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Psychotic disorders Flashcards

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1
Q

What is psychosis

A

Mental state in which reality is greatly distorted

Psychotic presentation

  • Delusions
  • Hallucinations
  • Thought disorders

Higher in black and ethnic minority populations

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2
Q

What are the non-organic causes of psychosis

A

Schizophrenia

Schizotypal disorders

Schizoaffective disorder

Acute psychotic episode

Mood disorder with psychosis

Drug-induced

Delusional disorder

Puerperal psychosis

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3
Q

What are the organic causes of psychosis

A

Drug-induced psychosis

Medication-induced psychosis

Complex partial epilepsy

Delirium

Dementia

Huntington’s disease

SLE

Syphilis

Endocrine disturbances (Cushing’s, B12 deficiency)

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4
Q

What is schizotypal disorder

A

Latent schizophrenia

Eccentric behaviour, suspiciousness, unusual speech, deviation of thinking

No hallucinations or delusions

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5
Q

What is acute psychotic disorder

A

Psychotic episode similar to schizophrenia

Lasts < 1 month

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6
Q

What is schizoaffective disorder

A

Symptoms of schizophrenia and mood disorders in the same episode

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7
Q

What is persistent delusional disorder

A

A set of delusions for >3 months

No other symptoms

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8
Q

What is induced delusional disorder

A

AKA shared paranoid disorder

Similar delusion in 2+ individuals

One person’s delusion believed by another

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9
Q

What are the characteristic features of schizophrenia

A

Hallucinations

Delusions

Thought disorders

Leading to functional impairment

M=F

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10
Q

What is the dopamine hypothesis for schizophrenia

A

Possible link to over-activity of mesolimbic pathway in brain

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11
Q

What are the predisposing factors for schizophrenia

A

Biological
- Genetics, high dopamine, low glutamate/serotonin/GABA, intrauterine infection, premature birth, fetal brain injury, age 15-35, extremes of parental age

Psychological
- Family history, childhood abuse

Social
- Substance abuse, low socioeconomic status, migrants, living in urban areas

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12
Q

What are the precipitating factors for schizophrenia

A

Biological
- Cannabis use, psychostimulant use

Psychological
- Adverse life event, poor coping skills

Social
- Adverse life event

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13
Q

What ate the perpetuating factors for schizophrenia

A

Biological
- Substance misuse, poor compliance

Psychological
- Adverse life event

Social
- Low social support, expressed emotion

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14
Q

What are the positive symptoms of schizophrenia

A

Delusions

Hallucinations

Formal thought disorder

Thought interference

Passivity phenomenon

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15
Q

What are the negative symptoms of schizophrenia

A

Lack of motivation

Antisocial behaviour

Anhedonia

Poverty of speech

Affect blunted

Cognitive deficits

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16
Q

What is post-schizophrenic depression

A

Depression within 12 months of schizophrenic illness

Some schizophrenia symptoms still present

17
Q

What is simple schizophrenia

A

Negative symptoms without psychotic symptoms

18
Q

What is undifferentiated schizophrenia

A

Meets diagnostic criteria for schizophrenia, but does not fit into a subtype

19
Q

What is the criteria for group A schizophrenia

A

Thought echo/insertion/withdrawal/broadcast

Delusions

Running commentary auditory hallucinations

Bizarre persistent delusions

Need 1 for >1 month

20
Q

What is the criteria for group B schizophrenia

A

Non-auditory hallucinations

Thought disorganisation

Catatonic symptoms

Negative symptoms

Need 2 for > 1 month

21
Q

What investigations are needed for schizophrenia

A

Bloods
- FBC, TFTs, glucose, HbA1c, calcium, LFTs, cholesterol, B12, folate

Urine drug screen

ECG (before antipsychotic use)

Consider CT

Consider EEG

22
Q

What are the poor prognostic factors for schizophrenia

A

Strong family history

Gradual onset

Low IQ

Premorbid history of social withdrawal

No obvious precipitant

23
Q

What is the biological management for schizophrenia

A

Antipsychotics

  • Typical
  • Atypical (risperidone, olanzapine)
  • Consider depot
  • Clozapine if treatment-resistant (2 failed)

Adjuvants

  • Benzodiazepines
  • Antidepressants
  • Lithium

ECT
- If treatment-resistant

24
Q

What is the psychological management for schizophrenia

A

CBT

Family intervention

Art therapy

Social skills training

25
Q

What is the social management for schizophrenia

A

Support groups

Peer groups

Supported employment programmes

Psych (11 decks)

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