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Year 4 Psychiatry > Psychotic disorders > Flashcards

Psychotic disorders Flashcards

1
Q

What is psychosis?

A

It is an umbrella term, used to describe the experience of hallucinations, delusions and/or thought disorder.
It is often described as the experience of being out of touch with reality, struggling to distinguish what is real from what is not

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2
Q

How is a thought disorder described?

A

An abnormality in the mechanism of thinking such that to the observer the person doesn’t make sense

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3
Q

What is a delusion?

A

A false, unshakeable belief, despite evidence to the contrary, not held by others in the same culture or religion and held with intense personal conviction and certainty

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4
Q

What is a hallucination?

A

A perceptual experience without an object or stimulus, that appears subjectively real but uncontrolled by the patient

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5
Q

What can cause psychosis? (6)

A
  1. Organic states and disorders e.g. delirium, dementia, space-occupying lesion, metabolic disorders
  2. Psychoactive substance misuse
  3. Schizophrenia
  4. Affective disorders e.g. depression, bipolar
  5. Sleep or sensory deprivation
  6. Bereavement
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6
Q

In order for a diagnosis of schizophrenia to be made, how long must the symptoms have been occurring for?

A

> 1 year

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7
Q

What are the positive symptoms associated with schizophrenia?

A
  1. Hallucinations - especially auditory
  2. Delusions
  3. Thought disorder
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8
Q

Are the positive symptoms of schizophrenia part of the acute or chronic phase/illness?

A

Acute

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9
Q

What is the mainstay of treatment for the positive symptoms of schizophrenia?

A

Medication - antipsychotics

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10
Q

What are the negative symptoms associated with schizophrenia?

A
  1. Avolition - lack of motivation
  2. Anhedonia - unable to experience pleasure
  3. Alogia - poverty of speech
  4. Asociality - lack of desire for relationships
  5. Affect - blunt
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11
Q

Which is easier to treat - the positive or negative symptoms of schizophrenia?

A

The positive - they are more acute and respond more rapidly to medication, whereas the negative symptoms don’t respond well to drug treatment

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12
Q

How is it possible to differentiate between depression and negative symptoms of schizophrenia?

A

The negative symptoms do overlap with symptoms of depression, however they normally don’t have low mood

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13
Q

What are the most common psychopathological phenomena seen in schizophrenia? (8)

A
  1. Thought echo
  2. Thought insertion or withdrawal
  3. Thought broadcasting
  4. Delusional perception
  5. Delusions of control/passivity/influence
  6. Hallucinatory voices
  7. Thought disorders
  8. Negative symptoms
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14
Q

What is schizoaffective disorder?

A

Schizophrenia and affective symptoms that are prominent at the same time i.e. in the same episode of illness

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15
Q

What are the features of paranoid schizophrenia?

A

Relatively stable, often paranoid delusions, usually accompanied by hallucinations, particularly of the auditory variety, and perceptual disturbances

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16
Q

What are the features of hebephrenic schizophrenia?

A

Affective changes are prominent, delusions and hallucinations fleeting and fragmentary, behaviour irresponsibly and unpredictable, and mannerisms common.
Mood is shallow and inappropriate, thought is disorganised and speech is incoherent.
Tendency to social isolation and rapid development of ‘negative’ symptoms, particularly flattening of affect and loss of volition.

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17
Q

In addition to paranoid and hebephrenic, what are the other sub types of schizophrenia?

A
  1. Catatonic
  2. Simple
  3. Undifferentiated
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18
Q

What are Schneider’s first rank symptoms?

A
  1. Delusional perception
  2. 3rd person auditory hallucinations
  3. Thought echo, insertion, withdrawal and broadcast
  4. Passivity - somatic and made
19
Q

What do somatic and made passivity refer to?

A 
Somatic = experiences of bodily influence
Made = acts, impulses, affects (emotions)
20
Q

What are SPECT scans?

A

It is a type of nuclear imaging test using radioactive substance - single photon emission computed tomography - showing how blood flows through tissues.

21
Q

What do SPECT scans show in people with schizophrenia?

A

Greater occupancy of dopamine receptors

22
Q

What do antipsychotics work on/mechanism of action?

A

They are all antagonists at post-synaptic dopamine receptors (5 types, mainly D2)

23
Q

What happens to dopamine activity when patients with schizophrenia experience positive symptoms?

A

They have increased mesolimbic dopamine activity

24
Q

What happens to dopamine activity when patients with schizophrenia experience negative symptoms?

A

They have decreased mesocortical dopamine activity

25
Q

What are the mesolimbic and mesocortical pathways in the brain responsible for?

A

Mesolimbic:
Memory
Behaviour
Arousal

Mesocortical:
Cognition
Socialisation

26
Q

Which pathways do antipsychotics work on?

