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PSYCH (Psychiatry) > Schizophrenia & Psychosis > Flashcards

Schizophrenia & Psychosis Flashcards

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1
Q

Antipsychotics - Indications (3)

A
  1. Urgent Treatment of Severe Psychomotor Agitation (Violent Behaviour) to Continue Assessment.
  2. Schizophrenia.
  3. Bipolar Disorder (Acute Episodes of Mania/Hypomania).
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2
Q

Antipsychotics (Typical) - Indications (4)

A
  1. Psychomotor Agitation.
  2. Schizophrenia (when Metabolic Side Effects of Atypical Antipsychotics are Bad).
  3. Bipolar Disorder.
  4. Nausea & Vomiting (especially in Palliative Care).
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3
Q

Antipsychotics (Atypical) - Indications (3)

A
  1. Psychomotor Agitation.
  2. Schizophrenia (if Negative Symptoms).
  3. Bipolar Disorder.
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4
Q

Antipsychotics - Mechanism of Action

A

Dopamine Antagonists (Block Post-Synaptic D2 Receptors) - main effect is on Mesolimbic/Mesocortical Pathway.

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5
Q

Dopaminergic Pathways of CNS (3)

A
  1. Mesolimbic/Mesocortical (Midbrain - Limbic System/Frontal Cortex).
  2. Nigrostriatal Pathway (Substantia Nigra - Corpus Striatum of Basal Ganglia).
  3. Tuberohypophyseal Pathway (Hypothalamus - Pituitary Gland).
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6
Q

Why can you use Typical Antipsychotics in Nausea & Vomiting?

A

D2 Receptors are found in the Chemoreceptor Trigger Zone.

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7
Q

Why might Atypical Antipsychotics have a lower risk of Extrapyramidal Symptoms and increased efficacy against Treatment-Resistant Schizophrenia/Negative Symptoms? (2)

A
  1. Higher Affinity for Other Receptors e.g. 5-HT.2A Receptors.
  2. ‘Looser’ Binding to D2 Receptors e.g. Clozapine, Quetiapine.
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8
Q

What are Extrapyramidal Side Effects?

A

Movement abnormalities that arise from blocking the Nigrostriatal Pathway.

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9
Q

Give 4 Extrapyramidal Side Effects.

A

AANT

  1. Acute Dystonic Reactions (Involuntary Parkinsonian Movements/Muscle Spasms) = Use Anticholinergics e.g. Procyclidine.
  2. Akathisia (State of Inner Restlessness) = Reduce Dose and Add Propanolol/Benzodiazepine.
  3. Neuroleptic Malignant Syndrome = Reduce Dose and Add Procyclidine.
  4. Tardive Dyskinesia (months/years later - pointless, involuntary, repetitive movements e.g. lip-smacking) = Use Tetrabenazine (MAO Depletor).
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10
Q

Give 4 Features of Neuroleptic Malignant Syndrome.

A

CRAP

  1. Confusion.
  2. Rigidity (Lead-Pipe Muscle).
  3. Autonomic Dysfunction.
  4. Pyrexia.
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11
Q

Give 5 other Adverse Effects of Typical Antipsychotics.

A
  1. Drowsiness.
  2. Hypotension.
  3. QT-Interval Prolongation.
  4. Erectile Dysfunction.
  5. Hyperprolactinaemia (Tuberohypophyseal Pathway).
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12
Q

Give 4 Metabolic Side Effects of Atypical Antipsychotics.

A
  1. Weight Gain (especially Olanzapine).
  2. Hyperglycaemia = Diabetes Mellitus.
  3. Hyperlipidaemia.
  4. Hypercholesterolaemia.
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13
Q

Give 2 Side Effects of Clozapine.

A
  1. Agranulocytosis (Severe Deficiency of Neutrophils).

2. Myocarditis.

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14
Q

Give 4 Examples of Typical Antipsychotics.

A
  1. Chlorpromazine.
  2. Thiothixine.
  3. Haloperidol.
  4. Supiride.
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15
Q

Give 5 Examples of Atypical Antipsychotics.

A

CORAQ.

  1. Clozapine.
  2. Olanzapine.
  3. Risperidone.
  4. Aripiprazole.
  5. Quetiapine.
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16
Q

Give 4 cautions/contraindications of Antipsychotics.

A
  1. Elderly (Sensitive so use Low-Dose).
  2. Dementia (Avoid - Increased Risk of Death/Stroke).
  3. Parkinson’s (Typical - Extrapyramidal).
  4. Cardiovascular disease (Avoid if on other QT Prolongers).
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17
Q

Why is Compliance usually Poor with Antipsychotics? (2)

A
  1. Lack of Insight.

2. Unpleasant Side Effects.

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18
Q

How can Compliance be Improved?

A

Depot Injections (Deep IM Injections of Oily Suspensions - Effective for 2-4 Weeks) - Only Available for Typical Antipsychotics and Risperidone.

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19
Q

Definition - Psychosis

A

A severe mental disorder in which thoughts and emotions are so impaired that contact is lost with external reality.

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20
Q

Clinical Features - Psychosis (3)

A

Delusions;
Hallucinations;
Lack of Insight.

21
Q

Definition - Delusions

A

Fixed False Beliefs Despite Contrary Evidence and Out of Keeping With Patient’s Social/Cultural Background.

