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3A Psychiatry > schizophrenia and psychosis > Flashcards

schizophrenia and psychosis Flashcards

1
Q

What is psychosis

A

An acute mental health state characterized by delusional beliefs and hallucinations

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2
Q

What are common causes of psychosis?

A

Schizophrenia, other mental health disorders, depression, bipolar disorder, drug and alcohol abuse, neurological disorders.

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3
Q

: What drugs are commonly associated with psychosis?

A

Amphetamines (especially methamphetamine), marijuana, hallucinogens (e.g., LSD)

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3
Q

What is a delusion?

A

A fixed, strange or irrational belief firmly held despite evidence to the contrary and out of context for the individual’s cultural background.

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4
Q

Name types of delusions.

A

Delusions of grandeur: Exaggerated importance (e.g., believing to be an important historical figure).
Paranoia: Belief in a plot against them.
Somatic: Belief in having a terrible incurable illness.

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5
Q

What is a hallucination?

A

A sensory perception without an obvious real-world stimulus, such as hearing voices or seeing things that aren’t there.

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6
Q

When do hallucinations occur besides psychosis?

A

In other disorders, particularly delirium

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7
Q

What is the typical age range for the onset of psychosis?

A

16-30

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8
Q

What should be included in the history and assessment of a psychotic patient?

A

Drug and alcohol history, onset and duration of symptoms, recent life events or stressors, personal and family history of mental illness, assessment of delusions and hallucinations.

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8
Q

What questions are useful in assessing delusions?

A

Do you think people are talking about you or taking special notice of you?”
“Is anyone trying to harm you?”
“Do you have any special powers?”
“Do you feel someone is controlling you?”
“Have you had thoughts put into your head that are not your own?”

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9
Q

What other risks should be assessed in a patient with psychosis?

A

Suicide risk and possibly homicide risk.

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10
Q

What initial investigations are performed for psychosis?

A

FTs, FBC, serology (syphilis, HIV), drug screening, EEG, fasting glucose, CT/MRI, full neuro exam.

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11
Q

What do deranged LFTs and macrocytosis suggest?

A

Alcohol abuse.

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12
Q

Which drugs can cause symptoms similar to schizophrenia?

A

cannabis, steroids, cocaine, ecstasy, LSD, magic mushrooms, mescaline, phencyclidine.

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12
Q

What does an EEG help rule out?

A

Epilepsy

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12
Q

What is the purpose of drug screening in psychosis?

A

To rule out amphetamines and cannabis as causes.

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13
Q

Q: What is the typical management approach for acute psychosis?

A

A: Admission to a mental health facility, often compulsory, with prompt recognition and treatment for better long-term outcomes.

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13
Q

Why perform a CT/MRI in psychosis?

A

o look for atrophy of the lateral ventricles and space-occupying lesions (rare causes of schizophrenia).

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13
Q

How is delusional disorder different from schizophrenia?

A

Delusional disorder involves only delusions and/or hallucinations without other schizophrenia-like symptoms. Common delusions include dysmorphophobia, morbid jealousy, and erotomania.

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13
Q

What are alcoholic hallucinations?

A

Hallucinations occurring due to alcohol withdrawal, mimicking schizophrenia for up to 2 weeks

14
Q

How does schizophrenia differ from bipolar disorder?

A

Schizophrenia has primarily persecutory delusions, while bipolar disorder may include elation, erratic behavior, and grandiose delusions.

15
Q

What distinguishes brief psychotic disorder from schizophrenia

A

Brief psychotic disorder lasts less than a month, often with a precipitating factor, and symptoms resolve.

16
Q

what is dysmorphophobia?

A

A delusion that one’s body is deformed or giving off a foul smell.

16
Q

What are the characteristics of schizophrenia?

A

Schizophrenia is a chronic condition with variable course; some recover fully while others may need lifelong care. It’s difficult to persuade patients lacking insight into their condition.

16
Q

What is usually the first-line treatment for acute psychosis?

A

Atypical antipsychotics such as olanzapine, quetiapine, or risperidone. Haloperidol (a typical antipsychotic) may be used in certain cases.

17
Q

Q: What is the peak incidence age for schizophrenia?

A

18-25 years for men and 25-30 years for women. The incidence is roughly equal in both genders

18
Q

What are early signs of schizophrenia?

A

Withdrawal, eccentric behavior, loss of interest, social withdrawal, self-neglect, depression, anxiety, and brief psychotic episodes during the prodromal period.

19
Q

What genetic risks are associated with schizophrenia?

A

General risk: 1%
Sibling with condition: 9%
Parent with condition: 13%
Both parents with condition: 45%

20
Q

What environmental factors contribute to schizophrenia?

A

Environmental factors are considered negligible, but obstetric complications and sensitive personalities (perceiving criticism harshly) are noted.

21
Q

What can trigger an episode of schizophrenia?

A

Stress, intense emotions, increased criticism, and drug use (e.g., hallucinogens, stimulants, alcohol, cannabis).

22
Q

What are the positive symptoms of schizophrenia?

A

Delusions, hallucinations, thought disorder, disorganized speech and behavior.

23
Q

What types of hallucinations are common in schizophrenia?

A

Auditory: Most common; includes third-person voices, thought echo, and second-person voices.
Visual/Olfactory: Less common, more associated with organic conditions.

24
Q

What are some thought disorders in schizophrenia?

A

Neologism, word salad, flight of thought, knight’s move thinking (derailment), pressure of speech, circumstantiality.

25
Q

How can post-psychotic depression be distinguished from negative symptoms of schizophrenia?

A

Post-psychotic depression symptoms do not change with positive symptoms’ severity, and patients often have insight into their depression, which is in response to their diagnosis.

25
Q

What are catatonia symptoms?

A

Stupor, strange postures, negativism, automatic obedience, waxy flexibility.

26
Q

What are Schneider’s First Rank Symptoms of Schizophrenia?

A

Primary delusions, persistent delusions, secondary delusions, thought insertion, thought broadcast, thought withdrawal.

26
Q

What are key risk factors for suicide in schizophrenia?

A

Thoughts or plans of suicide, auditory hallucinations related to suicide, and severe self-neglect.

27
Q

What is the prodromal period in schizophrenia?

A

A period before full-blown symptoms develop, characterized by withdrawal, loss of interest, depression, and anxiety. Longer prodromal periods are associated with a poorer prognosis.

27
Q

Q: What are negative symptoms in schizophrenia?

A

Negative symptoms include alogia, blunting of affect, avolition, and slowness of thought and movement. They lead to reduced function and are poor prognostic indicators.

27
Q

How can negative symptoms be distinguished from depression?

A

By noting the absence of depression symptoms like weight change, sleep problems, guilt, hopelessness, and low self-worth. Also, negative symptoms can be worsened by sedative medications.

27
Q

What are the DSM-V criteria for diagnosing schizophrenia?

A

Must include two or more of the following for at least one month: hallucinations, delusions, disorganized speech, negative symptoms, or grossly disorganized/catatonic behavior. Plus social or occupational dysfunction and no other causes for psychosis.

27
Q

What is alogia?

A

Alogia is characterized by impoverished thinking, often manifesting as poverty of speech (short answers) or poverty of content

27
Q

What is blunting of affect?

A

A lack of emotional expression in schizophrenia, where the individual shows diminished emotional responses.

28
Q

What neuroimaging findings are associated with schizophrenia?

A

Increased size of lateral ventricles, reduced brain size (especially in temporal lobes), and abnormalities in blood flow and brain connectivity.

28
Q

What is the first-line treatment for acute schizophrenia?

A

Atypical antipsychotics like risperidone, olanzapine, quetiapine, or aripiprazole. These can be given orally or via IM injection; depot preparations may be used if adherence is an issue.

29
Q

What is clozapine and when is it used?

A

Clozapine is an atypical antipsychotic used as a second-line treatment for schizophrenia. It requires close monitoring due to the risk of aplastic anemia and is effective in about 30% of cases.

30
Q

What is the prognosis for schizophrenia?

A

20% will recover fully with treatment.
35% will have long periods of remission.
35% will have persistent symptoms manageable in the community.
10% will have severe, treatment-resistant schizophrenia requiring institutional care.
Lifetime suicide risk is about 2%.

30
Q

What are some psychological therapies for schizophrenia?

A

Cognitive Behavioral Therapy (CBT), early warning sign interventions, and family therapy to educate about early signs and support.

31
Q

what is paranoid schizophrenia?

A

Prominent paranoid delusions and auditory hallucinations

3A Psychiatry (15 decks)

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