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Psychiatry > Schizophrenia & Psychosis > Flashcards

Schizophrenia & Psychosis Flashcards

1
Q

How is Schizophrenia managed?

A

1st line: Antipsychotic (Olanzapine)- response 3-4weeks treated for at least 1year
Alternative: Depot monthly
Clozapine: Tx resistant
Antidepressants
Lithium
psychotherapy: CBT, family interventions, art therapy, relapse signature, reduce expressed emotion
Catatonic: ECT

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2
Q

How is a first episode of psychosis managed in GP?

A

Urgent referral to secondary care

Early assessment: Stage & severity, Crisis team, inpatient care

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3
Q

What are the indications of antipsychotics? How quickly do they work?

A 
Psychotic disorders
Other: Affective, neurotic, organic illness
SE: Hours-days
Work: Days-weeks
Tranquilizing: Hours
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4
Q

What is the MOA of antipsychotics?

A

Bind to and block post-synaptic dopamine receptors

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5
Q

What areas of the brain in the dopamine pathways are associated with the different symptoms?

A

Inc dopamine pathway mainly involved in pathophysiology
+ve symptoms: Mesolimbic (arousal, memory, behaviour)
-ve symptoms: Mesocortical (cognition, socialisation)
EPSE: Nigrostriatal (Modulation of EPS, voluntary movements)
Tuberoinfundibular: Regulation of prolactin

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6
Q

What is ‘Depot’?

A 
IM slow release antipsychotic
Good in chaotic & poor compliance
Initial dose then 14days then monthly
Oral meds required until steady state
Weeks-months to see effect of starting/stopping
RISPERIDONE/OLANZAPINE/PALIPERIDONE
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7
Q

What are the risk factors for relapse of illness?

A 
Presence of persistent symptoms
Low socioeconomic status
Exposure to high level of expressed emotion
Lack of insight
Substance use
Poor adherence to Tx regimen
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8
Q

What are the chances of Schizophrenia relapse whilst on treatment?

A

On continuous antipsychotic meds= 1/3

Stopping antipsychotics esp abruptly increases risk of relapse in short-medium term

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9
Q

In Schizophrenia what are the good prognostic factors?

A 
Female, married
Older age of onset
Good pre-morbid intelligence & personality
Fhx of affective disorder
Acute onset, affective symptoms
Rapid & effective response to Tx
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10
Q

In Schizophrenia what are the bad prognostic factors?

A 
Male, single
Early age of onset
Abnormal pre-morbid personality (Schizoid)
Fhx of Schizophrenia
Delay in Tx
Substance abuse
Insidious onset, negative symptoms
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11
Q

In what disorders is psychosis present?

A

Organic states (Delirium, Dementia, metabolic disorders)
Psychoactive substance misuse (intoxication & withdrawal states, Delirium Tremens)
Schizophrenia
Affective disorders (Depression, mania)
Sleep/sensory deprivation
Bereavement

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12
Q

What are the symptoms of Schizophrenia?

A 
\+ve: Hallucinations (esp auditory)
Delusions
Thought disorder
-ve: Avolition (lack of motivation)
Anhedonia (unable to experience pleasure)
Alogia (poverty of speech)
Asociality (lack of desire for relationships)
Affect blunt
Part of continuum of normal traits
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13
Q

What are the psychopathological phenomena seen in Schizophrenia?

A 
Diagnosis made if symptoms >1/12m
Thought echo
Thought insertion/withdrawal
Thought broadcasting
Delusional perceptions
Delusions of control/influence/passivity
Hallucinations 
Thought disorder
Negative symptoms
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14
Q

What is schizoaffective disorder?

A

Schizophrenic & affective symptoms are prominent at the same time
AKA: Patient meets the criteria for Schizophrenia & mood disorder at the same time

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15
Q

What are the different types of Schizophrenia?

A 
Paranoid
Simple
Hebephrenic
Undifferentiated
Catatonic
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16
Q

What are the signs & symptoms of Hebephrenic Schizophrenia?

A 
Early age of onset- POOR PROGNOSIS
Rapid development of -ve symptoms (flattening of affect & loss of volition)
Speech: Incoherent
Incongruent affect 
Delusions& Hallucinations
Fleeting & fragmentary
Behaviour irresponsible & unpredictable
Mannerisms common
Mood: Shallow & inappropriate
Thought disorder
Tendency to social isolation
17
Q

What are the signs & symptoms of paranoid Schizophrenia?

A 
Most common subtype
Relatively stable
Often paranoid delusions usually accompanied by hallucinations (auditory)
Perceptual disturbances
Inc suicide risk
18
Q

What are Schneider’s first rank symptoms of Schizophrenia?

A

HIGHLY suggestive of Schizophrenia in absence of organic disease
-Delusional perception & Somatic passivity- body influences
- Auditory hallucinations: 3rd person, running commentary, thoughts spoken aloud, present in all settings
-Thought alienation: Echo, withdrawal, broadcast, insertion
-Influences: Made acts, impulses, emotions
CAVIAT: Absent in 20% schizophrenics, present in other psych disorders (depression, mania)

19
Q

What are the ‘causes’ of Schizophrenia?

