Shizophrenia + Psychosis Flashcards
What is psychosis
Inability to differentiate between symptoms of delusion / hallucination / disordered thinking from reality
What causes psychosis
Neurodevelopment Genetic Psychological Childhood experience / trauma Social - cannabis / migration / urvan Brain structure abnormality
What is a hallucination and in what senses
Experience with full force and clarity of true perception with No stimuli Auditory = most common Visual = associated with organic cause Tactile = drug Olfactory Gustatory
What is pseudo-hallucination and when is it common
Aware that you are hallucinating
Common when grieving
What is a delusion
Unshakeable idea or belief outwit person culture
Held with extra-ordinary conviction
Types of delusions
Paranoid Grandiose Nihilistic Hypochondrial Self-referential
What is a illusion
Misinterpretation of external stimuli
What else does psychosis present with
Thought disorder
What illness present with psychosis
Schizophrenia
Delerium
Severe affective disorder
Drug induced - cocaine / steroid
What is Charles-Bonnet
Persistent or recurrent hallucination in clear consciousness
Visual impairent
Insight preserved
What are RF for Charles bonnet
Age Visual - macular / glaucoma / cataract Isolation Decreased sensory Decreased cognition
What is Cotard
Patient believe they are dead so stop E+D
Very difficult to treat
Associated with severe depression
What is De Clerambault
Paranoid delusions
Single women believes a famous person is in love
Aetiology of Schizophrenia / R
M=F 15-35 Genetics / FH = biggest RF Cannabis smoking Childhood stress Life event may trigger Migration Urban environment Isolation Social class High EE family Malnurition Obstetric complication Maternal Flu
What genes associated
DiGeorge 22q11
CF
Neuroregulin
Dyslondin
What is neurochemistry in brain
Increased dopamine?
Decreased glutamate and GABA
What are changes in brain structure that can be found
Enlarged ventricle
Decreased frontal and temporal lobe
What is pre-morbid phase (notice when you look back)
Motor, cognitive and social difficulty
Anxiety
Mild paranoia
What is prodromal to an episode
Odd ideas and experiences
Altered affect
What is progression of disease
Single acute psychotic episode = 20%
Multiple = 40%
Chronic impairment = 40%
Increased risk of suicide
What are +ve symptoms of schizophrenia / 1st rank
Hallucination - auditory
Delusion
Thought disorder
Passivity
What are -ve symptoms (often chronic and poor response to Rx)
Apathy Poverty of speech Anhedonia Irritable Decreased attention Occupation and cognitive decline
What is needed to make Dx
> 1 month
Absence of organic / affective
At least one of 1st rank Sx
AND at least two of other Sx
What are 1st rank
Auditory hallucination
Delusional perception
Passitivity phenomena
Thought disorder
What are auditory hallucinations
Thought echo
Running commentary
3rd person discussing
What is delusional perception
Normal perception but misinterpreted
What is passivity
Body controlled by external force
Action / impulses and feeling
What is thought disorder
Thought echo
Thought insertion or withdrawal
Thought broadcasting
What are other Sx
Persistent hallucinations / delusions of any type Thought form disorder Catatonic behaviour - stopping voluntary movement Negative Sx Cognition Mood disturbance Circadian rhythm disturbance Occupational and social withdrawal
What is thought form
Flight of ideas - usually link Loosening of ideas - no link 'Knights' Neologism Ideas of reference - make events personal Clang - link words through sound Worrd salad - makes no sense
When is Flight more common in
Mania
What are examples of Catatonia
Posturing - stay in position themselves
Waxy flexibility - put in position
Mutism
Stupor
What suggests good prognosis
No FH Good pre-morbid Female Clear precipitant Late onset Acute Mood disturbed No -ve symptoms Prompt Rx No PMH No substance misuse Lack of life stressor Maintenance of initiative / motivation Good adherence to medication
What suggests poor prognosis
FH Male Low IQ SUbstance misuse Slow insidious onset Childhood onset Prominent -ve symptoms
What are DDX
Delerium Organic brain e.g. lung cancer Drug induced Delerium tremens Depression Mania Brain tumour / encephalitis / strok Personality disorder Anaemia SLE / Sarcoid
What suggests more likely organic
Visual hallucination Fluctuate Distubred consciousness Misidentify person Persecutory and evanescent delusion
What must you always exclude
Drug induced
Cocaine / steroid
What does depression tend to have
Delusions of guilt / worthlessness
Derogotary hallucination
Mania
Delusions of grandeur
What investigations do you do
Physical exam MMSE Blood - FBC, U+E TFT, glucose Urine for drug CT brain EEG - rare
CT brain indicated if
Elderly
New onset
How do you Rx
See pharmacology
Anti-psychotic 1st line
Wha can you use short term
Benzodiazepine
What is synergistic
Mood stabiliser
What is conservative measures
CBT - always offer
Social - SW / drug / housing / skills trainig
Family intervention
Address CVS risk
Treatment resistant
Clozapine
Police Place of Safety (section 136)
Person with mental disorder / suspicion
Risk of harm to self or others
Can take to place of safety - A+E,
What does mental health law do
Power to Rx people with mental disorder
Mental illness
Personality disorder
LD
What is emergency detention (section 4)
72 hours
NO RX
Used in emergency detention where only one doctor is available
Registered medical practitioner - not FY1
What is short term (section 2)
28 days
Can Rx
Approved medical (GP or 2+ doctor) + mental health officer
Can’t be renewed - may need section 3 after
What is compulsory treatment order (section 3)
Detention up to 6 months Allow Rx of mental illness Make application to tribunal 2 approved medical inc GP Can be renewed
Nurses holding power (section 5)
3 hours
What is criteria for detention under mental health act
Mental disorder Sig impairment in decision making for Rx Sig risk to health / safety / welfare of person or other Treatment available Order necessary and least restrictive
When do you use adults with incapacity act
Incapable of Making decision Acting on deciisoin Communicationg decision Understanding Retaining memory
What must you do when applying
Must benefit adult
Least restrictvie
Take in past and present wishes
Views of relatives / relevant other
When do you use
No-one to make decision
When can’t you use
Mental health
Intervention order
One off power
What is guardianship
Someone appointment to make decision
POA
Appointed when person had capacity
What is compulsion order
Same criteria as CTO
No requirement for impaired decision
What is assessment order
When going through court to assess
28 days
What does section 47 AWIA allow
Legalise Rx if can’t consent
If patient with LD needs invasive Rx what do you use
Section 47 AWIA
What is adult support and protection act
> 16
If unable to safeguard own well being
At risk of harm
Affected disability / mental or physical illness so more vulnerable
What is informal admission
Patient volunteers