A

Nigrostriatal and tuberoinfundibular

27
Q

What side effects do antipsychotics cause and why?

A

Due to the influence on the nigrostriatal pathway, they mimic symptoms of Parkinson’s; bradykinesia, extrapyramidal side effects
The action on the tuberoinfundibular pathway; blocking dopamine, increases prolactin levels and therefore causes irregular periods, sexual dysfunction and gynaecomastia

28
Q

What does an agonist do in relation to a neurotransmitter?

A

It mimics the action of a neurotransmitter

29
Q

What does an antagonist do in relation to a neurotransmitter?

A

It blocks the action of a neurotransmitter

30
Q

What does an inverse agonist do in relation to a neurotransmitter?

A

It causes the opposite action that a neurotransmitter would cause

31
Q

The dopamine mnemonic is a useful reminder for the actions and side effects of dopamine/lack of dopamine. What does each letter refer to?

A

D - drive = part of the reward system; any action that is done to receive a reward

psychOsis = drugs that block dopamine mitigate some features of psychosis e.g. delusions, hallucinations

P = parkinsonism; core of parkinson’s disease pathology is the brains inability to secrete dopamine

A = attention; drugs that boost dopamine, improves levels of attention and concentration

M = motor; dopamine is strongly linked to the body’s motor function, so imbalances in dopamine account for conditions such as Parkinsons

I = inhibition of prolactin (dopamine used to be called prolactin inhibiting factor

32
Q

Name 8 neurotransmitters?

A
  1. Serotonin
  2. Dopamine
  3. Histamine
  4. GABA
  5. Glutamate
  6. Acetylcholine
  7. Epinephrine
  8. Opioids/Endorphins
33
Q

What affect do dopamine D2 antagonists have on the 4 dopamine pathways?

A
  1. Mesolimbic pathway - reduces positive symptoms of schizophrenia
  2. Mesocortical pathway - increase in negative symptoms of schizophrenia
  3. Blocks nigrostriatal pathway …hence parkinsonian side effects
  4. Blocks tuberofundibular pathway - hence hyperprolactinaemia, sexual dysfunction, weight gain side effects
34
Q

What questions should be asked about auditory hallucinations? (9)

A
  1. How many voices?
  2. There all the time?
  3. 2nd/3rd person
  4. Command?
  5. Persecutory?
  6. Do you recognise the voices?
  7. Is there a running commentary?
  8. Do you hear them in your mind or are they as if someone is speaking to you who you can’t see?
  9. Are there any triggers?
  10. Where do they come from?
35
Q

What is the difference between functional and reflex hallucination?

A

A functional hallucination is experiencing a perception in a certain modality i.e. visual and then it triggers a visual hallucination whereas a reflex is one modality and then the hallucination is experienced in a different modality.

36
Q

What are Schneider’s first rank symptoms?

A
  1. Thought echo
  2. Thought insertion
  3. Thought withdrawal
  4. Thought broadcasting
  5. Auditory hallucinations - often third person and running commentary
  6. Delusions of control
  7. Delusional perception
37
Q

If antipsychotics can cause parkinsonian-like symptoms, what can cause schizophrenia-like symptoms?

A

L-dopa

38
Q

What is the hypothesis of positive and negative symptoms of schizophrenia related to dopamine?

A

The positive symptoms of schizophrenia result from hyperdopaminergia in the mesolimbic system, whereas the negative symptoms of schizophrenia result from hypodopaminergia in the mesocortical system.

39
Q

What is Pickwickian syndrome?

A

It is the association of obesity with sleep apnoea and hypersomnia. It is named after the character is Charles Dickens’ novel the pickwick papers, who was extremely obese and often fell asleep during the day.

40
Q

What is Ganser’s syndrome?

A

A factitious disorder in which people give approximate answers to simple questions that show that they understand the underlying theme of the questions asked. Individuals mimic what they believe to be psychotic behaviours, for example, when asked how many legs a donkey has, they will reply 12 as opposed to chicken wing or whatever.

41
Q

What is Munchausen’s syndrome?

A

A factitious disorder in which people repeatedly feign illness or self-inflict pathology for the sole purpose of seeking medical attention (e.g. injecting faecal matter into the skin).

42
Q

What is Fregoli’s syndrome?

A

A delusion that a persecutor is able to change into many forms and disguise themselves to look like different people, much like an actor. It is named after Leopold Fregoli, an Italian actor who was famous for being able to make quick changes of appearance during stage acts.

43
Q

What is Capgras syndrome?

A

The delusional belief that a close acquaintance or relative has been replaced by an identical imposter.

Year 4 Psychiatry (14 decks)

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