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Psychiatry > Schizophrenia and Psychosis > Flashcards

Schizophrenia and Psychosis Flashcards

1
Q

What is psychosis

A

Mental disorder in which thoughts, affective response, ability to recognise reality and the ability to communicate and relate to others, are sufficiently impaired
Cannot work out what is real and not real
Usually has a functional impact and a loss of insight

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2
Q

What are the characteristics of psychosis

A 
Hallucinations 
Delusions 
Disorder of the form of thoughts 
Lack of insight 
Functional impact
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3
Q

Illicit drugs can lead to psychosis - true or false

A

True

When they come down from the drug the psychosis often disappears

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4
Q

What is a hallucination

A

A perception which occurs in the absence of an external stimulus
Experienced as if it were real
Is not subject to conscious manipulation
Can occur in any sensory modality - hearing, seeing, smelling, tasting or feeling things that are not actually there but feel real to the person.

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5
Q

What is thought insertion

A

When you believe your thoughts are not your own

Being put there by someone else

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6
Q

What is passivity of action

A

When you believe that someone else is controlling your actions/movements

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7
Q

What is ideas of reference

A

When a person assigns significance or meaning to an event, speech, objects etc
Feel like specific things are jumping out at you
May believe that messages are being left in newspapers, TV reports are directly communicating to them etc

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8
Q

What is a delusion

A

A fixed but falsely held belief
Wont be able to convince the person that it is not real despite being contradicted by reality or rational argument
Held outwith the usual social, cultural and educational background of the patient
May be bizarre or impossible

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9
Q

What is paranoia

A

The belief that external events are related to oneself
It is self-referential - about your own mind
Can be transient or very intrusive
Often think people are talking about them or ‘out to get them’

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10
Q

What are Capgrass delusions

A

Where you believe people have been replaced by others (e.g. those aren’t nurses they are agents)

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11
Q

What is Capgrass nihilism

A

Where you believe you have died and are just waiting for your body to stop working

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12
Q

List some common types of delusion

A

Paranoid
Persecutory
Grandiose
Religious - have met God or are second coming
Misidentification - Capgrass or Fregoli
Guilt
worry that they have committed crimes
Sin – people will believe they have sinned
Nihilistic - believe they have lost everything

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13
Q

What is a Fregoli delusion

A

Were you think that one person changes their appearance and becomes another (e.g. one nurse leaves and another enters and you think it’s the same person)

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14
Q

What is Othello syndrome

A

You constantly believe you are being cheated on

Can lead onto violence and even homicide

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15
Q

What are primary delusions

A

These delusions arrive fully formed in the consciousness without need for explanation

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16
Q

What are secondary delusions

A

Usually present to try and explain another anomalous phenomenon such as a hallucination
E.g. the voices I’m hearing are being transmitted by the CIA

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17
Q

What is Knight’s move thinking

A

A type of thought disorder where the person will jump between topics based off previous words or topics
Random content that is hard to follow - no clear link or formal/coherent train of thought

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18
Q

What are the signs of a thought disorder

A 
You can identify it from speech patterns 
May have: 
Knight's moving
Clanging and punning
Going off on tangents 
Word salad 
Neologisms 
Loosening of associations
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19
Q

What is word salad

A

When the patient uses random words and syllables

Unable to communicate what they mean as they think these words make sense

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20
Q

What is thought withdrawal

A

When the patient believes that their thoughts are being extracted from their mind

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21
Q

What is thought broadcasting

A

When someone believes that everyone can tell/hear what they are thinking
Often linked to technology - transmitting them

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22
Q

What is thought blocking

A

Patients will be unable to finish a thought and stop suddenly
Feel as though they suddenly get blocked

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23
Q

What is meant by loss of insight

A

The patient cannot tell they are unwell and believe everything that is happening to them is real

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24
Q

List some of the differentials for psychotic symptoms

A

Unipolar depression
Bipolar - will be associated with mood changes
Schizoaffective disorder
Schizophrenia
Substance use - inlcuding withdrawal
Organic conditions - dementia, delirium, brain injury

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25
Q

What type of hallucinations are common in schizophrenia

A

3rd person auditory

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26
Q

How does drug induced psychosis present

A

Psychotic symptoms have an acute onset but are often short lasting (if substance is removed)

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27
Q

Which drug can lead to an insidious onset of psychosis

A

Heavy cannabis use

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28
Q

Describe depressive psychosis

A

Physctic symptoms have mood congruent (depressive) content
Delusions of worthlessness or guilt
Hallucinations which are persecutory, threatening or insulting (usually 2nd person)

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29
Q

Describe mania with psychosis

A

Symptoms are mood congruent
In mania delusions are often of grandeur, special ability, religious etc
Hallucinations are usually auditory (God talking to them)
People may believe that everyone is jealous of them
Hallucinations are usually 2nd person and encouraging them that their ideas are great
M

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30
Q

What can cause delirium

A 
Infection or sepsis 
Organ failure 
Hypoglycaemia 
Alcohol withdrawal 
Drug intoxication or withdrawal 
ETC
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31
Q

How does delirium present

A 
Acute and transient 
Fluctuating course - worse at night 
Clouding of consciousness 
Impaired concentration and memory 
Can be drowsy and quiet or very agitated 
Visual and auditory hallucinations
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32
Q

What are the first rank symptoms of Schizophrenia

A

Delusion
Auditory hallucinations - often persecutory
Thought disorders - withdrawal, insertion, broadcasting etc
Passivity experiences - impulse, affect etc

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33
Q

List the subtypes of schizophrenia

A

Paranoid - most common and predominately the frist rank symptoms
Hebephrenic - younger onset, immaturity and silliness to them, playing pranks and giggling
Catatonic – characterised by movement disorder, will go rigid and hold a strange position for hours on end

34
Q

What is schizoaffective disorder

A

The patient will have the first rank symptoms of schizophrenia and mania or depression

35
Q

What is persistent delusional disorder

A

Fixed delusions are the major or only feature

36
Q

What are the positive symptoms

A 
Hallucinations
Delusions
Passivity Phenomena
Disorder of the Form of  Thought 
Thought insertion, withdrawal, broadcasting 
Breaks in train of thought 
Neologisms
37
Q

What are examples of negative symptoms

A 
Reduced speech 
Reduce motivation 
Reduced interest or pleasure 
Reduced social interaction 
Blunting of affect
Catatonia
38
Q

What causes schizophrenia

A

A genetically determined neurodevelopmental vulnerability later triggered by environmental stressors

39
Q

When does schizophrenia present

A

Onset is usually in young adults
Peak incidence 15-25 years for men
Peak incidence 25-35 year for women

40
Q

There is a higher incidence of schizophrenia in lower socioeconomic classes - true or false

A

True

41
Q

What are the risk factors for schizophrenia

A 
Genetics - strong component 
Birth complications - labour issues, prem birth or infection exposure 
Winter/spring birth 
Drug use - cannabis 
Urban dwelling 
Social deprivation 
Neurodevelopmental changes 
Altered dopamine signalling
42
Q

What are the bad prognostic indicators for schizophrenia

A 
Poor pre-morbid adjustment
Insidious onset
Early onset
Long duration of untreated psychosis
Cognitive impairment
Enlarged ventricles
43
Q

What are the good prognostic indicators for schizophrenia

A

Older age of onset
Female gender
Marked mood disturbance especially elation
Family history of mood disorder

44
Q

What is the suicide risk for schizophrenia

A

10-15% completed suicide rate
May occur following recovery of insight
High risk time in first week of discharge from hospital

45
Q

Do genetics have an influence on schizophrenia

A

Yes
There is a 78% heritability
High incidence in MZ twins or if parents have it
No single gene involved though - it is a multifactorial

46
Q

What signs could be seen on a brain scan in someone with schizophrenia

A

Reduced frontal lobe volume
Reduced frontal lobe grey matter
Widely distributed grey matter abnormalities
Enlarged lateral ventricle volume

47
Q

How is dopamine associated with schizophrenia

A

Drugs which release dopamine in the brain can produce a psychotic state
Amphetamines do this and can make the symptoms of schizophrenia worse

48
Q

What class of drugs can be used to treat schizophrenia

A

Dopamine receptor antagonists

Reduce the amount of dopamine in the brain

49
Q

Which neurotransmitters may contribute to schizophrenia

A

Dopamine - excess
Serotonin
Glutamine

50
Q

List some of the typical antipsychotics

A

Chlorpromazine

Haloperidol

51
Q

List some of the atypical anti-psychotics

A

Olanzapine
Risperidone
Clozapine

52
Q

What are the benefits of the atypical anti-psychotics

A

Less likely to induce Extra-Pyramidal side-effects
Better efficacy against negative symptoms
Effective in patients unresponsive to typical drugs

53
Q

What are the side effects of blocking dopamine in order to treat schizophrenia

A

Acute dystonia (muscle spasms) - takes hours to days
Parkinsonism
Tardive dyskinesia- repetitive involuntary purposeless movements-

54
Q

What happens if you block histamine receptors

A

Sedation

Increased appetite

55
Q

What happens if you block alpha-adrenergic receptors

A

May cause hypotension and interrupts baroreflex response

Leads to dizziness, light-headedness and fainting

56
Q

What happens if you use drugs to cause a muscarinic blockade

A 
Blurred vision
Dry mouth
Constipation
Urinary retention
Sedation and confusion
Affects the parasympathetic
57
Q

Which antipsychotic can cause agranulocytosis

A

Clozapine

If the patient presents with a sore throat you must get a FBC

58
Q

What is clanging and punning

A

When the speech flows from one rhyming word to another or with pun associations
“Are you well, Adele, I like Adele”

59
Q

What are the diagnostic criteria for Schizophrenia

A

At least one of the first rank symptoms, lasting for over a month, 2 of the positive/negative and no evidence of influence of drugs, alcohol, mood disorder or any other organic cause (e.g. dementia)

60
Q

What type of hallucinations are common in withdrawal

A

Tactile and visual hallucinations

often bugs crawling on them

61
Q

Flight of ideas is characteristic of which disorder

A

Mania

62
Q

What is the most common type of hallucination seen in schizophrenia

A

third person auditory hallucinations

63
Q

What are the two main classes of drugs used to treat psychosis

A

Typical anti-psychotics - first generation

Atypical anti-psychotics - second generation

64
Q

Is there a genetic basis to schizophrenia

A

Yes
Increased risk in children of affected parents
Likely multiple genes and additional environmental effects

65
Q

Dopamine may be involved in the pathophysiology of schizophrenia - true or false

A 
True 
Central (mesolimbic) dopamine systems of the brain are considered to be overactive in schizophrenia
Studies have shown that dopamine agonists may induce schizophrenic symptoms
66
Q

What is posturing

A

The spontaneous adoption of fixed positions which are held for an abnormal length of time.
Seen in schizophrenia and catatonia.

67
Q

What is verbigeration

A

The obsessive repetition of random words and phrases without a stimulus.
Most commonly seen in schizophrenia.

68
Q

What is a made action

A

When the person feels as thought their actions are being controlled by an external agent.
Their bodies are performing the action but they are not in control of it.
Seen in schizophrenia.

69
Q

What is gedankenlautwerden

A

A type of hallucination where patients hear their own thoughts aloud at the same time they think them.
This is seen in schizophrenia.

70
Q

What is folie a deux

A

An identical or similar mental disorder affecting two or more individuals, usually the members of a close family.
They will share the same delusional beliefs and sometimes the same hallucinations

71
Q

What is psychomotor retardation

A

The slowing down or hampering of mental or physical activities, typically seen in the form of slow thinking or slow body movements.
Seen in depressive disorders.

72
Q

What is a flashback

A

Psychological phenomena during which a person relives a past event or fragments of a past experience.
This usually occurs involuntarily without a conscious attempt to remember the event.

73
Q

What is denationalization

A

When a person feels detached from their thoughts, feelings and body.
People may feel as though they are detached and observing themselves from outside their body.

74
Q

What is hyperkinesis

A

A state of excessive restlessness.

Seen in ADHD.

75
Q

What is mitgehen

A

Seen in catatonia.
Even the slightest touch or pressure will move the patient but the body part immediately returns to the original position.

76
Q

Describe flight of ideas

A

A manner of speaking where a person talks rapidly and jumps from topic to topic. It will be hard to keep up with them.

77
Q

What is loosening of associations

A

A thought disturbance demonstrated by speech that is disconnected and fragmented, with the individual jumping from one idea to another unrelated or indirectly related idea

78
Q

What is a nihilistic delusion

A

Persistent belief that the person is dead, decomposing or may have lost internal organs.
They may also believe they do not exist entirely as a human being.

79
Q

What is psychomotor agitation

A

Characterized by unintentional and purposeless motions and restlessness, often but not always accompanied by emotional distress.
May include, pacing, tapping feet, wringing hands etc.

80
Q

List signs and symptoms of catatonia

A

Immobility and stupor
Mutism
Staring and reduced blinking
Posturing and cataplexy
Grimacing - maintaining odd facial expressions
Echopraxia - mimicking examiner’s movement
Echolalia - mimicking examiner’s speech
Stereotypy - repetitive, non-goal-directed activity (playing with fingers etc.)
Repeating words and phrases - verbigeration
Rigidity
Waxy flexibility - initial resistance then allows repositioning
Doing the opposite of instructions
Withdrawal
Excitement
Passive obedience - mitgehen
Automatic obedience

Psychiatry (14 decks)

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