A

Genetics: Thought to be multiple genes involved
Environmental: Winter births, viral infection, CNS pathology (Neurosyphilis, encephalitis, temporal lobe epilepsy)
Life events: Social exclusion, childhood trauma, migration, urban living, negative attitude
Substance misuse: Cannabis, amphetamines
Peri-natal trauma: Hypoxia, maternal stress

20
Q

What are the types of delusional disorders? Describe them

A
  • Persecutory
  • Othello Syndrome: Morbid jealousy, partner having affair- no evidence, risk of stalking/violence, associated w/OH- or sexual dysfunction
  • De Clerambault’s Syndrome: Erotomania, belief another is in love with them, can’t declare love so communicate by signs
  • Capgras Syndrome: Misidentification, relative/spouse/friend replaced by identical imposter
  • Fregoli’s Syndrome: Different people are a single person who changes appearance/disguise, persecuted by that person
  • Cotards Syndrome: Dead, dying, non-existent, lost body parts, associated w/depression
  • Ekboms Syndrome: Parasitosis- infested w/parasites- no evidence, associated w/formication, risk of self-harm
  • Folie à deux: Induced, psychosis shared by 2 people
21
Q

What is a delusional disorder?

A

Long-standing delusions

Single or multiple related usually persistent

22
Q

What factors are not compatible with a diagnosis of delusional disorder?

A

Clear & persistent auditory hallucinations
Marked blunting of affect
Delusions of control
Definite evidence of brain disease

23
Q

What is Catatonic Schizophrenia?

A

Prominent psychomotor disturbances
Alter between extremes: Hyperkinesis & stupor
signs: Excitement, posturing, negativism, rigidity, wavy flexibility, perseveration of words, mutism
Episodes of violent excitment
Dream-like state w/vivid scenic hallucinations

24
Q

What is Simple Schizophrenia?

A

Insidious development fo -ve symptoms
Progressive development of oddities of conduct & decline in total performance
Inability ro meet demands of society
Characteristic negative features develop without any overt psychotic symptoms

25
Q

What is undifferentiated Schizophrenia?

A

Psychotic conditions meeting general diagnostic criteria

Not conforming to any subtypes

26
Q

What is somatic passivity?

A

Patient feels they are receiving bodily sensations from an outside agency (e.g alien twisting their intestine)

27
Q

What are the signs & symptoms of schizotypal disorder?

A 
Type of personality disorder:
Ideas of reference (differ from delusions in that some insight is retained)
Odd beliefs and magical thinking
Unusual perceptual disturbances
Paranoid ideation and suspiciousness
Odd, eccentric behaviour
Lack of close friends other than family members
Inappropriate affect
Odd speech without being incoherent
28
Q

What are the different types of personality disorders?

A 
Avoidant
Antisocial
Borderline
Dependent
Histrionic
Narcissistic
Obsessive-compulsive
Paranoid
Schizoid
Schizotypal
29
Q

How is a dissociative disorder characterised?

A

Loss of normally integrated concepts:
Self-identity
Memories
Awareness of the present
Control of bodily movements
MUST: Be some form of traumatic/interpersonal stress
AND: Absence of preexisting physical/psychiatric illness

30
Q

What is the theory of MOA of Schizophrenia?

A

Symptoms caused in part by central dopaminergic hyperactivity in mesolithic-mesocortical system.

31
Q

What is a sign associated with psychotic depression?

A

Nihilistic delusion- delusion that part of the patients body s rotting away (severe depression)

32
Q

Describe someone with a Schizoid type personality?

A

Prefer own company
Lack emotional expression (can be perceived as cold & disinterested)
Little interest in forming sexual/confiding relationships
May not gain pleasure from many activities

33
Q

What are the social theories related to Schizophrenia?

A

Lower socioeconomic group
Drift hypothesis
Life events
Cannabis use in adolescents

34
Q

What are the positive symptoms?

A 
Mesolimbic system affected
Delusions
Hallucinations
Bizarre behaviour
Formal thought disorder
35
Q

What are the criteria in ICD-10 to diagnose schizophrenia?

A

> 1: First rank symptoms
OR
2
Duration: >1months

36
Q

What are the causes of acute & transient psychotic disorders?

A

Duration: <1month
Acute schizophrenia
Drug induced psychosis
Acute polymorphic psychotic disorder (changing hourly)
PTSD
Personality disorder
Organic: Infection, Parkinson’s, temporal lobe epilepsy, hyperthyroidism, B12 deficiency

37
Q

What are the causes of Enduring psychotic disorders?

A 
Duration: >1month
Schizophrenia
Schizoaffective disorder
Persistent delusional disorder
Non-organic psychotic disorder
Psychosis associated w/mood disorder

Psychiatry (19 decks)

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