Psychotic Disorders Flashcards
1
Q
Definition of psychosis
A
- It is a disodred of higher brain functions, of conscious appraisal of sensory experiences
- An ability to differentiate between sensory experiences of internal and external origin
- Disruptuion to normal patterns of thought, speech, behaviour and personality
2
Q
Physical illnesses that can present with psychosis
A
- Main causes of psychsis include:
- Schizophrenia
- BPAD
- Delusional disorder
- Acute and transient psychotic disorders
- Schizoaffective disorder
- Organig - drugs, medical illnesses
- Other illnesses that present with psychosis
- Temporal lobe epilepsy
- Hyper or hypothyroidism
- Paraneoplastic syndromes
- Sensory impairment, musical hallucinations, Charles Bonnet syndrome
- Brain tumours, AV malformations
- Delirium
- Drug induced or drug withdrawal
NB - Very high incidence of schizophrenia in monozygotic twins.
3
Q
Features of psychosis
A
- Acute
- Lack of insight
- Auditory hallucinations
- Ideas of reference
- Suspiciousness
- Thought disorder
- Flat affect
- Voices speaking to the patient
- Delusional mood
- Delusions of persecution
- Thought alienation
- Thoughts spoken aloud
- Chronic
- Social withdrawal
- Under activity
- Lack of conversation
- Few leisure interests
- Slowness
- Over activity
- Odd idea
- Depression
- Odd behaviour
- Neglect of appearance
- Off postures and movements
- Threats of violence
4
Q
Biological, psychological and social factors
A
- Genetic
- Single or complex nucleotide polymorphisms
- Environmental
- Obstetric, birth season and complications, urban birth, substance misuse
- Social
- Occupational/social class, place of residence, migration, ethnic minority, social isolation, life events, culture
- Structural
- Decreased brain volume, enlarged lateral ventricles, smaller medial temporal lobes, decreased cortical grey matter, decreased weight, absence of gliosis
- Neurochemical
- Dopamine, glutamate, GABA, serotonin
- Inflammatoruy
- Psychological
- Psychodynamic, family factors, psychic splitting
5
Q
Areas of the brain involved with schizophrenia
A
- Cerebros pinal fluid may contain different relative ammounts of chemicals - associated with transmitting nerve impulses
- May be changes in frntal lobes - area concerned with emotional and higher cortical functions
- Hippocampus and adjacent regions may show some reduction in size - can affect sensory flittering that takes place in this region
- Ventricles may be larger than normal and put presure on surrounding brain tissue
- Excessive release of DA in striatum and inadequate DA in frontal cortex - not thought to be a primary abnormality, secondary to more proximal abnormality like glutamate or GABA - linked to positive symptoms and cognitive/negative symptoms respectively
6
Q
ICD-10 diagnosis of psychosis
A
- Symptoms lasting >1 month and at least one clear or two if less clear of:
- Thought echo, insertion, broadcasting
- Hallucinatory voices
- Persistent delusions
- Delusions of control of passivity
- Or two of:
- Persistent hallucinations/any modality
- Bizzare thoughts, speech
- Catatonic behaviour
- Negative symptoms
- Significant changes in behaviour
7
Q
DSM V diagnosis of psychosis
A
- At least 2 of:
- Delusions
- Hallucinations
- Disorganised speech
- Grossly disorganised or catatonic behaviour
- Negative symptoms
- Social/occupational dysfunction
- Duration
- Schizoaffective and mood disorder exclusion
- Substance/general medical condition exclusion
- Relationship to a pervasive development disorder
8
Q
Diagnosis of schizophrenia
A
- Symptoms must be present long term (6 months for DSM V, 1 month for ICD 10)
- Paranoid schizophrenia (delusions and hallucinations dominate)
- Hebephrenic schizophrenia (thought disorder and affective disturbance dominate)
- Catatonic schizophrenia (catatonia dominates)
- Undifferentiated (no specific subtype)
- Residual schizophrenia (negative symptoms dominate)
NB - FHx increases risk (1% general population, 10% affected sibling or DZ twin, 50% if MZ twin or both parents, later onset in women.
9
Q
Clinical features of schizophrenia
A
- Auditory hallucinations
- 3rd person or running commentary
- 2 or more voices discussing or arguing about oneself
- Hearing thoughts aloud (thought echo)
- Thought insertion, thought withdrawal, and thought broadcasting
- Made feelings, actions or somatic passivity (delusions of external control)
- Delusional perception
10
Q
Management of schizophrenia
A
- Assessment of 1st onset cases
- Risk asessment
- Physical health check
- Drug treatment
- Antipsychotics
- NICE recommends atypicals as well as typicals
- Continuous treatment more effective than intermittent
- Extrapyramidal side effects common (dystonia, akathisia, parkinsonism, tardive dyskinesia)
- Antipsychotics
- Family therapy
- CBT
- Social skills training
- ECT
11
Q
Factors predicting outcome
A
- Good
- Sudden onset
- Short episode
- No previous psych history
- Prominent affective
- Paranoid
- Old age onset
- Married
- Good social relationships
- Compliance
- Bad
- Insidious onset
- Long episode
- Previous psych history
- Negative symptoms
- Enlarged lateral ventricles
- Male
- Young at onset
- Single, seperated, widowed, divorced
- Social isolation
- Poor compliance
12
Q
Definition of illusion vs delusion
A
- Illusion - misinterpretation of external stimuli. No diagnostic significance.
- Delusion- a belief that is firmly held on inadequate and irrational grounds. It is not a conventuional belief to that person given their education. They significantly affect the way a person behaves and how they feel. Several types of delusions including persecutory, grandiose, guilt, bizarre or reference.
13
Q
First Rank Symptoms
A
- Hallucinations
- 3rd person auditory hallucinations
- Running commentary
- Thoughts spoken aloud
- Thought disturbance
- Thought insertion
- Thought withdrawal
- Thought broadcast
- Affective changes
- Made violation
- Made mood
- Made affect
