Psychotic Disorders

Question 1

What is Schizophreniform Disorder?

Answer 1

Same symptoms as Schizophrenia but less than 6 months duration

Question 2

What is Schizoaffective Disorder?

Answer 2

Psychotic symptoms which are temporally linked to a manic/depressive instance
Must be in the same episode

Question 3

What is Delusional Disorder?

Answer 3

Where there are isolated delusions but no hallucinations

Tend to be persecutory, hypochondriacal or grandiose

Question 4

What is Schizophrenia?

Answer 4

A psychotic disorder, lasting at least 6 months characterised by the presence of both positive and negative symptoms

Question 5

What is psychosis?

Answer 5

Psychosis is where someone loses contact with reality

Question 6

Prevalence of Schizophrenia?

Answer 6

1%

Question 7

What is an acute psychotic episode?

Answer 7

An episode of psychosis which resolves within one month

Question 8

Risk Factors for Psychosis?

Answer 8

Young (20s)
Male (tend to be more severe)
Substance Misuse
Poor Childhood 
Low SE Status
Urban Areas
Genetic (tenfold increase risk)
Obstetric Complications/Developmental problems

Question 9

Prevalence of Schizophrenia?

Answer 9

1%

Question 10

What are the symptoms of psychosis?

Answer 10

Hallucinations
Delusions
Formal Thought Disorders
Disorders of Self

Question 11

How do you diagnose schizophrenia?

Answer 11

More than 6 months of positive and negative symptoms
1st rank symptoms (one present can diagnose)
or 2 other symptoms - delusions, negative symptoms, hallucinations, overvalued ideas

Question 12

What are the 1st rank symptoms of schizophrenia?

Answer 12

Delusions of thought control

Auditory 2nd person hallucinations - running commentary

Delusions of passivity and control

Question 13

What are the negative symptoms of schizophrenia?

Answer 13

Social Isolation
Low Mood
Anhedonia

Question 14

Treatment of Schizophrenia

Answer 14

Anti-psychotics
2nd generation/Atypicals better as fewer EPSE
e.g. Rispiridone

Question 15

What are some EPSE?

Answer 15

Dystonia (involuntary, painful spasm)
Akathesia (inner restlessness)
Parkinsonism (resting tremor, bradykinesia, rigidity)
Tardive Dyskinesia (involuntary rhythmic movements)

Question 16

Other side effects of anti-psychotics

Answer 16

Weight Gain
Sedation
Hyperprolactinaemia
Dyslipidaemia
Anti-ACh effects

Question 17

How do anti-psychotics work?

Answer 17

They act on dopamine (D2) receptors and inhibit them

Cause EPSE, raised prolactin due to general effects on other dopamine pathways

Question 18

What is Neuroleptic Malignant Syndrome?

What can you see in the blood?

Answer 18

A rare life-threatening response to anti-psychotic medications

You get muscle rigidity, fever, tachycardia, labile BP and altered consciousness

Stop the anti-psychotic
Take to ICU

Raised WBCs and CK

Question 19

What is Post-Injection Syndrome?

Answer 19

Basically an OD
After a depot injection
Need to monitor closely

Can get low BP, HR, consciousness, ataxia, weakness

More common with Olanzapine

Question 20

What is an overvalued idea?

Answer 20

A thought that the individual places a lot more importance and meaning to so that it becomes almost an obsession. It has logic and tends to be from reality but taken a step too far
e.g. my neighbour goes out all the time, they must be a drug dealer

Question 21

What is an overvalued idea?

Answer 21

A thought that the individual places a lot more importance and meaning to so that it becomes almost an obsession. It has logic and tends to be from reality but taken a step too far
e.g. my neighbour goes out all the time, they must be a drug dealer

Question 22

What are delusions?

Answer 22

A fixed, firm belief held by the individual which is:
Outside of their cultural norms
Held contrary to evidence given

Question 23

What is an overvalued idea?

Answer 23

A thought that the individual places an unreasonable amount of importance and meaning to so that it becomes almost an obsession. It has logic and tends to be from reality but taken a step too far. It causes distress to themselves or others

e.g. my neighbour goes out all the time, they must be a drug dealer

Question 24

What are some organic causes of psychosis?

Answer 24

Hyperthyroidism
Drug Use and withdrawal
Delirium and Dementia
Malignancy - frontal lobe, SOL
Cushing's Disease
Epilepsy - temporal lobe

Question 25

Common Delusions?

Answer 25

Grandiose
Persecutory
Nihilistic
Delusions of Control

Question 26

Types of Auditory Hallucination?

Answer 26

Elementary (hearing noises, single words)
1st person - in head, tends not to be schizophrenia
2nd person and 3rd person
Can be running commentary, persecutory, talking to each other, command

Question 27

Common Delusions?

Answer 27

Grandiose
Persecutory
Nihilistic
Religious
Erotomanic
Guilt
Infestations
Paranoid

Question 28

What is a formal thought disorder?

Answer 28

Something to notice on the MSE, odd speech showing that thoughts are abnormal:
Tangential (Don’t get to end of original sentence)
Circumstantial (Convoluted route to end)
Flight of Ideas (Rapid, jump from one topic to another, punning, rhymes)
Loosening of Association (Word Salad)
Thought Block (lose track of sentence, and just stop)
Echolalia (repeating phrases back)
Persevation (repeating previous answers)

Question 29

What is a disorder of self?

Answer 29

When they have difficulty differentiating themselves from the outside world
Thought broadcast, control, insertion

Question 30

What do you use in refractory schizophrenia?

What are the side effects?

Answer 30

Clozapine

Weight gain
Salivation
Agranulocytosis
Long QT

Question 31

Name some typical anti-psychotics?

Why not first line?

Answer 31

Chlorpromazine
Haloperidol

More risk of EPSEs

Question 32

Name some atypical anti-psychotics?

Answer 32

Rispiridone
Olanzapine
Quetiapine
Clozapine