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Psychiatry > Psychotic Disorders > Flashcards

Psychotic Disorders Flashcards

1
Q

What are the 4 pure types of psychosis?

A
  1. Brief reactive psychosis-occurs for <1 month
  2. . Schizophreniform disorder- between 1-6 months
  3. Schizophrenia >6 months
  4. Delusional disorder >6 months delusions that are not bizarre
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2
Q

What are the psychotic disorders that present in mood disorders as well?

A
  1. Major depressive disorder with psychosis
  2. Bipolar mood disorder with psychosis
  3. Schizoaffective disorder
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3
Q

What is the definition of Schizophrenia?

A

It is defined as a serious psychiatric illness that is characterised by heterogenous aetilogy, pathogenesis,clinical picture, course and prognosis

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4
Q

What is the percentage of people that can get Schizophrenia?

A

1%

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5
Q

When does schizophrenia usually present?

A

Late adolescence or early adulthood and follows a a chronic course

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6
Q

What percentage of people with schizophrenia have a high likelihood of suicide?

A

50% and 10% manage to commit suicide

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7
Q

What is the aetiology of Schizophrenia?

A
  1. Genetic factors
    -the risk with one parent with schizophrenia is 10% and increases to 40% with both parents and monozygotic twins being 50-70% and dizygotic twins being 17%
    -specific susceptibility genes may be th problem
  2. Biochemical factors
    This is based on the dopamine hypothesis which states that there is possible over activity in the neurotransmitter dopamine in the memo-limbic system.
    The D2 dopaminergic pathway is NB but there may be involvement of the seroternergic and glutamatergic systems
  3. Structural factors
    -this is based on CT scans and MRI which show ventriculomegaly in patients with Schizophrenia.
    SPECT and PET have also identified hypofrontality and indicates diminished bilateral lobe functioning
    -changes in the left medical lobe have also been reported
    -these structural changes seem to appear early, even before the onset of clinical symptoms
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8
Q

What is the hypothesis that is used in understanding Schizopohrenia?

A

The neuro developmental disorder hypothesis that states that defective formation of neuronal structures occurs in early developmental years especially in the lambic and frontal lobe structures

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9
Q

What is the DSM 5 criteria for diagnosing schizophrenia?

A
  1. At least 2 of the following:
    Hallucinations, delusions, disorganized speech, grossly disorganized behavior, or negative symptoms to be present for a significant period in one month
  2. AND symptoms of disturbance must be there for at least 6 months
  3. One of them must be either delusions, hallucinations or disorganized speech
  4. Deterioration in the level of functioning at work, social relationships or self care
    5.
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10
Q

What is the differential diagnosis for a patient with schizophrenia?

A
  1. Brief reactive psychosis(Brief psychotic disorder)
  2. Schizoaffective disorder- when we cannot differentiate between schizophrena and a mood disorder
  3. Major depressive disorder with psychosis
  4. Bipolar mood disorder with psychosis
  5. Delusional disorder
  6. Substance induced psychosis
  7. Psychosis caused by medical condition-space occupying lesions, epileptic psychosis, cerebral infection
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11
Q

What is the clinical picture of a patient with schizophrenia?

A
  1. Delusions-particularly mood incongruent and bizarre delusions(they can be persecutory, somatic, grandiose and religious)
  2. Hallucinations particularly auditory 3
  3. Disorganized speech-loose association of ideas, vague thoughts, neologisms and thought blocking
  4. Negative symptoms: they have difficulty with emotional contact
    Conation disorder(difficulty with drive) and making decisions
  5. Catatonic behavior
  6. Grossly disorganized behavior
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12
Q

What is the course and prognosis of schizophrenia?

A

It is usually heterogenous
The patients go in and out of remission and the possibility of lasting remission is greatest after 5 years
-it is better during the first two years

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13
Q

What causes a better prognosis in schizophrenia?

A
  1. Acute onset
  2. Later age of onset
  3. Precipitating factor
  4. Supportive family and friends
  5. Open and positive attitude to treatment
  6. Good premorbid personality and adjustment
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14
Q

What is the goal of schizophrenic treatment?

