Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 Psych > Psychotic Disorders > Flashcards

Psychotic Disorders Flashcards

You may prefer our related Brainscape-certified flashcards:
Psychology 101 flashcards GRE® Psychology flashcards
1
Q

What is psychosis?

A

Not a condition or a syndrome - an umbrella term for a form of disorder. It is a disorder of perception, where people experience the world to be different from how it is in actuality

There any different syndromes and diseases that have psychotic features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List some examples of disorders/diseases where psychotic symptoms can occur (12)

A

1) Delusional disorder
2) Schizophrenia
3) Schizoaffective disorder
4) Acute and transient psychosis
5) Substance misuse (cannabis, LSD, shrooms)
6) Substance withdrawal (alcohol and opiates)
7) Dementia (LBD)
8) Sleep deprivation
9) Post-partum
10) Sensory deprivation
11) Severe depression or mania
12) Bereavement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are three broad features of psychosis?

A

1) Thought disorder
2) Delusions
3) Hallucinations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is a thought disorder?

A

An abnormality in the mechanism of thinking such that to an outside observer the person speaking does not make any sense

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a delusion?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a hallucination?

A

A perception which occurs in the absence of a stimulus

The perceptual experience is false but to the person experiencing it, has the full force and impact of a real perception and is consequently indistinguishable from a real perception

Occurs in external space (not in mind’s eye)

Auditory, Visual, Olfactory, Gustatory, Tactile, Somatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most common type of hallucination in psychosis?

A

Auditory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When do visual hallucinations tend to occur?

A

Not a feature of psychosis but tend to be more common in organic disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a pseudo-hallucination?

A

A sensory experience vivd enough to be regarded as a hallucination but recognised by the subject not to be the result of external stimuli and therefore not real

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What questions are important to ask to someone who is hearing voices?

A

Start with - do you ever hear voices when no one else is around / that no one else can hear?

1) How many are there?
2) What gender are the voices?
3) Are they talking about you or to you?
4) Do you recognise the voices?
5) Is there anything that triggers the voices?
6) What do they say?
7) How do they make you feel?
8) Are they constant / worse at a specific time of day?
9) Do they ever command you to do anything?
10) Do you think theres any chance the voices might not be real?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is thought broadcast?

A

The subject experiences his thoughts as actually being shared with others, often with large numbers of people

The subject often claim this sharing is via telepathy, radio and TV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is adhedonia?

A

A total inability to enjoy anything in life or even get the accustomed satisfaction from everyday events or objects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is lability?

A

The subjects affect is rapidly changeable and there are marked fluctuations

The subject maybe cheerful and smiling and then shortly after crying (emotional incontinence may be used in this extreme)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are ideas of reference?

A

A delusional belief that innocuous events or coincidences are directly linked and have personal significance to the subject

Eg the TV / radio is talking about / to them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are neologisms?

A

New words that have no meaning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is an illusion?

A

A false perception of a real stimulus. 3 types:

1) Affect
2) Completion
3) Pareidolia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is loosening of associations?

A

Loss of normal structured thinking

The subjects discourse seems muddled and illogical and does not become clearer with further questioning

As the interviewer it may feel that the more questions you ask to gain clarity the more difficult it is to understand them

= Disorder of thought form

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is clouding of consciousness?

A

A step down from normal alertness

There is a deterioration in thinking, attention, perception and memory and usually drowsiness and reduced awareness of environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are 3rd person auditory hallucinations?

A

The subject hears voices talking about him / herm, referring to them in the third person

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is thought withdrawal?

A

The subject believes that their thoughts have been removed from their mind by an external agency and they do not have control over it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is affect?

A

Short lived observable pattern of behaviour that expresses the subjective emotional state of an individual

Subject to variation over brief periods of time

Affect = Weather
Mood = Climate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are nihilistic delusions?

A

Delusions of extreme negativity - no longer existing, about to die or even being dead, about to experience terrible doom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is concrete thinking?

A

The inability to understand abstract ideas or concepts

Subjects will be focused on the hear and now, physical objects and literal meanings / delusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are delusions of control / passivity?

A

The subject believes that their thoughts, feelings and/or actions are not their own but are being imposed/ controlled by an outside force

Eg they believe that someone else’s words are coming out using their voice or they are being made to think a certain way

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is a delusional perception?

A

The subject receives a normal perception which is then interpreted ith delusional meaning and has immense personal meaning

Eg on seeing a traffic light change from green to red, a man declared that he was the King of Mars

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is psychomotor retardation?

