19 - Psychosis Flashcards

1
Q

What is the definition of psychosis?

A

Presences of hallucinations or delusions but patients have a lack of insight (don’t believe they are unwell)

This is not a diagnosis, it is symptoms

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2
Q

What is a hallucination?

A

- Perception of a stimulus without a stimulus e.g hearing, feeling, seeing

  • Visual are often due to a problem with the brain or the eyes
  • Normal to have hallucinations when going to sleep or waking up
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3
Q

What is a delusion?

A

A fixed false belief that is unshakeable and outside of cultural norms, e.g may think being spied on by the police

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4
Q

What are some different types of psychosis?

A
  • Schizophrenia
  • Drug induced
  • Affective
  • Post partum
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5
Q

What are the symptoms (first rank) of schizophrenia?

A

Thought withdrawal: patient believes someone is taking thoughts from their mind or broadcasting them

Delusional perceptions: seeing something and giving it a new meaning, e.g red traffic light means aliens are coming

Passivity experience: patient believes their body is being moved by an external force

Somatic hallucinations: patient can feel their insides moving

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6
Q

What are some of the different types of auditory hallucinations?

A

- Thought echo: hearing their thoughts echoed back to them

- Running commentary: someone is commenting on their actions e.g he is brushing his teeth and now sitting down

- Third person: voices referring to patient in third person and conversing with each other about the patient

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7
Q

What is thought withdrawal?

A
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8
Q

What are some other symptoms of schizophrenia apart from the first rank ones?

A

Often patients that are treated can be left with the negative symptoms

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9
Q

What are some organic causes of psychosis?

A
  • Delirium caused by infection
  • Hypercalcaemia
  • Acute drug/alcohol intoxication (amphetamines causing release of dopamine)
  • Post-ictal psychosis
    - Hyperthyroidism
    - Steroids
  • L-Dopa
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10
Q

iWhat is the pathophysiology behind schizophrenia in general?

A

- Too high dopamine binding to D2 receptors

  • Overactive mesolimib pathway and underactive mesocortical pathway
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11
Q

What is the mesolimbic and mesocortical pathway?

A
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12
Q

What are some of the brain changes that occur in a schizophrenic patient?

A
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13
Q

What is the neuropathology of schizophrenia?

A
  • Decreased pre-synaptic markers
  • Decreased oligodendroglia
  • Fewer thalamic neurones

Theory of aberrant connectivity

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14
Q

Apart from changes in the dopamine pathway, what other areas in the brain are affected in schizophrenia?

A
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15
Q

How is schizophrenia treated pharmacologically?

A

Typical Antipsychotics: (e.g haloperidol)

  • Block D2 receptors in all 4 dopaminergic pathways but mainly mesolimbic and mesocortical
  • Side effects from D2 antagonists, e.g parkinsonism

Atypical Antipsychotics (e.g clozapine)

  • Lower affinitity for D2 receptors so fewer side effects
  • Also block 5HT2 receptors
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16
Q

What are some of the side effects of antipsychotics?

A

Typical: parkinsonism (as involvement of substantia nigra) , get rid of positive symptoms but not negative

Atypical: impaired glucose tolerance, diabetes, weight gain, prolonger QT, hypercholesterolaemia, galactorrhea

Sexual dysfunction side effects due to lack of dopamine to inhibit prolactin production so hyperprolactinaemia

17
Q

Why do we get Parkinsonism if we overtreat a patient with a typical antipsychotic?

A
  • Decreased dopamine so increased inhibition on the thalamus so less glutamate going to excite the cortex
18
Q

What can happened to the movement of untreated schizophrenic patients and why does this occur?

A

Catatonia

  • Less GABA binding so loss of inhibitory effect (think about main pathway diagram)
  • Rare because we treat early
19
Q

What is the final dopaminergic pathway not mentioned?

A
20
Q

What are some side effects caused by the hyperprolactinaemia from antipsychotics?

A
  • Amenorrhoea
  • Galactorrhoea
  • Decreased fertility
  • Decreased libido
  • Long term osteoporosis
21
Q

Why is treating people with schizophrenia difficult?

A
  • They lack insight so often won’t take medication
  • Can give PO (inc orodispersible), short acting IM, depot long acting
22
Q

What are some good prognostic factors when diagnosed with schizophrenia?

A

Early treatment better prognosis

23
Q

What are some negative prognoses associated with schizophrenia?

A
  • Mortality 2x general population
  • Shorter life expectancy
  • Higher incidence of CVS, Resp Disease and cancer
  • Higher suicide risk and death from violent incidents
  • Higher rate of substance misuse and cigarette smoking
24
Q

When should you be careful prescribing the mood stabiliser sodium valproate?

A
  • To women of child bearing age as this drug affects folate synthesis so can cause neural tube defects if they fall pregnant
  • Should not prescribe to these patients unless they are involved in a pregnancy prevention programme
25
Q

What neurochemical changes occur in mania?

A
  • Increased dopamine, Ach and serotonin
  • Normal NA
26
Q

How do benzodiazepenes help anxiety?

A

They increases GABA which hyperpolarises cells with Cl- channels to decrease neuronal activity

27
Q

Jim is being treated with an IM injection of antipsychotic, he has started to experience some unpleasant involuntary movements, what are these caused by?

A

Acute dystonia found in early treatment with antipsychotics

Can treat by giving anticholinergics and antihistamines

28
Q

What are the ICD-10 criteria for OCD diagnosis?

A
29
Q

What are the different subtypes of schizophrenia?

A
30
Q

Deep brain stimulation of the subthalamic nucleus in OCD patients will cause what effect?

A

Increased excitation of globus pallidus internus and substatia nigra pars reticulata

31
Q

What is hebephrenic schizophrenia?

A

Shallow and inappropriate emotional responses, foolish or bizarre behaviour