A

To be able to place the patient back into the community at the highest level of functioning and the patient has maintenance medication, occupational therapy and socio-therapeutic programmes
-a multidisciplinary team is needed with the community physician, family members and other community workers

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15
Q

What are the 4 important dopamine systems in the brain that get targeted by the antipsychotic medication?

A
  1. Meso-Limbic system- this will be where the antipsychotic effect will take place
  2. Meso cortical system- negative or cognitive symptoms
  3. Nigrostriatal system-extrapyramidal side effects
  4. Hypothalamic pituatary system-hyperprolactinaemia which causes galactorrhea
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16
Q

What are the first generation anti-psychotics?

A
  1. Chlorpromazine(sedative) 5-300mg/day
  2. Trifluoperazine (non-sedative) 2-8mg/day
  3. Haloperidol 2-8mg/day
17
Q

What are the side effects of using first generation antipsychotics?

A
  1. Extrapyramidal symptoms:

Parkisonism (tremor, rigidity, shuffling gait)
2. Dystonic reactions( acute sustained involuntary contraction of muscles that is uncomfortable)
3. Akathisia-acute agitated restlessness
4.tardive dyskinesia(long term complication
-involuntary movement of the jaw, mouth ,tongue
5. Neuroleptic malignant syndrome
-life-threatening condition that can occur at any time of treatment
They present with fever, muscle rigidity, change in level of consciousness

  1. Orthostatic hypotension
  2. Epileptogenic
  3. Skin reactions
18
Q

What do we need to o if a patient presents with neuroleptic malignant syndrome?

A
  1. Autonomic symptoms such as hyperssalivation, sweating, labile blood pressure , heart rate etc.
    We need blood tests like FBC(will have increased white cell count), creatinine kinase(elevated), liver enzymes will be elevated, and myoglobinuria
19
Q

How long does neuroleptic malignant syndrome last?

A

10-14 days

And has a mortality rate of 20-30% and occurs more in young men

20
Q

What are the second generation of drugs that are used as antipsychotics(atypical)

A
  1. Clozapine
  2. Risperidone-6mg/day blocks the 5HT2 and D2 receptors
  3. Olanzipine-10-20mg per day
  4. Quetiapine -500-800 mg per day
  5. Amisulpride-400-1000mg per day
  6. Aripiprazole-10-15mg per day
  7. Ziprasidone
21
Q

What is the major disadvantage of using clozapine?

A

It causes agranulocytosis in a small percentage of patients and requires regular weekly white cell count checks

22
Q

What are the advantages of clozaopine?

A

It does not have any extrapyramidal side effects
It can be used to treat resistant schizophrenia
Effective in treating depressive or negative symptoms in schizophrenia

23
Q

Which drug is similar to clozapine but does not cause agranulocytosis?

A

Olanzipine

24
Q

Which drug is a partial agonist at D2?

A

Aripiprazole

It is also a complete antagonist at 5HT2

25
Q

What are the disadvantages of using second generation antipsychotics?

A

The metabolic complications-weight gain especially with clozapine and olanzipine
Hyperprolactinaemia in risperidone and amisulpride

26
Q

What are the injectibleanti-psychotics?

A
  1. Fluphenazine decanoate(modecate) 12,5-25mg three to four weekly
  2. Flupenthixol decanoate (flu an old) 10-40mg 2-4 weekly
    Only one agent should be used at a time
27
Q

What is delusional disorder?

A

Persistent delusions of persecution or jealousy not due to another psychiatric disorder or medical condition. The delusions may be non-bizarre or bizarre

  • there is no deterioration of function
  • social isolation and eccentric lifestyle
  • common in people with paranoid or schizoid personality disorder and occur in middle age
28
Q

What are the different types of delusional disorders?

A
  1. Persecutory
  2. Jealous
  3. Grandiose
  4. Somatic erotomanic(delusion that an important person is in love with them
29
Q

What is schizophreniform disorder?

A

It is identical to schizophrenia but is present for only less than 6 months

30
Q

What is schizoaffective disorder?

A

It is a disoder that has characteristics of both mood and schizophrenia

31
Q

What is brief reactive psychosis?

A

It is psychosis that occurs immediately after a psychosocial stressor and resolves within one month

32
Q

What do we need to exclude before we think of psychosis?

A

Delirium and dementia

33
Q

How much lithium is toxic?

A

Anything above 1,2

Psychiatry (17 decks)

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