A

The subject sits abnormally still / walks abnormally slowly / takes a long time to initiate movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is euthymia?

A

Happy, contented mood (happy medium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is depersonalisation?

A

TA peculiar change in the awareness of self, in which the individual feels as if they are not real and detached

They may feel that they have changed and that the world around them is vague, dreamlike or lacking in significance

The subject retains a measure of understanding and knows that the condition is abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is pressure of speech?

A

The subject talks too much and fast with a sense of urgency

Speech is often difficult to interrupt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is derealisation?

A

An alteration in the perception or experience of the external world so that it seems unreal

The subject may experience anything as colourless and artificial

Eg an office / bus / street seems like a stage with actors rather that real people going about their business

The subject retains a measure of understanding and knows that the condition is abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is thought echo?

A

The subject experiences his own thoughts as if they were being spoken out loud

The repetition may not be a simple echo but subtly or grossly changed in quality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are grandiose delusions?

A

Delusions of being of special status or significance, or having special powers or attributes, or a special mission or purpose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are negative symptoms?

A

A cluster of symptoms that often occur together in chronic schizophrenia

1) Poverty of speech
2) Flat affect
3) Poor motivation
4) Poor attention

Can result in low activity levels and poor self care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is dysthymia?

A

A chronic state of low mood, usually with an insidious onset and lasting at least 2yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is flight of ideas?

A

Rapid flow of thought, manifested by accelerated speech with abrupt changes from topic to tpoic although there is often some form of link between topics

There is a loss of the normal structure of thought, appearing illogical or muddled

Often seen in mania

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is aphasia?

A

Np speech, inability to produce words orally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is perseveration?

A

The repetition of a particular response (eg phrase, word, utterance or gesture) despite the absence or cessation of the stimulus

Often seen in organic brain disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are 2nd person auditory hallucinations?

A

The subject hears voices which appear to talk to them directly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is thought insertion?

A

The subject experiences thoughts which are not their own intruding into their mind

Eg alien thoughts are said to have been inserted into the mind from outside, by means of radar telepathy etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is alexithymia?

A

An inability to verbally express one’s emotions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is mood?

A

A word used to describe a sustained and pervasive emotion

Mood = Climate
Affect = Weather
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the most common psychotic disorder?

A

Schizophrenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How common is schizophrenia?

A

Approx 1% of population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the typical age of onset of schizophrenia?

A

20-28yrs males

26-32yrs female

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

In which populations is schizophrenia more common?

A

M>F (only slightly)
Lower SES
Urban areas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are some risk factors for schizophrenia? (5)

A 
FH +++++
Long term cannabis use
Living in urban environment
Black or Caribbean ethnicity
Being a migrant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are some causes of schizophrenia?

A

No specific causation but list of associations and risk factors

Genetic associations:

  • Higher concordance in Mz twins vs Dz twins
  • Babies adopted away from their schizophrenic parents still retain their risk

Winter babies at higher risk:
- ?second trimester influenza infection

Brain abnormalities

Neurotransmitter abnormalities

Life events (stress)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What neurotransmitter abnormalities are noted in schizophrenia?

A

SPECT scans show greater occupancy of DA receptors:

Overactivity of dopamine
- Particularly in the mesolimbic pathway

This is the focus of pharmacological treatments that try and block D2 receptors (5 types but mainly D2)
- Side effects are due to non-specificity of blockade

Serotonin might also be implicated because drugs blocking 5-HT pathway also seem to be effective treatments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What brain abnormalities are noted on CT scans in those with schizophrenia? What is the problem with this?

A
  • Ventricular enlargement = associated with negative symptoms
  • Reduced brain size = frontal and temporal lobes, hippocampus, amygdala, para-hippocampal gyrus

Unknown if this is due to disorder or treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are the four dopamine pathways in the brain?

A

1) Mesolimbic
2) Mesocortical
3) Tuberoinfundibular
4) Nigrostriatal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the mesolimbic pathway involved in?

A

Arousal
Memory
Behaviour

INcreased activity = positive symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is the mesocortical pathway involved in?

A

Cognition
Socialisation

DECreased activity = negative symptoms

53
Q

What is the tuberoinfundibular pathway involved in?

A

Regulation of prolactin

Increased activity = elevated prolactin levels

54
Q

What is the nigrostriatal pathway involved in?

A

Modulation of extrapyramidal symptoms

Increased activity = EPSE’s

55
Q

How may schizophrenia present?

