinations often seen in?

A

Delirium

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25
Q

What psych condition are auditory hallucinations often seen in?

A

Schizophrenia

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26
Q

What psych condition are olfactory (smell) hallucinations often seen in?

A

Aura in temporal lobe epilepsy

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27
Q

What psych condition are Gustatory (taste) hallucinations often seen in?

A

None, they are rare.

NOTE: They are sometimes seen in people with epilepsy

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28
Q

What psych conditions are tactile (touch) hallucinations often seen in?

A

Alcohol withdrawal
Stimulant use

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29
Q

Relationship between psychosis and schizophrenia

A

Schizophrenia =/= psychosis. Psychosis is a phenomenon where a person loses touch with reality, such as in Schizophrenia, but can also occur due to drug-use, acute stress, extreme fatigue and a range of other conditions.

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30
Q

What are the 3 core features of schizophrenia?

A

Cognitive dysfunction
Positive symptoms i.e. psychosis
Negative symptoms

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31
Q

First-Rank symptoms of schizophrenia

A

Thought insertion, withdrawal and broadcasting
Delusional perceptions (and passivity phenomena)
Auditory hallucinations (3rd person, thought echo, running commentary)

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32
Q

What auditory hallucinations are seen in schizophrenia?

A

2nd person = talk to you
3rd person = talking about you
Running commentary = narrating your actions
Thought echo = hearing your thoughts being said out loud

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33
Q

How does cognitive dysfunction in schizophrenia present?

A

Reduced ability to understand or make plans
Diminished memory
Inattention

34
Q

Examples of negative symptoms of schizophrenia

A

Blunted affect (objective) or incongruity (inappropriate emotions)
Alogia (objective decrease in speech) 🡪 paucity of speech
Avolition: no motivation or energy
Anhedonia: unable to enjoy things they used to
Asociality: lack of want for social interaction

35
Q

Who does schizophrenia affect more?

A

Male

36
Q

Lifetime prevalence of schizophrenia globally

A

1%

37
Q

Suicide risk in schizophrenia

A

High risk of suicide: 5% of schizophrenic commit suicide, 10% of suicide are done by schizophrenic patients

38
Q

What are delusions?

A

Persistent, false, fixed beliefs which cannot be explained by a cultural phenomenon normal for the patient

39
Q

What delusions are seen in schizophrenia?

A

Delusions of thought interference: insertion, broadcasting, or withdrawal
Delusions of control/passivity: believing that thoughts, feeling or impulses are externally controlled

40
Q

Types of delusions of thought interference

A

insertion, broadcasting, or withdrawal

41
Q

What are delusions of control/passivity?

A

believing that thoughts, feeling or impulses are externally controlled

42
Q

What is a common olfactory hallucination in schizophrenia?

A

burnt rubber

43
Q

Examples of associated hallucinations seen in schizophrenia

A

olfactory (common, classically burnt rubber), somatic – (interference with their organs), elementary (hearing or seeing e.g. whistles, flashes, shadows), formication (feeling of insects crawling from cocaine) or visual (more common in organic psychoses)

44
Q

How is cognition affected in schizophrenia?

A

reduced attention, processing speed, memory, executive function, social cognition.

45
Q

What type of behaviour may be seen in severe schizophrenia? what is it?

A

Catatonic behaviour: strange or purposeless movement

46
Q

How can schizophrenia be classified?

A

Paranoid
Hebephrenic
Catatonic
Undifferentiated
Post-schizophrenic depression
Residual schizophrenia
Simple schizophrenia

47
Q

What type of schizophrenia is Dominated by relatively stable, often paranoid delusions, usually accompanied by hallucinations (particularly auditory) and perceptual disturbances?

A

Paranoid

48
Q

What type of schizophrenia has affective changes which are prominent, and has a shallow and inappropriate mood? Who should it be diagnosed in?

A

Hebephrenic

Should only be diagnosed in adolescent or young adults

49
Q

What type of schizophrenia is dominated by prominent psychomotor disturbances?

A

Catatonic schizophrenia

50
Q

What type of schizophrenia has psychotic conditions meeting the general diagnostic criteria for schizophrenia but not conforming to any of the subtypes (i.e. not showing a clear predominance for a particular set of characteristics)?

A

Undifferentiated

51
Q

What type of schizophrenia presents with a depressive episode arising in the aftermath of a schizophrenic illness? What are they at iincreased risk of?

A

Post-schizophrenic depression, increased suicide risk

NOTE: Some schizophrenic symptoms may still be present, but they do NOT dominate the clinical picture. If there are no schizophrenic symptoms, a depressive episode can be diagnosed

52
Q

What type of schizophrenia presents with long-term negative symptoms?

A

Residual

53
Q

What type of schizophrenia presents with long-term negative symptoms without a psychotic symptom prodrome, and has progressive development of oddities of conduct?

A

Simple schizophrenia

NOTE: Insidious but progressive development of oddities of conduct, inability to meet the demands of society and a decline in total performance
Characteristic negative features of residual schizophrenia (e.g. blunted affect, loss of volition) develop without being preceded by overt psychotic symptoms

54
Q

Investigations for schizophrenia

A

History and physical examination:
Prescribed drugs causing psychosis: anticonvulsants; high-dose corticosteroids; levodopa and dopamine agonists; opioids or illicit substances.
Neurological examination.

