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Mental Health > Psychotic Disorders > Flashcards

Psychotic Disorders Flashcards

1
Q

What is a hallucination?

A

The perception of an object in the absence of an external stimulus

Can be any of the 5 modalities
Auditory most common in psychosis - can be 2nd or 3rd person
‘Hearing voices’ is pseudohallucination

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2
Q

What is a delusion?

A

A fixed, firmly held belief that is usually false, cannot be reasoned away, held despite evidence to the contrary
Is out of keeping with the person’s sociocultural norms

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3
Q

What is psychosis?

A

A mental state in which reality is greatly disorted.

Presents with delusions, hallucinations, thought disorder.

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4
Q

What is the ICD-10 classification of psychotic disorders?

A 
Schizophrenia
Schizotypal disorder
Persistent delusional disorder
Acute and transient psychotic disorder
Induced delusional disorder
Schizoaffective disorder
Other non organ psychotic disorders
Unspecified non-organic psychosis
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5
Q

What is formal thought disorder?

A

A problem of speech

Each sentence or phrase does not follow on from the next

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6
Q

What are the non-organic causes of psychosis?

A

Schizophrenia and Schizoaffective Persist for >1 month, paraphrenia presents late

Schizotypal disorder
Acute and transient psychotic disorders
Schizoaffective disorder
Persistent delusional disorder
Folie a deux - induced delusional
Mood disorders with psychosis
Puerperal psychosis
Late paraphrenia
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7
Q

What are the organic causes of psychosis?

A 
Drug induced psychosis
Istrogenic - medication
Complex partial epilepsy
Delirium and dementia
Huntington's
SLE
Syphilis
Endocrine e.g. Cushing's
Metabolic disorders
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8
Q

What is schizophrenia?

A

Most common psychotic condition, characterised by hallucinations, delusions and thought disorders which lead to functional impairment

Characterised by psychotic episodes (positive symptoms - added to normal experience) and negative symptoms

In the absence of organic disease, alcohol or drug-related disorders, not secondary to elevation or depression of mood.

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9
Q

What are the types of functional psychosis?

A

Schizophrenic - bizarre, persecutory, 3rd person
Manic - grandiose, 2nd person
Depressive - guilt, nihilism, 2nd person

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10
Q

What is the course of a psychotic episode?

A

Differs for patients
Can get better, have recurrent episodes, or personality change and recurrent episodes

Schizophrenia most likely to involve a personality change

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11
Q

What negative symptoms are found in schizophrenia?

A

Alogia - poverty of speech where patient gives short answers and no input into conversation
Avolition - decrease in motivation
Asocial behaviour
Anhedonia - lack in pleasure in activities prev enjoyed
Affect blunted
Attention - cognition deficits

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12
Q

What predisposing factors can increase risk of schizophrenia?

A

Genetic
Neurochemical - increase in dopamine, decrease in GABA and serotonin
Neurodevelopmental - intrauterine infection, premature birth, obstetric complications, age 13-35, extreme of parental age

Family history, childhood abuse
Substance misuse
Lower socioeconomic status

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13
Q

What is Schneider’s first rank symptoms?

A 
Hearing own thoughts spoken aloud
Hallucinatory voices - third person
Running commentary
Physical hallucinations 
Thought broadcasting - open to the world
Thought withdrawal, insertion
Influence of others - someone else controlling me
Delusional perception
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14
Q

What precipitating factors can cause schizophrenia?

A

Smoking cannabis or using psychostimulants

Adverse life events
Poor coping style

Adverse life events

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15
Q

What are the perpetuating factors that can increase risk of schizophrenia?

A 
Substance misuse
Poor compliance to medication
Adverse life events
Social support
Expressed emotion
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16
Q

What is the mnemonic for the ICD-10 classification of schizophrenia?

