Psychotic disorders Flashcards
1
Q
Definition
A
Mental state in which reality is grossly distorted
2
Q
Interrelated parameters in psychosis
A
- Perception
- Abnormal beliefs
- Thought disorder
- Negative symptoms
- Psychomotor
3
Q
Define perception
A
Making sense of physical information from our senses
4
Q
Difference between hallucination and illusion, pseudohallucination
A
Hallucination occurs without external stimulus
Illusion is misperception of stimulus
Pseudohallucination is an experience in the inner world->minds eye
5
Q
Components of thought disorder
A
1. Abnormal beliefs Delusions Overvalued ideas 2. Disorganised thinking Circumstantial Tangential LOA Neologisms FOI Thought blocking Perseveration Echolalia Irrelevant answers
6
Q
Negative symptoms
A
Poverty of speech Apathy Social isolation Poor self care Blunted affect Cognitive deficits
7
Q
Psychomotor->catatonia
A
Rigidity Posturing Flexibility Excitement Stupor Echopraxia Mannerisms Sterotypes
8
Q
Differential diagnosis
A
1. Psychotic disorders SchizoPF SchizoP SchizoA Brief psychotic episode Delusional disorder 2. Mood disorders with psychotic features 3. Personality Schizotypal BPD 4. Secondary GMC or substance
9
Q
GMC associated with psychosis
A
1. Neurology Stroke Dementia Delirium Infection Injury 2. Endocrinology 3. Epilepsy 4. Huntington 5. SLE 6. Vitamine B12 7. Wernickes
10
Q
Substances associated with psychosis
A
Alcohol Cannabis Amphetamine Antipsychotics Antiparkinsons Cocaine Steroids Hallucinogens PCP Organophosphates
11
Q
History
A
1. Psychosis Duration, onset Hallucinations: Noises, thoughts out loud, talking about you, commanding Delusions: Afraid someone harming, references, special powers, being controlled, thoughts don't belong to you Functional impairment Suicidal, homicidal Anxiety, depression, substance 2. Head trauma 3. Seizures 4. Blurred vision, speech, movement, HA, motor/sensory 5. Features of endoC 6. Medications 7. Heavy metals, organophosphates 8. DIet 9. Surgery 10. FHx->neurological, metabolic, autoimmune 11. Travel, sexual, social
12
Q
Physical examination
A
- Vitals->tachy/hyperT: drugs
- MSE
- Fluctuating LOC
- Fever, rash: menin/encephalitis
- Hyper/hypothyroid
- Malnourished
- Dysmorphic
- Complete neurological examination
Aphasia
Haemianopia
Haemiparesis
Ataxia
Brisk tendon reflexes
Babinski’s sign
Cranial nerve deficits
Tremors
Myoclonus
Paraesthesias
Neuropathy with weakness and
decreased vibrational and
position sense: may be seen
in vitamin B deficiencies
Signs of raised intracranial pressure
13
Q
Investigations
A
CBC UEC LFTs Creatinine UDS Vitamin B12 TFTs Consider ANA, ESR Glucose Urinalysis Febrile->BC, CXR
Depending on presentation
Urinary 24 hour cortisol, Ca, PTH, ceruloplasmin, HIV
CT/MRI->head injury, focal neurological signs, headache
