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NSB Lectures > TBL - identifying and managing psychosis > Flashcards

TBL - identifying and managing psychosis Flashcards

1
Q

What are the positive symptoms of psychosis?

A

Delusions, hallucinations, thought disorders.

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2
Q

What are the negative symptoms of psychosis?

A

Amotivation, social withdrawal, restricted affect (reduced emotional expression) and poverty of thought (reduced speech, not much content).

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3
Q

What is refractory schizophrenia?

A

Schizophrenic symptoms that have not responded to >2 types of antipsychotic drugs.

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4
Q

Refractory schizophrenic occurs in what percentage of patients?

A

30%

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5
Q

Which drug is the most effective in treating refractory schizophrenia?

A

Clozapine

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6
Q

Is psychosis more common in rural or urban areas?

A

Urban

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7
Q

Which antipsychotic increases the risk of extra-pyramidal side effects?

A

Chlorpromazine - a first generation antipsychotic, not routinely used.

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8
Q

Which drug would be most suitable in the management of first episode psychosis?

A

Olanzapine - a second generation antipsychotic.

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9
Q

Which dopaminergic pathway when hyper activated, contributes to the manifestation of positive symptoms of psychosis?

A

Mesolimbic pathway.

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10
Q

Which dopaminergic pathway when hyper activated, contributes to the manifestation of negative symptoms of psychosis?

A

Mesocortical pathway.

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11
Q

What is the ‘manic switch’ in bipolar?

A

The switch to manic symptoms from an episode of depressive symptoms. Increased risk of triggering this switch with treating depressive symptoms in bipolar.

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12
Q

In bipolar disorder, which mood stabiliser is given alongside an antidepressant, to reduce the risk of a manic switch?

A

Lithium

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13
Q

What type of side effects can occur if the nigrostriatal pathway is blocked?

A

Extrapyramidal

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14
Q

What is tardive dyskinesia?

A

A late onset movement disorder of lips and mouth. Can be a side effect of anti-psychotics.

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15
Q

What term describes sharp muscle spasms in the face and neck?

A

Acute dystonia

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16
Q

What is akathisia?

A

A sense of inner restlessness.

17
Q

Which term describes spasms of the extra ocular muscles leading to an upward deviation of the eye?

A

Oculogyric crisis.

18
Q

What are some risk factors for developing psychosis?

A

Childhood trauma
Substance misuse
Male
Urbanicity
1st/2nd trimester infection of malnutrition
Late winter/early spring baby
Paternal age >35
Maternal stress of influenza
Obststric complications
Poorer socioeconomic status
Childhood CNS infections

19
Q

What are the three main symptoms groups when assessing mental disorders?

A

Positive symptoms
Negative symptoms
Cognitive symptoms

20
Q

Which dopaminergic pathways are affected in psychosis?

A

Mesolimbic system
Mesocortical system

21
Q

How does psychosis affect the mesolimbic system?

A

Mesolimbic system involved in reward processing (pleasure) and salience (threat evaluation).
Psychosis causes dysfunction in the salience pathway, typically becoming hyperactive, resulting in positive symptoms.

22
Q

How does psychosis affect the mesocortical system?

A

Mesocortical system regulates the pre-frontal cortex (involved in cognition, motivation and social engagement).
Dysfunction makes it hypoactive and therefore reduced stimulation to pre-frontal cortex causes negative symptoms.

23
Q

What is the MOA of typical/1st generation anti-psychotics?

A

Dopamine antagonists

23
Q

What is the MOA of typical/1st generation anti-psychotics?

A

Dopamine antagonists

24
Q

What is the MOA of atypical/2nd generation anti-psychotics?

A

Dopamine and serotonin antagonists

25
Q

What is the MOA of atypical/3rd generation anti-psychotics?

A

Partial dopamine agonist

26
Q

Which type of antipsychotic produces less extrapyramidal side effects?

A

Atypical as they do not block the post-synaptic receptors for as long as 1st generation/typical.

27
Q

Which type of antipsychotic has an increased risk of cardio-metabolic symptoms?

A

Atypical

28
Q

What drug is an example of a atypical/third generation antipsychotic?

A

Aripiprazole

29
Q

Which symptoms do antipsychotics usually reduce?

A

Positive symptoms - they suppress pleasure and threat evaluation.

30
Q

Which non-pharmacological treatments can be used for psychosis?

A

CBT
Art therapy
Family intervention

31
Q

Why does clozapine need frequent blood monitoring?

A

There is an increased risk of neutropenia.

32
Q

Apart from neutropenia, which other major side effect can be caused by clozapine?

A

Constipation - caused by colonic hypomotility from the anticholinergic effect.
Can be serious and life-threatening.

NSB Lectures (48 decks)

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