A

Positive symtoms

Negative symptoms

Schneider’s first rank symptoms

56
Q

What are positive symptoms? Do these carry a good or bad prognosis in schizophrenia?

A

Hallucinations (mostly auditory)
Delusions
Thought disorder

Rare, good prognosis
Tends to present earlier

57
Q

What are negative symptoms? Do these carry a good or bad prognosis in schizophrenia?

A 
Lack of motivation
Poverty of speech
Blunt affect
Anhedonia
No relationship desires

Variants of normal traits, less treatment response
Worse prognosis

58
Q

What are Schneider’s first rank symptoms?

A

1) Auditory hallucinations
- 3rd person
- Discussing / commentating

2) Delusions of control
- Thought insertion
- Withdrawal
- Broadcast
- Echo = auditory hallucination

3) Delusions of passivity
- Affect, sensations and impulses are under external agent’s control

FRS help to distinguish schizophrenia from other psychotic disorders
- Absent in 20% of those with schizophrenia but do not occur in other mental illness

59
Q

What are the four types of schizophrenia?

A

1) Paranoid
2) Hebephrenic
3) Catatonic
4) Undifferentiated

60
Q

Briefly describe paranoid schizophrenia

A

Stable, paranoid delusions and hallucinations

61
Q

Briefly describe hebephrenic schizophrenia

A

Prominent affective changes:

  • Blunted and inappropriate
  • Incoherent speech
  • Disorganised thoughts
  • Irresponsible and unpredictable behaviour
62
Q

Briefly describe catatonic schizophrenia

A 
Psychomotor disturbance
Posturing
Mutism
Staring
Rigidity

10-15%

63
Q

Briefly describe undifferentiated schizophrenia

A

Meets the general criteria but no symptom subtype predominates

64
Q

What may be found upon MSE of a pt with schizophrenia?

A

A&B - may be normal, social awkwardness, inappropriate smiling, withdrawal
- Arousal eg aggression less common

Speech - may be difficult to follow is acutely ill, poverty of speech, neologism

Mood - changes are uncommon, blunting / indifference, depression and euphoria, incongruous (not in keeping with trigger)

Thought form - difficult to follow, concrete ideas, loosening of associations, thought block (stop mid sentence)

Thought content - delusions common, often persecutory and sometimes grandiose, delusions of reference, control, passivity

Perception - mostly auditory hallucinations

Cognition - reduced, may not be orientated

Insight - variable

65
Q

How is schizophrenia diagnosed?

A

> 1 month of symptoms:

“Fundamental and characteristic distortions of thinking and perception with inappropriate or blunted affect”

Diagnosis should not be made in the presence of extensive depressive or manic symptoms unless schizophrenic symptoms clearly predate the affective disturbance

NOT in the presence of overt brain injury (including epilepsy), during state of drug intoxication, use of psychoactive substances or withdrawal

66
Q

What investigations should be done for schizophrenia?

A 
FBC
ESR
U&Es
TFTs
LFTs
Glucose
Calcium
Syphilis
HIV
Urine drug screen
ECG (anti-psychotics prolong QT)
67
Q

List some organic ddx for schizophrenia (8)

A

1) Delirium
2) Dementia
3) Stroke
4) CNS infection
5) Brain tumour
6) Huntington’s
7) Wilson’s
8) Brain lesion - temporal lobe, limbic system, basal ganglia

68
Q

List some psychological ddx for schizophrenia (10)

A

1) Drug induced psychosis
2) Schizoaffective disorder
3) Psychotic depression
4) Manic psychosis
5) Puerperal psychosis
6) Personality disorder
7) Schizotypal disorder
8) OCD
9) Body dysmorphia
10) Hyperchondriasis

69
Q

Who is involved in care in a first episode of psychosis?

A

First episode of psychosis often requires urgent hospital admission

Early assessment:

  • Early intervention team
  • Crisis team
  • Inpatient care

MDT - psychiatric, medical wellbeing, psychological, occupational, social

Risk assessment

70
Q

What is the short term management of schizophrenia?

A

Medication
- Antipsychotics

Psycho-social

  • Psycho education
  • CBT / family interventions
71
Q

What is the long term management of schizophrenia?

A

Medication

  • Antipsychotics (oral / depot)
  • Antidepressants
  • Lithium

Psycho-social

  • CBT
  • Supported employment
  • Family interventions
  • Reduced expressed emotion
  • Relapse signature
  • Art therapy
72
Q

What antipsychotics are used in the management of schizophrenia?

