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Year 2 Psych > Pyschosis > Flashcards

Pyschosis Flashcards

1
Q

What is psychosis?

A

difficulty perceiving and interpreting reality

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2
Q

What can cause psychosis?

A 
Schizoaffective disorder 
Bipolar
Schizophrenia
Delusional disorder
Substance related
Depression with psychotic features 
Due to other medical condition
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3
Q

What are the three symptom domains in psychosis?

A

Postitive symptoms
Negative symptoms
Disorganisation

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4
Q

What are positive symptoms?

A

Hallucinations

Delusions

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5
Q

What are the main features of hallucinations?

A

Percepts in absence of a stimulus

Auditory
Voices commenting on you
Voices talking to each other
Visual
Somatic/tactile
Olfactory (rare)
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6
Q

What are the main features of delusions?

A

Fixed, false beliefs, out of keeping with social/cultural background

Persecutory
Control
Reference
Mind reading
Grandiosity
Religious
Guilt/sin
Somatic
Thought broadcasting
Thought insertion
Thought withdrawal
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7
Q

What are negative symptoms?

A

Alogia
Anhedonia/Asociality
Avolition/Apathy
Affective flattening

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8
Q

What is alogia?

A

Poverty of speech

Paucity of speech, little content
Slow to respond

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9
Q

What is anhedonia?

A

Few close friends
Few hobbies/interests
Impaired social functioning

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10
Q

What is avolition?

A

Poor self-care
Lack of persistence at work/education
Lack of motivation

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11
Q

What is affective flattening?

A 
Unchanging facial expressions
Few expressive gestures
Poor eye contact
Lack of vocal intonations
Inappropriate affect
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12
Q

What are disorganisation symptoms?

A

Bizarre behaviour

Thought disorder

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13
Q

What characterises bizarre behaviour?

A

Bizarre social behaviour
Bizarre clothing/appearance
Aggression/agitation
Repetitive/sterotyped behaviours

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14
Q

What characterises thought disorder?

A 
Derailment
Circumstantial speech
Pressured speech
Distractibility
Incoherent/illogical speech
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15
Q

Describe the onset of psychosis

A

Can occur at any age
Peak incidence in adolescence/early 20s
Peak later in women

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16
Q

Describe the course of psychosis

A

Often chronic & episodic

Very variable

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17
Q

Describe morbidity with psychosis

A

Substantial, both from disorder itself and increased risk of common health problems e.g. heart disease

Significant impact on education, employment and functioning

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18
Q

Describe mortality with psychosis

A

Substantial

All-cause mortality 2.5x higher, ~15 years life expectancy lost

High risk of suicide in schizophrenia – 28% of excess mortality

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19
Q

What comprises a psychiatric history?

A 
History of Presenting Concern
Past Psychiatric History
Background History (Family, Personal, Social)
Past Medical History and Medicines
Corroborative History
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20
Q

How do you explore the history of the presenting complaint?

A

The patient’s description of the presenting problem – nature, severity, onset, course, worsening factors, treatment received
Circumstances leading to arrival to hospital
WHY NOW?

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21
Q

How do you explore past psychiatric history?

A

Any known diagnosis?
Any treatment?
Known to a community team?
Any previous admissions to hospital?

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22
Q

What do you explore when taking a family history?

A

Age of parents, siblings, relationship with them
Atmosphere at home
Mental disorder in the family, abuse, alcohol/drugs misuse, suicide

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23
Q

What do you explore when taking a personal history?

A

Mother’s pregnancy and birth
Early development, separation, childhood illness
Educational and occupational history
Intimate relationships

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24
Q

What do you explore when taking a social history?

A

Living arrangements
Financial issues
Alcohol and illicit drug use
Forensic History

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25
Q

What do you explore when taking a past medical history?

A

Medical problems = a cause or consequence of

mental disorder or psychiatric treatment

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26
Q

What do you explore when asking about medication?

A

Regular medications?
Compliance?
Over the counter medications?
Interactions?

27
Q

What do you need to consider when taking a corroborative history?

A

Need for consent!

Informants: relatives, friends, authority
Confidentiality

28
Q

What do you look at in a mental state examination?

A 
Appearance and Behaviour
Speech
Mood
Thoughts
Perceptions
Cognition
Insight
29
Q

What do explore when looking at appearance and behaviour?

A 
General appearance
Facial expression
Posture 
Movements 
Social behaviour
30
Q

What issues may there be with someone’s general appearance?