Beside:
ECG
Urine studies: drug screen, MSU (UTI delirium), STD
Bloods
FBC, U&Es, LFTs, CRP, Vitamin B12 + folate, TFTs
Screen for STDs
Plasma drug level monitoring: if already on these, to check concordance or within therapeutic range
Anti-NMDA blood test: rare autoantibody encephalitis causing psychosis and seizures
CT head: for first episode psychosis, to rule out an organic cause

EEG: Temporal lobe epilepsy

55
Q

What prescribed drugs can cause psychosis?

A

anticonvulsants; high-dose corticosteroids; levodopa and dopamine agonists; opioids or illicit substances.

56
Q

What bloods must be done when investigating schizophrenia?

A

FBC, U&Es, LFTs, CRP, Vitamin B12 + folate, TFTs
Screen for STDs
Plasma drug level monitoring: if already on these, to check concordance or within therapeutic range
Anti-NMDA blood test: rare autoantibody encephalitis causing psychosis and seizures
CT head: for first episode psychosis, to rule out an organic cause

57
Q

Why do a CT head in schizophrenia?

A

for first episode psychosis, to rule out an organic cause

58
Q

Why do an EEG in schizophrenia?

A

Temporal lobe epilepsy –> can cause hallucinations

59
Q

Why do an anti-NMDA blood test in schizophrenia?

A

rare autoantibody encephalitis causing psychosis and seizures

60
Q

What is the 1st thing to determine in management of schizophrenia?

A

Determine if inpatient or outpatient admission for safety

61
Q

Biological management of schizophrenia if 1st episode

A

Distress, agitation, or anxiety: PO/IM Haloperidol or Lorazepam
PO atypical antipsychotic: olanzapine, risperidone, quetiapine, aripiprazole
Strong PMH/FH of DM, HTN, CVD: typical antipsychotics (reduced risk of metabolic SEs)

62
Q

What to give if 1st presentation of distress, agitation or anxiety in schizo?

A

PO/IM Haloperidol or Lorazepam

63
Q

What to give in 1st presentation of schizophrenia without distress, agitation or anxiety?

A

PO atypical antipsychotic: olanzapine, risperidone, quetiapine, aripiprazole

64
Q

Examples of atypical antipsychotis

A

olanzapine, risperidone, quetiapine, aripiprazole

65
Q

What to give in 1st presentation of schizophrenia with a strong PMH/FH of DM, HTN, CVD?

A

typical antipsychotics (reduced risk of metabolic SEs)

66
Q

Management of schizophrenic patients who have deteriorated but have a prior diagnoses

A

Review current dose
Consider switching to depot – common in post-TBI psychosis
Pros: known compliance, predictable bioavailability, steady plasma levels, regular contact for monitoring
Cons: inflexible administration, longer duration if SEs, patient acceptability, injection site complications

67
Q

PACES Pros and Cons of depot medication for schizophrenia that has deteriorated

A

Pros: known compliance, predictable bioavailability, steady plasma levels, regular contact for monitoring
Cons: inflexible administration, longer duration if SEs, patient acceptability, injection site complications

68
Q

What is treatment resistance schizophrenia? What to give?

A

If symptoms not controlled on 2x atypical antipsychotics switch to Clozapine

69
Q

When is Clozapine given in schizophrenia?

A

Treatment resistant schizophrenia, If symptoms not controlled on 2x atypical antipsychotics switch to Clozapine

70
Q

PACES: Psychological support for schizophrenia

A

CBT: general or targeted - early use is beneficial in limiting impact & relapses and promotes early identification of an episode
Family support: education, counselling and therapy to improve communication within family, medication adherence and patient wellbeing

71
Q

PACES: Social support for schizophrenia

A

Education
Early Intervention Service (after 1st episode), key worker allocation and MDT
CMHT support
Smoking cessation and substance misuse services
Employment services and benefits schemes
Group therapy: social skills training and cognitive rehabilitation for social functioning
Lifestyle: advice on exercise and diet

72
Q

Who should be involved after the 1st episode of psychosis/schizophrenia?

A

Early intervention service, key worker allocation and MDT

73
Q

How long do symptoms need to be present for in order to diagnose schizophrenia?

A

12 months

74
Q

Examples of schizoprenia-like conditions

A

Schizophreniform disorder
Milder form of schizophrenia
Less than 6 months

Brief psychotic disorder:
Milder than schizophreniform disorder
Less than 1 month
Women > Men, following stressful life events e.g. death in the family, job loss

Delusional disorder:
One or more delusions, one month or longer but no other abnormal behavior
Folie a deux: close friends share delusion

75
Q

What is schizophreniform disorder? How long does it last for?

A

Milder form of schizophrenia
Less than 6 months

76
Q

What is a brief psychotic disorder? How long does it last for? Who does it affect most?

A

Milder than schizophreniform disorder
Less than 1 month
Women > Men, following stressful life events e.g. death in the family, job loss

77
Q

What is a delusional disorder? How long does it last?

A

One or more delusions, one month or longer but no other abnormal behaviour

NOTE: Folie a deux: close friends share delusion

78
Q

Schizophrenia that has lasted less than 6 months

A

Schizophreniform disoder

NOTE: if less than 1 months –> brief psycotic disorder

79
Q

One or more delusions, for on emonth or longer with no other abnormal behaviour

A

Delusional disorder

80
Q
A

Psych (11 decks)

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