A

Depends on age, co-morbidities, previously tried and tolerated, SE impact

First generation (typical)

  • Chlorpromazine
  • Flupenhazine
  • Flupenthizol
  • Zuclopenthixol
  • Haloperidol
Second generation (atypical)
- Olanzapine
- Risperidone
- Amisulpride
- Quetapine
(Any 2nd gen that is not clozapine)

3rd generation = Aripiprazole
- Dopamine Serotonin system stabiliser

73
Q

What is the goal of antipsychotics?

A

Stabilise high levels of dopamine that are seen in the brain in psychosis

Antagonise hyperactivity of dopamine in the mesolimbic pathway

Done by antagonising D2 receptors

However, SE occur as antipsychotics do not just block receptors in mesolimbic pathway

74
Q

What is the side effect profile of first generation (typical) antipsychotics?

A

Movement disorders due to extrapyramidal side effects (D2 antagonists)

1) Acute dystonia = painful spastic contractions to maximal limit of certain muscle groups, usually neck, eyes, trunk
- Eg torticollis - abnormal position of neck or an oculogyric crisis
- Treat with anticholinergics (procyclidine 5-10mg PO/IM/IV)

2) Parkinsonism = triad of tremor, rigidity and bradykinesia
- Occurs >1wk after administration
- More common in F and those with pre-existing neurological damage
- Treat with anticholinergics

3) Akathisia = restlessness, usually in lower limbs and drive to move
- Occurs >1month after initiation
- Difficult to treat, use BDZs and propranolol

4) Tardive dyskinesia = continuous slow writhing movements and sudden involuntary, repetitive movements usually in oral-lingual area
- Eg grimacing or smacking of the lips
- Presents late after treatment

5) Neuroleptic malignant syndrome
6) Hyperprolactinaemia

75
Q

What medication can be given to treat tardive dyskinesia resulting from first generation antipsychotics?

A

Tetrabenazine or procyclidine

76
Q

What is the side effect profile of second generation antipsychotics?

A

Side effects due to the tubero-fundibular action = effects on metabolism (D2 / 5HT2A antagnoists)

1) Hyperlipidaemia

2) Sexual dysfunction
- Decreased libido
- Erectile / ejaculatory dysfunction

3) Weight gain

(Hyperprolactinaemia = tends to only occur at higher doses, more a problem in typical)

  • Galactorrhoea
  • Gynaecomastia
77
Q

What is clozapine? When is it used? What are the SE?

A

Clozapine = 2nd gen (atypical) antipsychotic

Used for Treatment Resistant Schizophrenia (TRS)

  • If pt fails to respond to 2 other 2nd generation antipsychotics that have been trailed at adequate an dose and for an adequate time
  • Not advised if immunosuppressed eg HIV / chemo

Risk of AGRANULOCYTOSIS

  • Regular FBC to check WCC
  • Titrate dose up slowly, if dose missed have to restart slow titre
  • If neutropenia spotted at any time then immediately stopped

Can also lower seizure threshold

NB smoking cessation can cause a rise in clozapine

78
Q

Other than dopamine related SE, what are some SE of antipsychotics?

A

Anti-cholinergic:
- Dry mouth, blurred vision, constipation, urinary retention

Anti-adrenergic (alpha 1)
- Postural HTN, sexual dysfunction

Anti-histamine (H1)
- Sedation, anti-emetic

Hepatotoxicity
- Chlorprimazine

Diabetes / dyslipidaemia
- Olanzapine, clozapine

Blood dyscrasias
- ALL esp clozapine

79
Q

Which generation of antipsychotics can lead to weight gain?

A

2nd generation

80
Q

Which generation of antipsychotics can lead to dyslipidaemia?

A

2nd gen

81
Q

Which generation of antipsychotics can lead to tardive dyskinesia?

A

1st gen

82
Q

Which generation of antipsychotics can lead to QTc prolongation?

A

Both

83
Q

Which generation of antipsychotics can lead to changes to plasma glucose and DM?

A

2nd gen

84
Q

Which generation of antipsychotics can lead to changes to seizure threshold?

A

Both

85
Q

When should aripiprazole used?

A

Has a very minimal side effect

2nd gen, use if prolactin SE troubling

86
Q

What antipsychotics are most commonly used in pregnancy?

A

Haloperiodol

Olanzapine

87
Q

What may clozapine interact with?

