Psychotic disorders Flashcards
How does psychosis typically present?
Delusions - fixed, false belief, firmly held despite evidence on the contrary going against normal social and cultural belief system
Hallucinations - perception in the absence of an external stimulus
Thought disorder
Name some non-organic causes of psychosis?
Schizophrenia
Schizotypal disorder
Schizoaffective disorder
Acute psychotic episode
Mood disorder with psychosis
Drug-induced psychosis
Delusional disorder
Puerperal psychosis
What are some organic cause of psychosis?
Drug induced psychosis
Iatrogenic (medication)
Epilepsy
Delerium
Dementia
SLE
Endocrine disturbances e.g. Cushing’s syndrome
Vit B12 deficiency
What is schizotypal disorder?
Aka latent schizophrenia characterised by eccentric behaviour, suspiciousness, unusual speech, deviations of thinking but there are no hallucinations or delusions
What is an acute and transient psychotic disorder?
Psychotic episode appearing as schizophrenia but lasting < 1 month so not meeting the criteria
What is schizoaffective disorder?
Both symptoms of schizophrenia and mood disorder (depression or mania) in the same episode
What is delusional disorder?
Single or set of delusions of at least 3 months, content of the delusion is often persecutory, grandiose or hypochondrial in nature
What is induced delusional disorder (folie a deux)?
‘Shared paranoid delusion’ = similar delusion in 2 or more individuals
What is schizophrenia?
Psychotic condition characterized by hallucinations, delusions and thought disorderswhich lead tofunctional impairment
What are some risk factors for schizophrenia?
- Positive family history
- Obstetric complications, fetal injury and low birth weight
- Adverse life events and psychological stress
- 15-35 years old
- Extremes of parental age
- Childhood abuse
- Substance misuse
- Low socio-economic status
What is the strongest risk factor for psychotic disorder?
Family history
What is the dopamine hypothesis of schizophrenia?
Schizophrenia is secondary to over-activity of mesolimbic dopamine pathways in the brain (supported by the fact that conventional antipsychotics work by blocking dopamine receptors )
What are the positive symptoms of schizophrenia?
- Delusions (usually persecutory, grandiose, nihilistic or religious)
- Hallucinations
- Formal thought disorder (thoughts are linked in abnormal ways)
- Thought interference (insertion, withdrawal, broadcast)
- Passivity phenomenon (actions, feelings or emotions are being controlled by an external force)
What are Schneider’s first rank symptoms?
Symptoms, which, if one or more are present, are strongly suggestive of schizophrenia (alternative tool to ICD-10 in diagnosing schizophrenia)
What are Schneider’s first-rank symptoms?
- Delusional perception (delusion which forms in response to a real perception e.g. traffic light turned red so I am the chosen one)
- Third person auditory hallucinations
- Thought interference (withdrawal, insertion and broadcast)
- Passivity phenomenon (bodily sensations being controlled by external force)
What are the negative symptoms of schizophrenia?
Avolition (reduced motivation)
Asocial behavious
Anhedonia
Alogia (poverty of speech)
Affect blunted
Attention deficits
What do the following forms of thought disorder mean:
Circumstantiality
Tangentiality
Neoligism
Clang association
Word salad
Knight’s move thinking
Flight of ideas
Perseveration
Circumstantiality = inability to answer a question without giving excessive, unnecessary details
Tangentiality = wandering from a topic without returning
Neoligism = new word formulation
Clang association = ideas are related to each other only by the fact they sound similar
Word salad = real words together in nonsense sentence
Knight’s move thinking = loosening of associations, unexpected, illogical leaps in schizophrenia
Flight of ideas = leaps from one topic to another with links
Perseveration = repetition of ideas or words despite an attempt to change topic
Echolalia = repetition of someone else’s speech
What is paranoid schiophrenia?
Most common - dominated by positive symptoms (hallucinations and delusions)
What is hebephrenic schizophrenia?
Thought disorganization predominated (onset of illness is usually earlier) with poorer prognosis
What is simple schizophrenia?
Rare form where negative symptoms develop without psychotic symptoms
What is undifferentiated schizophrenia?
Meets diagnostic criteria for schizophrenia but doesn’t conform to any of the subtypes
What are the investigations for patients presenting with symptoms of schizophrenia?
Bloods: FBC (anaemia), TFTs (psychosis), glucose (atypical antipsychotics = metabolic syndrome), serum calcium, U&Es and LFTs (before antipsychotics), cholesterol (metabolic syndrome), vit B12 and folate (deficiencies can cause psychosis)
Urine drug test: illicit drugs can cause and exacerbate psychosis
ECG (antipsychotics and prolonged QTc)
CT scan
EEG (temporal lobe epilepsy)
Why is a CT performed in elderly patients with first episode of psychosis?
Rule out brain tumour, stroke or CNS infection
What are the management steps for schizophrenia? (Biopsychosocial)
- Risk assessment / MHA
- For first presentation then early intervention in psychosis team should be involved (to reduce the duration of untreated psychosis)
Biological = Antipsychotics (atypical e.g. risperidone / olanzapine), depot formulation considered, clozapine for treatment resistant schizophrenia, benzos for short term relief, antidepressants / lithium can also be use, ECT for catatonic schizophrenia
Psychological = CBT (reduces residual symptoms), family intervention (helps reduce high levels of expressed emotion), art therapy (alleviation of negative symptoms), social skills training
Social = support groups, peer support worker delivered by someone who has recovered
