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Psychiatry > Schizophrenia and other psychoses > Flashcards

Schizophrenia and other psychoses Flashcards

1
Q

What are the classic characteristics of psychosis?

A

hallucinations; delusions and disorder of the form of thought with lack of insight

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2
Q

What is hallucination?

A

a perception which occurs in the absence of an external stimulus

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3
Q

How is a hallucination experienced?

A

as originating in real space not just in thoughts; same qualities as normal perception and not subject to any conscious manipulation

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4
Q

When are hallucinations significant?

A

only in the context of other relevant symptoms

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5
Q

What is seen in the brain activity of those experiencing auditory hallucinations?

A

pattern is very similar to that in normal volunteers geneerating inner speech except supplementary motor area and hippocampus

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6
Q

What is the function of the supplementary motor area in the context of hallucinations?

A

monitors self geenerated actions

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7
Q

What is the function of the parahippocampal gyrus in the context of hallucinations?

A

detects mismatch between perceived and expected activity

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8
Q

What is the core problem pathophysiologically in auditory hallucinations?

A

self-generated inner speech is not recognised as such and so is attributed to external reality

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9
Q

What are the types of auditory hallucination?

A

second person; third person and though echo

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10
Q

What is though echo?

A

patient experiences his own thoughts spoken or repeated outloud

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11
Q

What are visual hallucinations often associated with?

A

altered consciousness or organic impairment

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12
Q

What is passivity phenomenon?

A

behaviour is experienced as being controlled by an external agency rather than by the individual

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13
Q

What is thought insertion?

A

“people can put thoughts into my head”

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14
Q

Waht is thought withdrawal?

A

“people are taking my thoughts away”

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15
Q

What is thought broadcasting?

A

“everyone knows my thoughts”

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16
Q

What are teh typical themes of delusion in depression?

A

disease; nihilism; poverty; sin and guilt

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17
Q

what are the typical themes of delusion in schizophrenia?

A

control; persecution; reference; religion; love

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18
Q

What are teh typical themes of delusion in mania?

A

grandiosity; persecution; religion

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19
Q

What determines the specific content of a delusion?

A

cultural norms eg. someone in japan will probbaly not be worried about MI5

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20
Q

What is usually the origin of delusions?

A

secondary- an attempt to explain anomalous expereinces eg hallucinations, passiviity expereinces

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21
Q

What are self-referential expereinces?

A

belief that external events are related to oneself

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22
Q

Give examples of self-referential experiences?

A

TV or radio are transmitting messages for me or newspapers contain hidden codes

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23
Q

What is the differential diagnosis of psychotic symptoms?

A

schizophrenia; psychoactive substance use; mania; depression; delirium; dementia; other organic cause

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24
Q

What is delusional perception?

A

a fully formed delusion which arises from a real/ genuine perception

25
Q

What are the core psychotic symptoms of schizophrenia?

A

auditory hallucinations; passivity phenomena; delusional perception

26
Q

What are the characterstics of auditory hallucinationsin SZ?

A

thought echo; 3rd person; in form of running commentary

27
Q

What are the negatvie symptoms of SZ?

A

reduced amount of speech; motivation; interest/pleasure; social interaction; restricted range of afffect

28
Q

What is seen premorbidly in patients who develop SZ?

A

subtle motor, cognitive and social deficits in childhood that become greater as time goes on

29
Q

What are the prodromal ymptoms of SZ?

A

gradual onset with non-specific- odd ideas and expereinces, eccentrciity, altered affect

30
Q

What is the most common outcome of SZ?

A

multiple epsidoes with signficant chronic progressive impairment

31
Q

How many patients with SZ have only one epsidoe with no-minimal impairment?

A

20%

32
Q

What are the bad prognostic indicators in SZ?

A

poor pre-morbid adjustment; insidious onset; early onset; cognitivie impairment; enlarged ventricles

33
Q

What are the good prognostic indicators in SZ?

A

older age of onset; female gender; marked mood disturbance esp. elation; family history

34
Q

What is the biggest known risk factor for dveloping SZ?

A

positive family history

35
Q

What is seen during pregnancy or birth complications of those who go on to develop SZ?

A

higher rates of perinatal complications= prematurity; prolonged labour; fetal distress; hypoxia; 2nd trimester viral infections or malnutrition

36
Q

What is seen in the brain with SZ?

A

enlarged lateral ventricles; reduced frontotempral volume; reduced activation of prefrontal areas on specific tasks

37
Q

What test do SZ patients tend to do badly in and why?

A

Stroop test- involves prefrontal areas

38
Q

What supports the dopamine hypothesis in SZ?

A

drugs which release dopamine or D2 receptor agonists a psychotic state or make SZ worse

39
Q

What are the functions of the D2 receptor family ?

A

inhibit adenyly cyclase; inhibit voltage-activated calcium channels and open K channels

40
Q

What are the genes implicated in SZ?

A

neuregulin; dysbindin; DISC-1

41
Q

What may precipitate onset/relapse of SZ?

A

stresss

42
Q

How can you indentify drug-induced psychosis from other causes of psychosis?

A

if stop drug; psychosis improves within days

43
Q

What is depressive psychosis typified by?

A

mood congruent content of psychotic symptoms

44
Q

What are the features of delirium?

A

clouding of consciousness- disorentation in time, place and person; fluctuating severity; worse at night; impaired conc. /memory

45
Q

What are the psychotic symptoms of delirium?

A

visual hallucinations +/- audtiory; persecutory delusions; psychomotor distubrnace

46
Q

What do 3rd person auditory hallucinations suggest?

A

SZ

47
Q

Give examples of typical antipsychotics?

A

chlorpromazine; haloperidol

48
Q

How is antipsychotic action and D2 receptor blockade related?

A

strong correlation between average dose rewuired and D2 receptor binding activity

49
Q

What problsm does D2 blockade cause?

A

EPSE; hypereprolactinaemia

50
Q

What is the treatment fro acute dystonic reaction?

A

IV anticholinergics

51
Q

What problems can 5HT-2 blockade cause and why?

A

metabolic syndrome; interactions at serotonin receptors my modulate aspects of hte immune response and inflammation

52
Q

What problems does histamine blockade cause?

A

sedation and increased appetite

53
Q

What is clozapine used for?

A

treatment resistant SZ

54
Q

What are the problems associated with clozapine?

A

agranulocytosis; myocarditis

55
Q

How often should FBCs be done with clozapine?

A

weekly for first 6 months; fortnightly for next 6 months; every 4 weeks thereafter

56
Q

What diseases is formal thought disorder seen with?

A

SZ and mania

57
Q

What is formal thought disorder?

A

group of first rank symptoms of delusions of thought interference-thought withdrawal; thought insertion and thought broadcasting

58
Q

What diseases is passivity phenomenon seen with?

A

SZ and substance misuse

59
Q

What diseases are visual hallucinations seen with?

A

substance misuse and delirium/dementia

Psychiatry (20 decks)

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