Psychotic disorders (F2)

Question 1

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Define Psychosis
Components of psychosis

Answer 1

Delusion
Hallucination
Disorganization
No insight

Question 2

Differentiate psychiatric vs medical cause of psychosis

Answer 2

Question 3

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Ddx psychotic disorders

Answer 3

Schizophrenia
Schizoaffective disorder
ATPD (<2w), Brief psychotic disorder (<1m), Schizophreniform disorder (1-6m)
Delusional disorder (>3m or 1m)

Question 4

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Ddx mood disorders with psychotic features

Answer 4

Question 5

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Secondary causes of psychosis

Answer 5

Medical: CNS, Endocrine, Metabolic

Delirium
Dementia/ LBD

Substance abuse

Question 6

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Schizophrenia

DSM-5 criteria

Answer 6

Question 7

Hallucinations

Questions for auditory hallucination

Answer 7

Question 8

Hallucinations

Questions for non-auditory hallucinations

Answer 8

Question 9

Delusuions

Questions for different types of delusions

Answer 9

Question 10

Thought disorganization

Questions for assessment

Answer 10

Question 11

Negative symptoms of psychosis

Questions for assessment

Answer 11

Question 12

Risk assessment of psychosis

Answer 12

Question 13

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Psychosis

Investigations

Answer 13

CBC
LRFT for metabolic encephalopathy
Other metabolic: TFT, B12
Urine toxicology
Infection: VDRL, HIV
Scans: ECG before TCA, EEC/ CT brain

Question 14

Schizophrenia

Demographics
Mortality rate

Answer 14

Question 15

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Schizophrenia

Symptom spectrum

Answer 15

Question 16

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Schizophrenia

First rank symptoms

Answer 16

SPECTRA

Question 17

Schizophrenia

Positive symptoms

Answer 17

Question 18

Schizophrenia

Negative symptoms

Answer 18

Question 19

Schizophrenia

Thought, affective symptoms

Answer 19

Question 20

Schizophrenia

Cognitive and motor symptoms

Answer 20

Motor – Catatonia
- Retarded, Excited, Malignant

Cognitive
- Sustained attention, executive function, memory, social cognition…etc

Question 21

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Subtypes of schizeophrenia
Clinical features

Answer 21

Paranoid - +ve symptoms, most common
Hebephrenic - -ve symptoms, thought disorder, poor prognosis
Catatonic – motor symptoms: wavy flexibility, automatism, rigidity, stupor, posturing…
(Simple)

Question 22

Schizophrenia

Clinical course

Answer 22

First episode psychosis = golden window for intervention

Question 23

Cycloid psychosis

Criteria

Answer 23

Question 24

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Schizoaffective disorder

Criteria
Clinical presentation

Answer 24

Question 25

# * Schizotypal disorder Clinical features Associated disorders

Answer 25

Question 26

# * Delusion disorder Criteria Clinical features

Answer 26

Additional notes: - Must screen for schizophrenic and bipolar disorder, could be manic episode - Likely to have poor adherence to medications and followup - Unlikely to have complete remission - Higher risk of suicide compared to schizophrenia due to higher level of functioning - Does not progress into schizophrenia - Collateral history must be taken to ascertain delusions - Likely to cause family violence **Non-bizarre, Systemized, Single theme**

Question 27

Schizophrenia Genetic risk factors

Answer 27

Question 28

Schizophrenia Environmental risk factors

Answer 28

Question 29

Schizophrenia Neurobiological risk factors

Answer 29

Question 30

Schizophrenia Familial and developmental risk factors

Answer 30

EE = Critical, hostile, over involvement attitude

Question 31

# * Schizophrenia Treatment phases

Answer 31

FEP = Hospitalize Acute = Anti-psychotics Maintenance = Antipsychotics, psychosocial interventions Late/ resistant = Clozapine

Question 32

# * Antipsychotics MoA Efficacy Examples S/E

Answer 32

FGA: Chlorpromazine Flupenthixol Haloperidol SGA: Sulpiride Clozapine/ Olanzapine Quetiapine S/E: Anti-HAM + Dopaminergic S/E

Question 33

# * Antipsychotic prescription Preparation Onset of action Choice Dosing Regimen RoA Monitoring

Answer 33

Start: CBC, LRFT, Metabolic profile, ECG Choice: Clozapine/ SGA first Dose: Start minimal effective dose, regular never prn Regimen: Monotherapy first, change dose/ combo/ drug if needed RoA: Oral or depot Monitor: Metabolic profile, mental state, physical health

Question 34

# * Treatment resistant schizophrenia Definition Treatment Monitoring

Answer 34

Clozapine: - Deadly: Agranulocytosis, Functional IO, Liver failure - Not deadly: Seizure, Pancreatitis, Carditis Monitor: Neutrophil count Q1w for 18 weeks, Q2 weeks until 1 year, Q4w until end Fail: Add antipsychotics, ECT, Lamotrigine

Question 35

# * Non- pharmocological treatment of schizophrenia Indications Modalities

Answer 35

Question 36

Schizophrenia Early intervention paradigm: effect, procedure, efficacy

Answer 36

Question 37

Schizophrenia Clinical course and prognosis

Answer 37

30% resistant 20% remission 10% suicide 50% poor outcome