A

Paranoid Psychotic Humans Can’t Supply Understandable Reasoning

Paranoid schizophrenia
Postschizophrenic depression
Hebephrenic schizophrenia
Catatonic schizophrenia
Simple schizophrenia
Undifferentiated schizophrenia
Residual schizophrenia
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17
Q

What is paranoid schizophrenia?

A

Most common

Dominated by positive symptoms - hallucinations and delusions

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18
Q

What is post schizophrenic depression?

A

Depression predominates with schizophrenic illness in the past 12 months, some schizophrenic symptoms still present

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19
Q

What is hebephrenic schizophrenia?

A

Thought disorganisation predominates, onset of illness in earlier - 15-25
Has poorer prognosis

20
Q

What is simple schizophrenia?

A

Rare

Negative symptoms develop without psychotic symptoms

21
Q

What questions can you ask about hallucinations?

A

Have you heard voices
How many voices
Do they speak to you or about you - 2nd or 3rd person
Do they make comments about what you are doing - running commentary

Are you afraid someone is trying to harm you - persecutory
Do you have any special powers - grandiose delusions

22
Q

What is observed in a MSE with someone with schizophrenia?

A

Appearance - normal or inappropriate with poor self care

Behaviour - preoccupied, restless, noisy, suspicious if positive symptoms
Withdrawn, poor eye contact, apathy - negative symptoms

Speech - may reflect underlying thought disorder, interruption to flow, poverty of speech

Mood - depression, anxiety, irritability, flattened affect

Thought - delusions, formal thought disorder, word salad, concrete thinking - all positive symptoms

Perception - hallucinations, especially third person auditory

Cognition - normal orientation, attention and concentration impaired, evidence of premorbid cognitive impairment

Insight is generally poor

23
Q

What are the investigations for schizophrenia and psychosis?

A

Bloods: FBC (anaemia) TFTs, glucose or HbA1C as atypical antipsychotics can cause metabolic syndrome, serum calcium (hypercalcaemia)
U&Es, LFTs assess renal and liver function before antipsychotics

Urine drug test - illicit drugs
ECG - antipsychotics can cause prolonged QT interval

CT scan to rule out organic causes such as a SOL.
EEG: rule out temporal lobe epilepsy

24
Q

What are poor prognostic factors for schizophrenia?

A 
Strong family history
Gradual onset
Decreased IQ
Premorbid history of social withdrawal
No obvious precipitant
25
Q

What is the general management of schizophrenia and psychosis?

A 
Risk assessment
Use of Mental Health Act may be required if refuse admission
Care Programme Approach
Early intervention
Assess social circumstances
Bio-psychosocial model
26
Q

What is the bio-psychosocial approach to the management of schizophrenia?

A

BIOLOGICAL
Antipsychotics:
atypical are first line e.g. risperidone or olanzapine, clozapine is most effective used for treatment-resistant schizophrenia

Adjuvants: benzos can provide short term relief for behaviour, antidepressants and lithium to augment antipsychotics

ECT: if resistance to pharmacological agents, or have catatonic schizophrenia

PSYCHOLOGICAL
CBT: reduces residual symptoms
Family intervention: psychoeduction
Art therapy: alleviates negative symptoms
Social skills training

SOCIAL
Support groups e.g. Rethink and SANE
Peer support
Supported employment programmes

27
Q

What is recommended in the management of first-episode schizophrenia?

A

Either agree choice of antipsychotic with patient and/or worker, or start second generation antipsychotic
Titrate to minimum effective dose, adjust according to response and tolerability
Assess over 2-3 weeks

If effective - continue
Not effective - change and restart
If not tolerated - discuss poor compliance, consider early use of depot injection

Still not effective - clozapine

28
Q

What are the types of delusions a patient may have in psychosis?

A

Grandiose - special powers, wealth, talents etc.

Persecutory - other people conspiring against them

Reference - Random events or others behaviour have special significance

Guilt - belief they have done something shameful

Hypochondrial - belief they have illness

Morbid jealousy - belief spouse is being unfaithful

29
Q

What are the types of thought disorder?

