Psychotic Disorders Flashcards
What is Schizophreniform Disorder?
Same symptoms as Schizophrenia but less than 6 months duration
What is Schizoaffective Disorder?
Psychotic symptoms which are temporally linked to a manic/depressive instance
Must be in the same episode
What is Delusional Disorder?
Where there are isolated delusions but no hallucinations
Tend to be persecutory, hypochondriacal or grandiose
What is Schizophrenia?
A psychotic disorder, lasting at least 6 months characterised by the presence of both positive and negative symptoms
What is psychosis?
Psychosis is where someone loses contact with reality
Prevalence of Schizophrenia?
1%
What is an acute psychotic episode?
An episode of psychosis which resolves within one month
Risk Factors for Psychosis?
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
Prevalence of Schizophrenia?
1%
What are the symptoms of psychosis?
Hallucinations
Delusions
Formal Thought Disorders
Disorders of Self
How do you diagnose schizophrenia?
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
What are the 1st rank symptoms of schizophrenia?
Delusions of thought control
Auditory 2nd person hallucinations - running commentary
Delusions of passivity and control
What are the negative symptoms of schizophrenia?
Social Isolation
Low Mood
Anhedonia
Treatment of Schizophrenia
Anti-psychotics
2nd generation/Atypicals better as fewer EPSE
e.g. Rispiridone
What are some EPSE?
Dystonia (involuntary, painful spasm)
Akathesia (inner restlessness)
Parkinsonism (resting tremor, bradykinesia, rigidity)
Tardive Dyskinesia (involuntary rhythmic movements)
Other side effects of anti-psychotics
Weight Gain Sedation Hyperprolactinaemia Dyslipidaemia Anti-ACh effects
How do anti-psychotics work?
They act on dopamine (D2) receptors and inhibit them
Cause EPSE, raised prolactin due to general effects on other dopamine pathways
What is Neuroleptic Malignant Syndrome?
What can you see in the blood?
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
What is Post-Injection Syndrome?
Basically an OD
After a depot injection
Need to monitor closely
Can get low BP, HR, consciousness, ataxia, weakness
More common with Olanzapine
What is an overvalued idea?
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
What is an overvalued idea?
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
What are delusions?
A fixed, firm belief held by the individual which is:
Outside of their cultural norms
Held contrary to evidence given
What is an overvalued idea?
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
What are some organic causes of psychosis?
Hyperthyroidism Drug Use and withdrawal Delirium and Dementia Malignancy - frontal lobe, SOL Cushing's Disease Epilepsy - temporal lobe
Common Delusions?
Grandiose
Persecutory
Nihilistic
Delusions of Control
Types of Auditory Hallucination?
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
Common Delusions?
Grandiose Persecutory Nihilistic Religious Erotomanic Guilt Infestations Paranoid
What is a formal thought disorder?
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)
What is a disorder of self?
When they have difficulty differentiating themselves from the outside world
Thought broadcast, control, insertion
What do you use in refractory schizophrenia?
What are the side effects?
Clozapine
Weight gain
Salivation
Agranulocytosis
Long QT
Name some typical anti-psychotics?
Why not first line?
Chlorpromazine
Haloperidol
More risk of EPSEs
Name some atypical anti-psychotics?
Rispiridone
Olanzapine
Quetiapine
Clozapine
