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Toni's Psych > Psychotic Disorders > Flashcards

Psychotic Disorders Flashcards

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1
Q

What is the epidemiology of schizophrenia ?

A

1% lifetime risk
Age of onset: male 18-25 female 25-35
Incr prevalence in lower socio economic classes
Genetic risk, monozygotic twins show 50% concordance

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2
Q

What anatomical abnormalities are thought to be associated with schizophrenia?

A

Ventricular enlargement

Reduced brain size

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3
Q

What is the hypothesised pathophysiology of schizophrenia?

A

Over activity of the mesolimbic dopamine pathway

Based in the effects of conventional antipsychotics which block D2 receptors
Drugs which potentiate the pathway e.g. Amphetamines are known to cause psychotic sx

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4
Q

What are the main psychotic disorders?

A

Schizophrenia
Delusional disorder
Schizoaffective disorder
Acute + transient psychoses

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5
Q

What can increase relapse risk in schizophrenic patients?

A

High expressed emotion in family members

Compliance failure: 80%

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6
Q

What is the first line treatment for schizophrenia?

A

Atypical antipsychotics:
Olanzapine
Risperidone

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7
Q

What is treatment resistant schizophrenia?

A

Lack of satisfactory clinical improvement
Despite sequential use of two antipsychotics (one being an atypical) for 6-8 wks
Start on clozapine asap

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8
Q

How can compliance be improved in schizophrenic patients?

A

depot IM 2-4 wkly (risperidone)
Increased social support
Patient education

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9
Q

What is the role of benzodiazepines in the treatment of schizophrenia?

A

Short term relief of:
Insomnia, aggression, agitation, behaviour disturbance
No antipsychotic effect

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10
Q

What are negative symptoms?

A

Apathy: anhedonia, flat affect

Poverty of thought + speech

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11
Q

What are the positive symptoms?

A

Delusions
Hallucinations
Thought disorder

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12
Q

What is the role of antidepressants in schizophrenia?

A

Sometimes used to augment antipsychotics in treatment resistant cases
Especially with significant affective symptoms
Used in schizoaffective disorder + post schizophrenia depression

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13
Q

What is the role of ECT in treatment of schizophrenia?

A

Rarely used

Indicated only with severe catatonic symptoms

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14
Q

What is the role of CBT in treatment of schizophrenia?

A

Effective in reducing symptoms as an adjunct to pharmacological treatment
Improves insight and compliance

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15
Q

What is the role of family psychological interventions in treating schizophrenia ?

A

Can help reduce expressed emotion:
Expressions of hostility and criticism
Reducing relapse and admission rates

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16
Q

How should acute behaviour disturbance be managed?

A

Environmental + behavioural interventions

Medical:
Oral - benzo +- atypical antipsychotic or typical antipsychotic
Refusing oral - IM lorazepam 0.5-2mg +- IM haloperidol

17
Q

What is paranoid schizophrenia?

A

Schizophrenia dominated by florid positive symptoms

Delusions may be built into a complex conspiracy theory
Paranoid: sense of things occurring around them having special personal significance

18
Q

What is simple schizophrenia?

A

Presents only with negative symptoms

19
Q

What is hebephrenia?

A 
Mix of positive and negative symptoms
Insidious onset
Adolescent onset 15-25
Disorganised + chaotic: mood, behaviour and speech
Shallow/inappropriate affect
Behaviour seems aimless
20
Q

What organic causes might you want to rule out in a schizophrenic picture?

A

Complex partial seizures- temporal lobe epilepsy
Cerebral lesions
Hypothyroidism
SLE
Alcoholism, illicit drug use, medications causing hallucinations

21
Q

What is a hallucination ?

A

A perception in the absence of stimulus

22
Q

What is a delusion?

A

A fixed, false belief held despite rational argument or evidence to the contrary.
That cannot be explained by the patient’s cultural, religious or educational background

23
Q

What are the three stages of schizophrenia?

A

At risk mental state: prodrome
Acute phase: positive symptoms predominate
Chronic phase: negative symptoms predominate

24
Q

What are the features of the at risk mental state?

A

Low grade symptoms of:
Social withdrawal
Loss of interest in work/study/relationships
No frank psychotic symptoms

25
Q

What are diagnostically significant hallucinations?

A

Thought echo
Voices giving running commentary on patient’s actions
Voices discussing/arguing about the patient

26
Q

What are diagnostically significant delusions?

A

Delusional perception: real stimulus delusional interpretation
Passivity: movement, sensation, emotion or impulse being controlled by an external force
Thought interference: withdrawal/insertion/broadcasting

27
Q

What symptoms might be expected in the chronic phase of schizophrenia?

A 
Apathy
Blunted affect
Anhedonia
Social withdrawal
Poverty of thought and speech
28
Q

What is catatonic schizophrenia?

A 
Stupor
Excitement
Posturing
Rigidity
Waxy flexibility
Automatic obedience
Perseveration
29
Q

What are Schneider’s first rank symptoms?

A

Delusional perception
Passivity
Delusions of thought interference: insertion, withdrawal, broadcasting
Auditory hallucination: thought echo, third person, running commentary

30
Q

What is the differential diagnosis in a patient seemingly presenting with schizophrenia?

A 
Organic causes: substance misuse, dementia, delerium, epilepsy esp temporal lobe, medication, brain tumour, stroke, HIV, wilson's, porphyria, neurosyphillis
Acute and transient psychotic episode
Mood disorder
Schizoaffective
Persistent delusional disorder
Schizotypal disorder
31
Q

How would you investigate a patient with apparent schizophrenia?

A

FBC, TFTs, U&Es, LFTs, CRP, fasting G, ?HIV, ?Syphillis, lipids
MSU
Urine drug screen
CT if cerebral pathology suspected, EEG if epilepsy suspected
Symptom rating scale
OT Assessment of activities of daily living
Social work assessment of housing, finances, carers needs
Collateral history

32
Q

What is DUP?

A

Duration of untreated psychosis
Time delay from first symptoms to first ever effective treatment
Psychosis is toxic: greater the DUP, the greater the damage to cognitive abilities, insight and social situation
The sooner treatment started the better the prognosis
Hence early intervention services aim to keep DUP

33
Q

Why is there increased risk of CVD in schizophrenic patients?

A

Antipsychotic medication

Increased smoking rates

Toni's Psych (14 decks)

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