A

Broadcasting - internal thoughts can be heard out loud by others

Insertion - thoughts being put into your mind

Withdrawal - thoughts are being removed

30
Q

What is a thought disorganisation?

A

Impairment in ability to form thoughts from logically connected ideas

31
Q

What are some types of thought disorganisation?

A

Loosening of associations - loss of normal structure of thought

Tangential disorder - person divert from original thought but never return

Circumstantiality - Thinking proceed slowly with many unnecessary details before getting to the point

Neologisms - Words and phrases devised by patient

Alogia - little information conveyed by speech

Word salad - real words but linked incoherently i.e. talking nonsense

32
Q

What is schizoaffective disorder?

A

Symptoms of schizophrenia and a mood disorder in the same episode

33
Q

How does schizotypal disorder appear?

A

No hallucinations or delusions

Eccentric behaviour, suspiciousness and unusual speech

34
Q

What prodrome may indicate schizophrenia?

A

Patients show:

  • Loss of interest
  • Social withdrawal
  • Self-neglect
  • Depression and anxiety
  • Brief psychotic episodes
35
Q

What is Charles Bonnet syndrome?

A

Visual release hallucinations
Type of psychophysical visual disturbance - person with partial or severe blindness experiences visual hallucinations

May see simple repeated patterns or complex images of people, objects or landscapes

More likely to occur if vision loss affects both eyes, common in macular degeneration

36
Q

What is Cotard syndrome?

A

Walking corpse syndrome

Person holds delusional belief that they are dead, do not exist, putrefying (decomposing) lost their blood or internal organs.

37
Q

What is De Clerambault syndrome?

A

Erotomania

Paranoid condition characterised by an individual’s delusions of another person being infatuated with them

38
Q

What is pseudohallucination?

A

An involuntary sensory experience vivid enough to be regarded as a hallucination, but recognised by the person experiencing it as being subjective and unreal.

39
Q

What are the differentials of psychosis?

A

Schizophrenia
Bipolar disorder - may have some of the first rank symptoms, but elation, erratic behaviour and grandiose delusions rather than persecutory
Alcoholic hallucinations in withdrawal
Drugs e.g. cannabis, steroids, cocaine, ecstasy, LSD
Organic disorders - temporal lobe seizures in epilepsy, dementia, trauma, hypos
Other mental health disorders e.g. brief psychotic, delusional, morbid jealousy, erotomania

40
Q

What is thought to be the pathology of schizophrenia?

A

Excess dopaminergic activity
Thought the excitatory neurotransmitter glutamate is involved

Neuroimaging may show increased size of lateral ventricles, reduced brain size usually in temporal lobes
Reduced connections between different brain areas can often be deduced from EEGs

41
Q

What are the types of schizoaffective disorder?

A

Bipolar type - manic or mixed episode occurs

Depressive type - illness mainly depressive episodes

42
Q

What must be present in a major depressive episode in schizoaffective disorder?

A 
Depressed
Decreased pleasure
Weight loss
Insomnia or hypersomnia
Fatigue
Feelings of guilt or worthlessness
Recurrent thoughts of death or suicidal notions
43
Q

What must be present in a manic episode in schizoaffective disorder?

A 
Inflated self esteem
Grandiosity
Reduced need for sleep
Pressure of speech
Flight of ideas
Easily distracted
Psychomotor agitation
Increase in goal-directed activity
Excessive involvement in high risk activities
44
Q

What schizophrenic symptoms need to be present in schizoaffective disorder?

A

Two or more during one month of the illness

Delusions
Hallucinations
Speech abnormalities e.g. incoherent or derailment
Behavioural abnormalities
Negative symptoms e.g. apathy, lack of emotions

45
Q

What are the differentials for schizoaffective disorder?

A 
Substance misuse
Organic e.g. hypothyroid, delirium, HIV
Medication side-effects
Depressive episode 
Dementia, delusional disorder

Mental Health (15 decks)

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