22
Q

Definition - Hallucinations

A

Perceptions in Absence of a Stimulus - most commonly Auditory (Visual is common in Organic Psychosis).
Pseudohallucinations - patient realises that stimulus is not perceived from an external source e.g. “voices in my head”.

23
Q

MSE - Psychosis (ABSTPCI)

A 
A - Brightly Dressed (Hallucinations)
B - Restless and Distractable
S - Neologisms and Alogia
T - Content : Delusions
T - Form : Block/Withdrawal/Insertion; Passivity (External Control); Broadcasting (Others' are Aware); Disorder (e.g. Knight's Move Thinking, Loosening of Association, Word Salad).
P - Hallucinations.
C - Disoriented.
I - Lack of Insight.
24
Q

Delirium vs. Psychosis (4)

A

Delirium - Fluctuating consciousness, acute onset, visual hallucinations, co-morbidities.

25
Q

Psychosis Management - At Risk Patients

A

CBT - 1st line.

26
Q

Psychosis Management - Acute Episode

A

Oral Antipsychotic Medications.

27
Q

Psychosis Management - Chronic Symptoms

A

1st Line - Oral 2nd-Gen Antipsychotics.
2nd Line - Oral 1st-Gen Antipsychotics.
3rd Line - IM 2nd/1st-Gen Antipsychotics.
With any line, give psychosocial interventions and health maintenance.
* - Antidepressants/Ginkgo Extract/Ondansetron - Negative Symptoms.

28
Q

Definition - Schizophrenia

A

Chronic/Relapsing condition that presents in late teens or early 20s with psychotic symptoms; disorganisation symptoms and negative symptoms. These symptoms must occur for a significant part of a 1 month period and continuously over 6 months.

29
Q

Risk Factors - Schizophrenia (5)

A
  1. Family History (Strongest).
  2. African-Caribbean Ethnicity (Misdiagnosis, Institutional Racism, Cannabis Use, Social Disorganisation, Social Exclusion).
  3. Migration.
  4. Urban Environment.
  5. Cannabis Use.
30
Q

What are Schneider’s 1st Rank Symptoms of Schizophrenia? (4)

A

D-TAP :

  1. Delusions.
  2. Thought Disorders/Alienation (insertion, withdrawal, broadcasting).
  3. Auditory Hallucinations (2+ voices discussing in the 3rd person, thought echos).
  4. Passivity Phenomena (bodily sensations controlled by external influences).
31
Q

Give 2 Theories about Schizophrenia Aetiology.

A
  1. Increased Dopaminergic Activity in Mesolimbic Pathway (Positive Symptoms) and Decreased Dopaminergic Activity in Prefrontal Cortex Pathway (Negative Symptoms).
  2. Neurodevelopment : Enlarged Ventricles and Smaller/Lighter Brains.
32
Q

What are the Types of Schizophrenia?

A
  1. Type I - Acute, Positive Symptoms, Good Response to Neuroleptics, No Intellectual Impairment.
  2. Type II - Chronic, Negative Symptoms, Responds to Clozapine ONLY, Sometimes Intellectual Impairment.

Type I can progress to Type II after years.

33
Q

Schizophrenia Management

A 
1st Line - Oral Atypical Antipsychotics + CBT.
Regular Monitoring (CVD Risk and Weight).
34
Q

What is the commonest long-term adverse effect of Atypical Antipsychotic use?

A

Metabolic Syndrome :

Development of Glucose Dysregulation and Diabetes.

35
Q

What is de Clerambault’s Syndrome?

A

Erotomania; Delusion that someone is in love with you.

36
Q

What is Cotard Syndrome?

A

Delusion that you are dead.

37
Q

What is Othello Syndrome?

A

Delusional Jealousy (usually of a partner).

38
Q

What is Capgras’ Delusion?

A

Delusion that a close acquaintance has been replaced by an imposter.

39
Q

What is Charles Bonnet Syndrome?

A

Recurring hallucinations in those with impaired vision.

40
Q

What is an Oculogyric Crisis?

A

An acute dystonic reaction where there is sustained upward deviation of both eyes.

41
Q

Which Antipsychotic can reduce the seizure threshold most making seizures likely?

A

Clozapine.

42
Q

What can cause Clozapine levels to rise?

A

Smoking cessation. This should be discussed with a psychiatrist before stopping. Starting smoking or smoking more can reduce Clozapine levels.

Tar induces CYP450 Activity -> increased metabolism of Clozapine -> lower blood levels.

43
Q

What is Torticollis?

A

An acute dystonic reaction where there is “wry neck”; unilateral pain and deviation of the neck with pain on palpation and restricted range of motion.

44
Q

What is Echolalia?

A

Speech Disorder where the patient repeats the words or phrases used by another individual.

45
Q

What is Clang Association?

A

Speech Disorder where the patient’s speech is based on ideas only related by rhymes or being similar sounding.

46
Q

What is Catatonia?

A

The stopping of voluntary movement or staying still in an unusual position; commonly associated with Schizophrenia.

47
Q

What is Delusional Parasitosis/Ekbom Syndrome?

A

Delusion that they are infested with bugs.

48
Q

Give 5 poor prognostic factors of Schizophrenia.

A
  1. Strong Family History.
  2. Gradual / Late Onset.
  3. Low IQ.
  4. Prodromal Phase of Social Withdrawal (Negative Symptoms First).
  5. Lack of an Obvious Precipitant.

PSYCH (Psychiatry) (11 decks)

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