A

neglect: alcoholism, drug addiction, dementia, depression, schizophrenia

weight loss: anorexia nervosa, depression, cancer, hyperthyroidism, financial issues/homelessness

31
Q

What issues may there be with someone’s facial expression?

A

depressive, anxious,

“wooden” parkinsonian

32
Q

What issues may there be with someone’s posture?

A

hunched shoulders, downcast head and eyes – depressive

sitting upright, head erect, hands gripping the chair – anxious

33
Q

What issues may there be with someone’s movements?

A 
overactive, restless – manic
inactive, slow - depressive
immobile, mute – stupor
tremors, tics, choreiform movements, dystonia, tardive dyskinesia 
mannerisms, stereotypies
34
Q

What issues may there be with someone’s social behaviour?

A

disinhibited, overfamiliar
withdrawn, preoccupied
signs of impending violence: raised voice, clenching fists, pointed fingers, intrusion into personal space

35
Q

What do you look at when exploring someone’s speech?

A

Quantity
Rate
Spontaneity
Volume

36
Q

What issues could there be with quantity of speech?

A

less, more, mutism

37
Q

What issues could there be with rate of speech?

A

slow, fast, pressure of speech (cannot stop them they go at 100 miles an hour)

38
Q

What issues could there be with spontaneity of speech?

A

Latency

39
Q

What do you look at when you consider mood?

A 
Subjective
Objective
Predominant mood
Constancy		
Congruity
40
Q

What is subjective mood?

A

What the patient feels

41
Q

What is objective mood?

A

How you think the patient feels

42
Q

What do you look for specifically with constancy of mood?

A

emotional lability/incontinence
reduced reactivity/blunting/flattening
irritability

43
Q

What is congruity?

A

cheerful while describing sad events

44
Q

What do you explore when looking at thoughts?

A

Stream
Form

Content
Preoccupations 
Morbid thoughts, suicidality 
Delusions, overvalued ideas
Obsessional symptoms
45
Q

What issues can there be with stream of thought?

A

pressure, poverty, blocking

46
Q

What issues can there be with form of thought?

A

flight of ideas, loosening of associations, preservation

47
Q

What are primary and secondary delusions?

A

primary – occurs suddenly

secondary – arises from previous abnormal idea/experience (hallucination/mood/delusion)

48
Q

What is folie à deux?

A

Shared delusion

49
Q

Give examples of delusional ideas?

A 
paranoid
of reference
grandiose/ expansive
of guilt/ worthlessness 
hypochondriacal
of jealousy
sexual/ amorous
religious
of control
concerning the possession of thought (insertion, withdrawal, broadcast)
50
Q

What are obsessional symptoms?

A

obsessional thoughts: dirt and contamination, aggressive actions, orderliness, disease, sex, religion

compulsions: checking, cleaning, counting, dressing rituals

51
Q

What are perceptions people may have?

A

Illusions
Hallucinations
Distortions

52
Q

What are illusions?

A

misperception of a real external stimulus

53
Q

What are hallucinations?

A

perception in the absence of external stimulus

54
Q

What are the different types of hallucinations?

A

true perception

coming from outside the head

(pseudohallucination)

55
Q

What senses can hallucinations affect?

A 
auditory – second person, third person
visual – Charles Bonnet syndrome
olfactory
gustatory
tactile, of deep sensation
56
Q

What do you look at exploring cognition?

A 
Consciousness 
Orientation
Attention and concentration
Memory
Language functioning
Visuospatial functioning
57
Q

What are the main features of insight?

A

Awareness of oneself as presenting phenomena that other people consider abnormal

Recognition that these phenomena are abnormal

Acceptance that these abnormal phenomena are caused by mental illness

Awareness that treatment is required

Acceptance of the specific treatment recommendations

58
Q

How can you make it seem to the patient that you are on the same page?

A

Mirror their language

59
Q

Where else can you get information?

A

Family
Friends
Work/Education

Healthcare records
GP
Mental Health

60
Q

How can psychosis be managed pharmacologically?

A

Antipsychotic medications

Often mainstay of treatment

61
Q

How can psychosis be managed psychologically?

A

CBT for psychosis

Newer therapies like avatar therapy

62
Q

What social support can you give to those with psychosis?

A

Supportive environments, structures and routines
Housing, benefits
Support with budgeting /employment

63
Q

What are the side effects of anti-psychotics?

A 
Sedation
Constipation
Increased prolactin (release is suppressed by dopamine)
Increased appetite
Weight gain
Diabetes
Dysrhythmia 
Long QTc
64
Q

What is word salad?

A

Stream of words

No grammatical sense

Year 2 Psych (6 decks)

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