A

Both clozapine and carbamazepine can cause agranularcytosis

Should never be used together

88
Q

What may quetiapine interact with?

A

Erythromycin

Both prolong QT interval

89
Q

Why may antipsychotics interact with metaclopraminde?

A

Both have anti-cholinergic effects

90
Q

What investigations should be done before starting antipsychotics?

A 
FBS, U&Es, LFTs
Lipids and weight
Fasting blood glucose
Prolactin
BP
ECG
91
Q

What investigations should be done during treatment with antipsychotics?

A

FBC, U&Es, LFTs

  • At least annually
  • For clozapine = weekly FBC for first 18 weeks, then fortnightly, then after 1 year done monthly

Lipids and weight
- After 3 months of treatment and then annually

Fasting blood glucose ad prolactin
- After 6 months of therapy and then yearly

BP

92
Q

What is the course of anti-psychotic medication?

A

Select appropriate medication and begin, assess over 2/3 weeks:

  • Some effect = continue for 4 weeks then reassess
  • No effect = increase dose and if still no effect consider change

If two unsuccessful consider clozapine

Continue for 1-2yrs

Discontinuation should be gradual
- High risk of relapse of psychotic symptoms when antipsychotics are discontinued suddenly

93
Q

What are the timeframes of the following effects of antipsychotics:

1) Tranquillising
2) Side effects
3) Antipsychotic effects

A

1) Tranquillising - hrs
2) Side effects - hrs to days
3) Antipsychotic effects - days to weeks

94
Q

What is a depot?

A

IM slow release antipsychotic preparation

95
Q

When are depots used?

A

Good if chaotic and poor compliance

Various FGA available - Risperidone, paliperidone, olanzapine

Give initial test dose then use 2-4 weekly dose

Usually PO required until steady state reached

Long half life - wait weeks/months to see effects

96
Q

Other than antipsychotics, what medications can be given in schizophrenia?

A

Augmentation with lithium if unresponsive to clozapine

BDZs to treat anxiety and agitation
- Rapid transuilisation = lorzepam 1mg PRN up to 4mg per 24hrs

Antidepressants and ECT to treat negative symptoms

97
Q

What factors suggest a poor prognosis in schizophrenia?

A 
Gradual onset
Positive FH
Low educational attainment
Pre-morbid evidence of social isolation
Male
Single
Insidious onset
Substance abuse
Negative symptoms
Early onset
Delayed response to treatment
98
Q

What factors suggest a good prognosis in schizophrenia?

A 
Good educational attainment
Sudden onset
Recognisable precipitating event
Female
Married
Acute onset
Affective symptoms
Older onset
Rapid response to treatment
99
Q

What is the prognosis of schizoprenida

A

1/3rd live independently (more than a third)

1/3rd live independently with treatment and various levels of support

1/3rd need long term dependence care

5% suicide rate

100
Q

What is schizoaffective disorder?

A

Disorder combining features of both schizophrenia and bipolar affective disorder

Where classification into either of the categories would not correctly classify the disease

101
Q

How may schizoaffective disorder present?

A

Schizophrenia and mood order in the same episode

At least one (preferably 2) of Schneider’s first rank symptoms several

Plus affective symptoms - depression, anxiety and mania

Symptoms occurring simultaneously or within a few days of each other

102
Q

What are the two types of schizoaffective disorder?

A

Schizomanic = manic symptoms

Schizodepressive = depressed symptoms

103
Q

Which type of schizoaffective disorder carries a better prognosis?

A

Schizomanic

104
Q

How are delusional disorders distinct from schizophrenia?

A

Development of a single set of delusions for the period of >3 months is the prominent or only feature

105
Q

List some types of delusion (8)

A

1) Grandiose
2) Persecutory
3) Bizarre
4) Jealousy
5) Nihilistic
6) Guilt
7) Hypochondrial
8) Delusions of control / passivity - don’t have control of your actions or thoughts

  • Somatic passivity = something else controlling symptoms or physical sensations such as sexual feelings
106
Q

What features are incompatible with a diagnosis of delusional disorder?

A

Clear and persistent auditory hallucinations

Delusions of control

Marked blunting of affect

Definite evidence of brain disease

NB presence of occasional auditory hallucinations esp in elderly does not exclude the diagnosis provided they are not typically schizophrenic and form only a small part of the overall picture

107
Q

What is the delusional belief that a partner is having an affair? What is it associated with / what are the risks?

