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Psychiatry > Schizophrenia and Psychotic Disorders > Flashcards

Schizophrenia and Psychotic Disorders Flashcards

1
Q

What is psychosis?

A

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

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2
Q

Presentation of psychosis

A

Hallucinations
Delusions
Confused and disturbed thoughts

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3
Q

What are hallucinations?

A

Where someone sees, hears, smells, tastes or feels things that do not exist outside their mind

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4
Q

What are delusions?

A

Where a person has an unshakeable belief in something untrue

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5
Q

What are persucatory delusions?

A

Where the person may believe an individual or organisation is making plans to hurt or kill them

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6
Q

What are grandiose delusions?

A

Where the person may believe they have power or authority

For example, they may think they’re the president of a country or they have the power to bring people back from the dead

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7
Q

What are psychotic episodes?

A

Often unaware that their delusions or hallucinations are not real, which may lead them to feel frightened or distressed

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8
Q

What are signs of confused and disturbed thoughts?

A

Rapid and constant speech
Disturbed speech
A sudden loss in their train of thought, resulting in an abrupt pause in conversation or activity

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9
Q

What is puerperal psychosis?

A

Postnatal psychosis, severe form of postnatal depression

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10
Q

Illnesses with psychotic symptoms

A

Schizophrenia
Delirium
Severe affective disorder

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11
Q

What is the most common cause of psychosis?

A

Schizophrenia

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12
Q

Positive symptoms of schizophrenia

A

Hallucinations
Delusions
Disordered thinking

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13
Q

Negative symptoms of schizophrenia

A

Apathy
Lack of interest
Lack of emotions

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14
Q

How is schizophrenia diagnosed?

A

For more than a month in the absence of organic or affective disorder
At least one of the following:
- Alienation of thought as thought echo, thought insertion or withdrawal, or thought broadcasting
- Delusions of control, influence or passivity, clearly referred to body or limb movements
actions, or sensations; delusional perception
- Hallucinatory voices giving a running commentary on the patient’s behaviour, or discussing him between themselves, or other types of hallucinatory voices coming from some part of the body
- Persistent delusions of other kinds that are culturally inappropriate and completely impossible (e.g. being able to control the weather)
- Persistent hallucinations in any modality, when occurring every day for at least one month
- Neologisms, breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech
- Catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor
- “Negative” symptoms such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses

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15
Q

What are the types of schizophrenia?

A 
Paranoid schizophrenia
Hebephrenic schizophrenia
Catatonic schizophrenia
Undifferentiated schizophrenia
Post schizophrenic depression
Residual schizophrenia
Simple schizophrenia
Other schizophrenia
Unspecified schizophrenia
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16
Q

What are the types of auditory hallucination?

A

Hearing their thoughts being repeated aloud

3rd person auditory hallucinations- a running commentary on their actions, or voices arguing about them

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17
Q

What are some delusions about thought alienation?

A

Thought withdrawal
Thought insertion
Thought broadcasting

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18
Q

What is thought withdrawal?

A

Their thoughts are being taken from their head by some external force or person

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19
Q

What is thought insertion?

A

That thoughts are being inserted into their heads by some external force or person

20
Q

What is thought croadcasting?

A

That their thoughts are being read and broadcast to others

21
Q

What are passivity phenomena?

A

Delusions that their thoughts, feelings, or impulses are driven by some external force or person

22
Q

What is somatic passivity?

A

A delusion that some external force is causing physical sensations (which may be hallucinations) in their body

23
Q

What is delusional perception?

A

A delusion which arises because of a completely unrelated happening in external reality e.g. “Three letters, which is the number of the Holy Trinity, came through my letter box, and then I realized I was the son of God”

24
Q

Non psychotic symptoms of schizophrenia

A

Mood disturbance

Unusual behaviour

25
Q

Differential diagnosis in apsychotic patient

A

Psychotic mania or depression
Delirium
Drug induced psychosis or intoxication
Medication e.g. steroids
Cerebral causes e.g. tumour, infection, infarction, epilepsy
Endocrine disease e.g. thyroid, chronic hypoglycaemia, Cushing’s, Addison’s
Systemic illness such as anaemia, carcinoma, or sarcoid

26
Q

Acute stage treatment of schizophrenia

A

Antipsychotic medication

Sedatives

27
Q

Long term treatment of schizophrenia

A

Antipsychotic medication
Support in the community e.g. housing, employment, support worker
Rehabilitation in dedicated facilities

28
Q

Scheider’s first rank symptoms of schizophrenia

A

A - Auditory Hallucinations
B - Broadcasting of Thought
C - Controlled Thought (delusions of control)
D - Delusional Perception

29
Q

What is shown on a brain scan in someone with schizophrenia?

A

Enlarged ventricles

30
Q

Which neurotransmitter is most implicated in schizophrenia?

A

Dopamine

31
Q

What are the extrapyramidal side effects associated with typical antipsychotics?

A

Parkinisonism

Acute dystonias

32
Q

What increases the chance of relapse of schizophrenia?

A

Non compliance to treatment
Misuse of illicit substances
High expressed emotion at home
Major life events

33
Q

What are the side effects of clozapine?

A 
Neutropenia
Seizures
Idiopathic hyperthermia
Weight gain
Hypersalivation
34
Q

How can schizophrenia cause diabetes?

A

Associated with stress, and an increase of cortisol, which may increase the risk of diabetes
Antipsychotics (especially clozapine/olanzapine) cause weight gain/insulin resistance

35
Q

Which antipsychotics can cause hyperprolactinaemia?

A

Amisulpride
Risperidone
Typical Antipsychotics

36
Q

What is caused by hyperprolactinaemia?

A 
Galactorrhea
Menstrual irregularities
Sexual dysfunction
Osteoporosis
Increased risk breast cancer
37
Q

Good prognostic factors in schizophrenia

A 
Absence of family history
Good premorbid function - stable personality, stable relationships
Clear precipitant
Acute onset
Mood disturbance
Prompt treatment
Maintenance of initiative, motivation
38
Q

Poor prognostic factors in schizophrenia

A

Slow, insidious onset and prominent negative symptoms are associated with a worse outcome
Shorter life expectancy is linked to cardiovascular disease, respiratory disease and cancer
Suicide risk is 9 times higher
Death from violent incidents is twice as high
Poorer if starts in childhood

39
Q

Which antipsychotics are more likely to cause tardive dyskinesia?

A

Typical antipsychotics

40
Q

Which antipsychotics are more likely to cause weight gain and diabetes?

A

Typical psychotics

41
Q

Third generation antipsychotics

A

Aripiprazole

42
Q

What are the cardiac effects of antipsychotics?

A

QTc elongation

43
Q

Positive symptoms of schizophrenia

A

Hallucinations
Delusions
Disordered thinking

44
Q

Negative symptoms of schizophrenia

A

Apathy
Lack of interest
Lack of emotions

45
Q

Acute presentation of schizophrenia treatment

A

IV lorazepam

Psychiatry (9 decks)

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