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Psychiatry > Schizophrenia and psychotic disorders > Flashcards

Schizophrenia and psychotic disorders Flashcards

Personality disorders

1
Q

Psychosis definition [2]

A

Represents an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality

Lack of insight

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2
Q

When is auditory hallucination classically seen

A

Classical psychosis

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3
Q

When is visual hallucination classically seen

A

Organic illness

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4
Q

4 eg of psychotic delusions

A

Grandiose

Persecutory

Hypochondriacal

Self-referential

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5
Q

Positive symptoms [3]

Negative symptoms [3]

A

Positive - hallucinations, delusions, disordered thinking

Negative - apathy, lack of interest, lack of emotions

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6
Q

Dx schizophrenia

Duration [2]

At least one of [4] or at least two of [4]

A

More than a month in absence of organic/affective disorder

At least one of:

  1. Alienation of thought
  2. Delusions of control
  3. Hallucinatory voices
  4. Persistent delusions

OR

  1. Persistent hallucinations in any modality occurring everyday for at least 1 month
  2. Schizotalk
  3. Catatonic behavior
  4. Negative symptoms
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7
Q

Catatonic behavior [5]

4 negative symptoms

A
  • Posturing
  • Waxy flexibility
  • Negativism
  • Mutism
  • Stupor

Negative symptoms

    • Marked apathy
    • Paucity of speech
    • Blunt affect
    • Incongruity of emotional responses
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8
Q

Aetiology of psychosis:

Biological factors

  • 4 genetic disorders
  • 4 neurochemistry factors
  • 5 other factors
A

Genetic disorders

  • CF
  • Neuregulin
  • Dysbindin
  • Di George syndrome

Neurochemistry

  1. Dopamine hypothesis
  2. Glutamate
  3. GABA
  4. Serotoninergic transmission - negative symtoms

Others

  • Obstetric complications
  • Maternal influenza
  • Malnutrition, famine
  • Winter birth
  • Substance misuse (if predisposed to..)
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9
Q

What is serotonergic symptoms responsible for? In terms of schizophrenia etiology

A

negative symptoms in schizophrenia

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10
Q

Psychological factors [2]

A

Jung’s concept of collective unconscious Gestalt psychology

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11
Q

Social factors [5] with regards to schizophrenia etiology

A

Mirgant populations - gross excess of schizophrenia

Drift hypothesis - drifting to an unfamiliar environment

Social isolation

Life events precipitate

Familial factors

  • Schizophrenogenic mother - but not evidenced
  • High EE families
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12
Q

3 differentials of psychosis (illnesses with psychotic sx)

A

Delirium

Affective psychoses

Schizophrenia

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13
Q

Features of delirium [4]

A

Visual experience - hallucinations, illusions

Affect of terror

Delusions: persecutory, evanescent (disappearing, not consistent)

Fluctuating but worse at night

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14
Q

Affective psychoses types[2] and name 2 features

A

Depressive episode with psychotic symptoms

  • Delusions of guilt, worthlessness, persecution
  • Derogatory auditory hallucinations

Manic episode with psychotic symptoms

  • Grandiose delusions - messianic roles
  • Gross overactivity, irritability, behavioural disturbance, manic excitement
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15
Q

Good prognostic factors of psychosis [7]

A

Good prognosis factors

  • Absence of FMH
  • Good premorbid function - stable personality and relationships
  • Clear precipitant
  • Acute onset
  • Mood disturbance
  • Prompt treatment
  • Maintenance of initiative and motivation
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16
Q

Poor prognostic factors of psychosis [7]

A

Slow, insidious onset and prominent negative sx

  • Lack of obvious precipitant

Higher mortality in those with CVD, resp disease, ca - due to shorter life expectancy

  • Suicide risk higher

Low IQ

Substance misuse problems

Cigarette smoking

Onset in childhood

17
Q

Specific personality disorders:

Name 3 cluster A

Prominent problems are…?

All cluster A disorders have same onset?

A

Paranoid personality disorder

Schizoid personality disorder

Schizotypal personality disorder

Prominent problems are with perceived safety of interpersonal relationships

Onset: early adulthood

18
Q

Specific personality disorders: Name 3 cluster B

Prominent problems are

A

Antisocial personality disorder

Narcissistic personality disorder

Borderline personality disorder

Histrionic personality disorder

Prominent problems are with keeping feelings tolerable without acting

19
Q

Specific personality disorders: Name 3 cluster C Prominent problems are

A

OCD Personality disorder

Avoidant personality disorder

Dependent personality disorder

Prominent problems relate to anxiety and how it is managed in relationships

20
Q

Paranoid personality disorder [1]

A

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent

21
Q

Schizoid personality disorder [2]

A

Pervasive pattern of detachment from social relationships

Restricted range of expression of emotions in interpersonal settings

COLD

22
Q

Schizotypal personality disorder [3]

A

Pervasive pattern of social and interpersonal deficits

Marked by acute discomfort of/for close relationships

Marked by cognitive/perceptual distortions and behavioural eccentricities

ODD

23
Q

Antisocial personality disorder

Define in 1 sentence

Features [3]

Criteria [2] - includes age

A

Failure to conform social norms with respect to lawful behaviours Features: Deceitfulness Impulsivity Irritability and aggressiveness Lack of remorse

At least 18 yo AND evidence of conduct disorder before 15 yo

24
Q

Narcissistic personality disorder Onset 3 defining features

A

Onset: early adulthood Features:

  • Pervasive pattern of grandiosity
  • Need for admiration
  • Lack of empathy
25
Q

Borderline personality disorder

Onset

Features [2]

A

Pervasive pattern of instability of interpersonal relationships, self-image and affects

Marked impulsivity

26
Q

Histrionic personality disorder definition [1]

Onset

A

§ Pervasive pattern of excessive emotionality and attention seeking Onset: early adulthood

27
Q

OCD personality disorders

Onset

Definition

A

Pervasive pattern of pre-occupation with orderliness, perfectionism and mental/interpersonal control

Onset: early adulthood

28
Q

Avoidant personality disorder

Onset

A

Pervasive pattern of social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation

Onset: early adulthood

29
Q

Dependent personality disorder

Onset

A

Pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour, fears of separation

Onset: early adulthood

30
Q

Management of schizophrenia

Acute psychotic episode

First line

Second line

Third line

A

Anti-psychotics

IM or inhaled

IM lorazepam

ECT

31
Q

Chronic mx schizophrenia

A

Atypical anti-psychotics

Full trial of 2 different anti-psychotics and it doesn’t work

  • Try 2 months each
  • Maintenance tx at least 18m

Psychosocial interventions eg psychotherapy (CBTp)

32
Q

Schizophrenia mx: treatment resistant forms

First line, second line, third line

A

Not responsive to 2 antipsychotics (incl SGA) > clozapine

Clozapine + second SGA

Clozapine + lamotrigine

Psychiatry (8 decks)

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