A

Othello syndrome

No evidence / misinterprets minor evidence

Associated with alcohol dependence and sexual dysfunction

Risk of stalking and / or violence to partner

108
Q

What is De Clerambault’s syndrome?

A

Erotomania

Delusional belief that another (often famous) person is in love with them

Can’t declare love so via secret signs / communication

109
Q

What is delusional misidentification?

A

Capgras syndrome

Relative / spouse / close friend replaced by identical looking double or impost

110
Q

Is Capgras syndrome more common in M or F?

A

M:F 2:3

111
Q

In what syndrome is there the belief that different people are a single person who changes appearance or is in disguise?

A

Fregoli’s syndrome

Often believe they are being persecuted by that person

112
Q

What is Cotards syndrome? What does it often coexist with?

A

Delusion of being dead, dying, non-existent, ortting, lost part s of body / organs

Often co-exists with depression

113
Q

What is delisional parasitosis?

A

Ekboms syndrome

Delusion of being infested with parasites

No evidence - only little marks / freckles / spots

Associated with formincation

Risk of self harm to get rid of parasties

114
Q

Where does Ekboms syndrome often present?

A

Deramtologists

115
Q

What is delusional cleptoparasitosis?

A

Delusion that house / home infested

116
Q

What is folie à deux?

A

Induced delusional disorder

Psychosis shared by two people - often one primary person with a delusional disorder who will induce delusions in the other

When separated, non-psychotic pt tends to recover

117
Q

What other features may be present in delusional disorders?

A

Hallucinations - can be a feature but are usually fleeting and not schizophrenic in nature

Depressive episodes can occur but they are often brief

Affect, speech and behaviour are often all normal and pt have good social skills / appear wel

118
Q

What is the management of delusional disorders?

A

Antipsychotics

Antidepressats if indicated

Psychotherapy

Supportive therapy

119
Q

Are delusional disorders more common in F or M?

A

F

120
Q

What is Charles-Bonnet syndrome

A

Visual hallucination

Associated with eye disease, particularly peripheral field visual loss

Common things to hallucinate include faces, animals and children

Occurs in clear consciousness

Other risk factors include social isolation and increased age

121
Q

What % of pt do not respond to D2 antagonists?

A

20-50%

122
Q

List some indications for antipsychotics

A

1) Psychosis
2) Bipolar disorder
3) Sedation
4) Severe anxiety
5) Agitation
6) Behavioural symptoms in dementia
7) Depression
8) Nausea
9) Anaesthetsia premedication
10) Intractable hiccups
11) Terminal illness

123
Q

What is neuroleptic malignant syndrome (NMS)?

A

Sympathetic hyperactivity as a result of dopaminergic antagonism in the context of psychological stressors and genetic predisposition

Rare (0.5-1%)

124
Q

How does NMS present?

A 
Muscular rigidity
Decreased conscious level
Hyperthermia
Labile BP, tachycardia
Increased CK
Diaphoreses
Abnormal LFTs
125
Q

What are some risk factors for NMS?

A 
High potency typical antipsychotics
Rapid dose increases / reductions
Agitation
Dehydration
Alcoholism
Antipsychotic polypharmacy
126
Q

Over what time period does NMS take place?

A

Evolves rapidly over 24-72hrs

127
Q

What is the prognosis of NMS?

A

5-20% of pt on PO medication and 30% on depot will die if untreated

Usual cause of death is renal failure secondary to rhabdomyolysis

128
Q

Outline ATHLETICS for atypical antipsychotics

A

A - Schizoprenia is caused by an over-activity of chemicals in transmission of messages in the brain.
Olanzapine works by blocking the receptors in the brain that are involved in transmitting these messages between the nerve cells
T - tablet daily or depot injection every 2-4 weeks
H - tablet or depot. Start at a small dose and build up over 1 / 2 weeks. Dose adjusted depending on persons response
L - long term (keeps symptoms from returning). Tell doctor if wanting to get pregnant
E - several days / weeks
T - occasional LFTs (may impair liver function)
I - anti-dopaminergic (tardive dyskinesia, tremor, movement disorders), anti-cholinergic (constipation, dry mouth), anti-histaminergic (weight-gain, dizziness, drowsiness), anti-adrenergic (hypotension)
C - complications: NSM (high fever and muscle rigidity), agranulocytosis (swelling of mouth or throat or rash), withrawal
CI: liver failure, phaeochromocytoma
Caution: epilepsy, DM, glaucoma, Parkinsons, heart, prostate or kidney problems, pregnancy
S - rethink.org

Year 4 Psych (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions