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y4 psychiatry > Schizophrenia and Psychoses > Flashcards

Schizophrenia and Psychoses Flashcards

1
Q

A sensory experience vivid enough to be a hallucination but recognised by the subject not to be real.

A

Pseudohallucination

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2
Q

The subject hears voices which talk to them directly (e.g. “You’re going to die, you’re going to die”)

A

2nd person auditory hallucination

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3
Q

The subject hears voices talking about them but not to them, or commentating on their actions. (e.g. “he’s having a drink, now he’s going to the bathroom”)

A

3rd person auditory hallucination

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4
Q

False perception of a real stimulus. Three types: affect, completion and pareidolia.

A

Illusion

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5
Q

A perception which occurs in the absence of a stimulus. To the person this has the impact of a real perception and is indistinguishable. It occurs externally (not in the mind).

A

Hallucination

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6
Q

What is the difference between “illusion” and “hallucination”?

A

An illusion is based on a real sensory stimulus that is interpreted incorrectly whereas a hallucination is created by the mind without any stimulus.

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7
Q

What are the three types of illusion?

A

Pareidolia

Completion

Affect

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8
Q

What is a pareidolia illusion?

A

Seeing shapes in inanimate objects

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9
Q

What is a completion illusion?

A

The mind completes partial images

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10
Q

What is an affect illusion?

A

Based on the subject’s current affect

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11
Q

Seeing faces in clouds would be an example of which type of illusion?

A

Pareidolia illusion

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12
Q

Seeing a monster in the corner of the room when you are scared would be what type of illusion?

A

Affect illusion

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13
Q

A cluster of symptoms that often occur in chronic schizophrenia including poverty of speech, flat affect, poor motivation, poor attention and neglect.

A

Negative symptoms

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14
Q

A cluster of psychotic symptoms including hallucinations and delusions.

A

Positive symptoms

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15
Q

To the subject the external world appears unreal or artificial. They’re aware this is abnormal.

A

Derealisation

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16
Q

A change in awareness of self, in which the individual feels they’re not real and are detached from the world. They are aware this is abnormal.

A

Depersonalisation

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17
Q

A fixed firmly held belief that is held with unshakeable conviction despite evidence to the contrary and cannot be explained by the subject’s cultural or religious background.

A

Delusion

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18
Q

Extremely negative delusions of being dead or part of the body decaying.

A

Nihilistic delusions

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19
Q

Loss of structured thinking. The subject seems muddled and doesn’t become clearer with further questioning, things often seem more confusing the more you ask them.

A

Loosening of associations

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20
Q

Rapid flow of thought, manifested by accelerated speech with abrupt changes from topic to topic. There is often some form of link between topics. Often seen in mania.

A

Flight of ideas

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21
Q

Delusion of having of a higher status or significance, special powers or a secret mission.

A

Grandiose delusions

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22
Q

The subject receives a normal perception but it’s interpreted with delusional meaning and has immense significance (e.g. I know I’m the king as I saw the traffic light turn green)

A

Delusional perception

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23
Q

The subject believes their thoughts, feelings and/or actions are not their own but are being imposed/controlled by an outside force.

A

Delusion of control/passivity

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24
Q

Thoughts which are not believed to be the subject’s own infiltrate their mind. They often have bizarre explanations of how it’s happened.

A

Though insertion

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25
Q

The subject believes their thoughts are being shared with others (e.g. being broadcast on the radio)

A

Thought broadcast

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26
Q

The subject believes their thoughts have been removed from their mind by an external agency.

A

Thought withdrawal

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27
Q

The belief that innocuous events have direct personal significance to the subject (e.g. believing something on the TV is a direct message to them).

A

Ideas of reference

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28
Q

What is the difference between “thought broadcast” and “ideas of reference”?

A

In thought broadcast they believe their thoughts are being broadcast for others to receive. With ideas of reference they take special meanings from inoculous stimuli.

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29
Q

The repetition of a particular response (phrase, word, or gesture) despite the absence or cessation of the stimulus. Often seen in organic brain disorders.

A

Perseveration

30
Q

The subject experiences his own thoughts as if they were being spoken aloud.

The repetition may not be a simple echo but subtly or grossly changed in quality.

A

Thought echo

31
Q

A new word that has no real meaning.

A

Neologism

32
Q

The three clusters of psychotic symptoms

A
  1. Hallucinations
  2. Delusions
  3. Thought disorder
33
Q

What is a delusion?

A

A false, unshakable belief held with intense conviction and despite evidence to the contrary; but not explained by culture or religious background.

34
Q

What is thought disorder?

A

An abnormality in the mechanism of thinking.

To the observer their speech doesn’t make sense.

35
Q

True or false: psychosis is not a psychiatric diagnosis.

A

True. It is an umbrella term for a number of symptoms that involve a disconnection with reality.

36
Q

In which gender is schizophrenia more common?

A

Males

37
Q

What is the average age of onset of schizophrenia in men and women?

A

Men tend to develop symptoms earlier (~20-28yo).

Female average onset ~26-32yo.

38
Q

What are the rates of incidence and prevalence of schizophrenia?

A

Incidence 0.1%

Prevalence 1%

39
Q

What are some of the aetiological factors for schizophrenia?

A

Genetics

Cannabis (4x risk if regular use before age 15)

Living in urban area

Children of migrants

Economic adversity/social exclusion

Childhood trauma and/or abuse

Winter birth or if perinatal viral infection or trauma

40
Q

Which neurotransmitter is most implicated in schizophrenia?

A

Dopamine

41
Q

What are the main dopamine pathways in the brain?

A

Dopamine is produced in the midbrain and taken to different active sites via 4 pathways:

  1. Mesocortical: midbrain to frontal cortex

Cognition and executive function

Low levels of DA here cause schizophrenia negative symptoms.

  1. Mesolimbic: midbrain to limbic system

Motivation, emotion, reward (assigns emotional importance to experiences)

High DA levels create schizophrenia positive symptoms.

  1. Nigrostriatal: basal ganglia.

Stimulation of movement.

Normal levels in schizophrenia, but this pathway explains the extrapyramidal side effects of some antipsychotics.

  1. Tuberoinfundibular pathway: pituitary gland.

Normal levels of DA here in schizophrenia. But, DA functions as a prolactin inhibitor. Therefore, antipsychotics may reduce DA levels and increase prolactin = sexual dysfunction, dysmenorrhea, gynaecomastia.

42
Q

__A__ of schizophrenia include delusion, __B__ and hallucinations. These are psychotic symptoms and are the focus of medical treatments. The presence of these symptoms offers a __C__ prognosis.

A

A) Positive symptoms
B) thought disorder
C) better

43
Q

Lack of motivation, __A__, poverty of speech and __B__ affect are examples of __C__ sometimes seen in schizophrenia.

These are part of the continuum of normal traits and often present __D__ in the course of the disease. They are __E__ to treatment.

A 
A) anhedonia
B) blunt
C) negative symptoms
D) later
E) less responsive
44
Q

Define the ICD-10 classification of schizophrenia

A

For at least one month and without an organic cause or substance abuse:

One or more of:

  • Delusion
  • Delusional perception
  • 3rd person hallucination
  • Thought insertion/echo/withdrawal/broadcast
  • Delusion of control/passivity

Two or more of:

  • Any other hallucination
  • Negative symptoms
  • Loosening of associations
  • Catatonia
45
Q

What is catatonic schizophrenia?

A

A state of immobile stupor with cardinal features such as posturing and waxy flexibility.

46
Q

What is paranoid schizophrenia?

A

Paranoid delusions usually with auditory hallucinations. The most common type.

47
Q

What is simple schizophrenia?

A

Profound negative symptoms without any delusions or hallucinations.

48
Q

What subtype of schizophrenia is being described?

Prominent affect changes with shallow and inappropriate mood. Irresponsible and unpredictable behaviour.

Fleeting delusions and hallucinations. Rapid development of negative symptoms.

A

Hebephrenic

49
Q

What is the prognosis for a subject with schizophrenia?

A

Following 1st psychotic episode:

Third recover, third relapse/remit with good function between, third have chronic schizophrenia.

50
Q

Taking an antipsychotic reduces risk of schizophrenia relapse by __A__. Stopping an antipsychotic within six months increases the risk of relapse by __B__.

A

A) a third

B) four times

51
Q

Which of the following is a good prognostic factor for schizophrenia?

A) Single
B) Older age of onset
C) Insidious onset
D) Male

A

B) Older age of onset

Interestingly, older age of onset is a better prognostic factor than early age of onset.

52
Q

What is acute psychotic disorder?

A

Patient has psychotic symptoms lasting less than 28 days.

If symptoms persist beyond 28 days then they will later be given the diagnosis of schizophrenia

53
Q

What is schizoaffective disorder?

A

Schizophrenia can’t be diagnosed in the presence of extensive affective symptoms (mania or depression).

Therefore, a patient is diagnosed with schizoaffective disorder if he displays both psychotic and affective symptoms are simultaneously present and equally prominent.

54
Q

What are delusional disorders?

A

Mental illness in which delusions are the most prominent feature.

They are typically well formed and long standing (they can be life-long!) and very difficult to treat. Patients usually retain delusion but are less preoccupied with it.

Hallucinations aren’t present or are only fleeting

Delusions of control/passivity experiences aren’t compatible with this diagnosis.

55
Q

They believe their partner is cheating on them. Risk to the partner and the other individual of violence and stalking.

A

Othello syndrome (delusion disorder)

56
Q

A nihilistic delusion without other psychotic symptoms. They believe they are dead, rotting or have lost body parts.

A

Cotard’s syndrome (delusion disorder)

57
Q

They believe that someone from a higher social standing is in love with them and sends them secret messages to convey their love.

A

De Clerambault’s syndrome (sometimes known as ‘erotomania’; a delusion disorder)

58
Q

They believe they are infested with parasites despite no evidence of this. Risk of self harm through excoriation or trying to get the parasites out.

A

Ekbom’s syndrome (delusion disorder)

59
Q

The dominant partner has a delusional belief and then the dependent partner develops the same belief.

The dominant partner requires treatment but the dependent partner recovers upon separation.

A

Folie a Deux

sometimes known as ‘induced delusional disorder’; a delusion disorder

60
Q

They believe multiple people are actually one individual in disguise who is persecuting them.

A

Fregoli’s syndrome (delusion disorder)

61
Q

They believe someone has been replaced by an imposter

A

Capgras syndrome (delusion disorder)

62
Q

What class of drugs are used in the management of schizophrenia and other psychotic-related disorders?

A

Antipsychotics

The indications for use of antipsychotics include:

  • Psychotic disorders (e.g. schizophrenia)
  • Affective disorders (e.g. mood-stabiliser for bipolar)
  • Sedative (e.g. palliative care to ease agitation)
63
Q

How quickly do you see the effects antipsychotics have?

A

Sedative - within hours

Side-effects - hours to days

Antipsychotic effects - days to weeks

64
Q

How are antipsychotics classified?

A

Typical/First Generation:
- Haloperidol, zuclopenthixol, flupentixol

Atypical/ Second Generation:
- Olanzapine, risperidone, quetiapine, aripiprazole, clozapine

65
Q

Which is the most effective of the common antipsychotics?

A

Clozapine.

It also has some high-risk side effects which mean it should never be a first line treatment.
- agranulocytosis in 1%, myocarditis, reduced seizure threshold.

Clozapine should only be started after two other antipsychotics have failed, including at least one 2nd gen (atypical).

66
Q

What preparations are available for antipsychotic medication?

A

Oral (acute management and maintenance therapy)

IM (acute agitation where unable to give oral medication)

Depot (often preferred for longer term, or may use if poor compliance)

67
Q

What investigations should be performed prior to commencing antipsychotics?

A

Observations:

  • BP and BMI (2nd gen can cause metabolic side-effects)
  • Heart rate (some increase QTc)

Blood:

  • FBC, U&E, LFT, TFT
  • Prolactin (can be raised due to DA inhibition)
  • HbA1c and lipids (2nd gen can cause metabolic side-effects)

ECG:
- Many can cause prolonged QTc

68
Q

What are the extrapyramidal side effects of some antipsychotics?

A

EPSE’s are particularly prominent in typical (1st gen).

Acute:

  • Acute dystonia (spasms, torticollis; managed with anticholinergics)
  • Parkinsonism (tremor, rigidity, bradykinesia; managed with anticholinergics)
  • Akathisia (restlessness; managed with sedatives or medication change)

Chronic:
- Tardive dyskinesia (choreoathetoid movements, lipsmacking, pinching and other pointless repetitive movements; manage by changing drug or reducing dose, anticholinergics worsen TD symptoms)

69
Q

True or false: Metabolic side effects are more common in antipsychotics like haloperidol.

A

False. Haloperidol is a typical (1st gen) antipsychotic. Metabolic side-effects are more common in 2nd gen (atypical) antipsychotics.

Include: weight gain, diabetes, dyslipidaemia.

70
Q

True or false: Extrapyramidal side effects are more common with typical antipsychotics than atypicals?

A

True. First gen (typical) antipsychotics such as haloperidol are more likely to give EPSEs than second gen’s like olanzapine and risperidone.

71
Q

What psychosocial interventions are available for psychoses and schizophrenia?

A

Family therapy

CBT

Art therapy (rec. for those with negative symptoms)

72
Q

What conditions may cause psychosis?

A

Schizophrenia

Schizoaffective disorder

Affective disorders (depression, bipolar)

Organic diseases (dementia, delirium, encephalitis, metabolic disturbance)

Illicit substance use/withdrawal

Alcohol (intoxication, delirium tremens, withdrawal)

Sleep deprivation

Bereavement/grief

y4 psychiatry (9 decks)

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