Psychotic disorders Flashcards
what is Psychosis? symptoms?
is defined as a mental Psychotic state in which reality is greatly distorted.
(term used to describe a person experiencing things differently from those around them.)
It typically presents with:
- Delusions
- Hallucinations
- Thought disdorders
Types of Delusions
Fixed false beliefs, which are firmly held despite evidence to the contrary and go against the individual’s normal social and cultural belief system.
GREG is HOPIN
- Grandiose
- Reference
- Erotomania
- Guilt
- Hypochondriacal
- Othello
- Persecutary
- Infestation
- Nihlistic
Causes of Psychosis?
divided into organic and non-organic causes
Organic: (Purple MADSSS)
- Mood disorders
- Acute psychotic episode
- Delusional disorder
- Puerperal psychosis
- Schizophrenia
- Schizotypal disorder
- Schizoaffective disorder
Non-Organic
- Illicet drugs
- Iatrogenic medications
- SLE
- Delerium or Dementia
- endocrine shit–>cushings
- Metabolic shit–>Vb12 deficeincy
- Huntington’s disease
which Medications causes Psychosis? (4)
levodopa, methyldopa, steroids, antimalarials.
Pathophysiology/Aetiology/epidemiology Schizophrenia
over-activity of mesolimbic dopamine pathways–> + symp
dysfunction of mesocorticol pathways–> - and cog symp
epidem: peak age of onset is 15–35 years.
Schneider’s first rank symptoms
SAD Passive Thoughts
Somatic hallucinations (not really in Schneider’s)
Auditory Hallucinations-->3rd person/running comentry
Delusions–> fixed false belief
Passive thoughts: Actions, feelings or emotions being controlled by an external force.
Thought (insertion, broadcast, withdrawl)
ICD-10 Criteria for schizophrenia
- at least ONE from group A or
- 2 or MORE from group B
- FOR AT LEAST ONE MONTH!!!!
Group A (Bizarre thoughts running out of control)
- Thought echo/insertion/withdrawal/ broadcast.
- Delusions of control, influence or passivity phenomenon.
- Running commentary auditory hallucinations.
- Bizarre persistent delusions.
Group B (hallucinating negative cats with disorganized thoughts )
- Hallucinations in other modalities that are persistent.
- Thought disorganization (loosening of associations, neologisms, incoherence).
- Catatonic symptoms.
- Negative symptoms.
Schizophrenia Types
PUSH the Red CAT
- Paranoid Schizophrenia– > Delu + hallu
- Undifferentiated Schizophrenia
- Simple Schizophrenia –>No delu or Hallu, just Neg symp
- Hebephrenic Schizophrenia–> Thought disorganization predominates.
- Residual Schizophrenia–> 1 year of chronic negative sympx preceded by a psychotic episode.
- Catatonic
cataonic schizophrenia symptoms
- Stupor / mutism
- excitement
- Posturing
- Negativisim (resist what u get them to do)
- Rigidity
- WAXY flexibility
- command automatism
(tell them to do somthing & tell them to do it over and over again)
schizophrenia positive and Neg symptoms?
Negative–>decreased functionality (povery of speech) Chronic symptoms
- Alogia
- Attention reduced
- Asocial behaviour
- Avolition (lack of motivation)
- Anhedonia
- Affect blunted
Positive: acute symptoms ( hallucinations and delusions ) SAD Passive Thoughts
- Somatic hallucinations
- Auditry hallucinations
- Delusions
- Passive thoughts (Actions, feelings or emotions being controlled by an external force. )
- Thought disorder (insertion, w/drawl, broadcast)
schizophrenia Ix
Ix are used to rule out the other causes of confusion/psychotic symptoms
Blood tests:
- FBC (anaemia, infection)
- TFTs (thyroid dysfunction can present with psychosis), glucose or HbA1c (atypical antipsychotics can cause metabolic syndrome)
- Serum calcium (hypercalcaemia can present with psychosis)
- U&Es & LFTs (assess function b4 giving antipsychotics)
- cholesterol (as atypical antipsychotics cause metabolic syndrome)
- vitamin B12 & folate (deficiencies can cause psychosis).
Urine drug test: drug intoxication
ECG: Antipsychotics cause prolonged QT interval.
CT scan: To rule out organic causes such as space-occupying lesions.
EEG: To rule out temporal lobe epilepsy as possible cause of psychosis
who is involved int he treatment of schizophrenia? (3)
what is Care programme approach?
- Early intervention team (initial referral after the first psychotic episode)
- Community mental health team (provide day-to-day support and treatment)
- Crisis resolution team (for patients experience an acute psychotic episode)
There are 4 stages to a CPA:
- Assessing health and social needs
- Creating a care plan
- Appointing a key worker to be the first point of contact
- Reviewing treatment
Schizophrenia Treatment?
- how would u treat DRUG-RESISTANT Schizophrenia?*
- what if they are non-complient to their medications?*
Bio-Pscho-Social
BIO: 1st LINE–> Atypcial antipsychotic–> OLANZIPINE or RISPERIDONE
- Drug-resis–>Clozapaine(regular bloods to check neutrophil levels bc can cx agranulocytosisssss)
- Adjuvant: Benzo’s–>Behaviour symp, antidepress and lithium
- ECT
If non complient!–>consider once monthly IM antipsychotic depot injections.
Psycho:
- Psycho education
- CBT–>YASSSS
- Art therapy
- Social skills
Social:
- support groups–> REthink and SANE
- peer groups–>done by a peer support woker who recovered from Psychosis or Schizo
- Supported employment programmes
Poor prognostic factors in Schizophrenia (5)
- Gradual onset
- LOW IQ
- Strong FHx
- Premorbid history of social withdrawal.
- lack of obvious precipitant
Side effects of Atypical Antipsychotics
Extrapyramidal side-effects : PAD-T
- Parkinsonism
- Dystonia-->Mx procyclidine and benztropine
- Akathisia (severe restlessness)–> Mx Propranolol
- Tardive dyskinesia–> LATE ONSET of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)–> Mx Tetrabenazine
other:
- Agranulocytosis–>cloz
- FATAL bowel obstruction
- hypersalivation–>cloz
- orthostatic hypotension–>risp
- hyperprolactinemia–>risp
- weight gain –>risp and cloz
- Hyperlipidemia–> risp and cloz
- diabetes>risp and cloz
- Long QT
- sedation
