Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BRS PSYCHIATRY > 1b Psychosis > Flashcards

1b Psychosis Flashcards

1
Q

What is psychosis?

A
  • A group of mental illnesses that features a difficulty perceiving and interpreting reality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which type of mental illnesses are associated with psychosis (7)?

A
  • Schizoaffective disorder
  • Bipolar I
  • Schizophrenia (1%)
  • Delusional disorder
  • Depression with psychotic features
  • Substance related
  • Due to other medical condition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the epidemiological onset of psychosis?

A
  • Can occur at any age
  • Peak incidence in adolesence / early 20s
  • Peak later in women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Outline the course of psychosis.

A
  • Often chronic & episodic
    • Very variable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Outline the morbidity of psychosis (2).

A
  • Increased risk of common health problems (e.g. heart disease)
  • Significant impact on education, employment & functioning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Outline the mortality of psychosis (2).

A
  • All - cause mortality 2.5 time higher (~15 years of life expectancy lost)
  • High risk of suicide in schizophrenia ~ 28% of excess mortality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the genetic risk factors for psychosis & schizophrenia?

A
  • Schizophrenia is highly heritable
  • Psychosis is highly polygenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the environmental risk factors for psychosis (6)?

A
  • Cannabis and drug use
  • Maternal infections
  • Migrant status
  • Socioeconomic deprivation
  • Childhood trauma
  • Prenatal / birth complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What type of symptoms typically precede psychosis?

A
  • Prodromal symptoms
    • Changes in social behaviour, social withdrawal and impairments in functioning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 3 domains of psychosis symptoms?

A
  • Positive symptoms
  • Negative symptoms
  • Disorganisation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the 2 main positive symptoms of psychosis?

A
  • Hallucinations (Percepts in absence of stimulus)
  • ​Delusions (Fixed, false believes, out of keeping with social / cultural background)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are types of hallucinations in psychotic patients (6)?

A
  • Auditory
  • Voices commenting on you
  • Voices talking to each other
  • Visual
  • Somatic/tactile
  • Olfactory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are types of delusions in psychotic patients (11)?

A
  • Persecutory
  • Control
  • Reference
  • Mind reading
  • Grandiosity
  • Religious
  • Guilt / Sin
  • Somatic
  • Thought broadcasting
  • Thought insertion
  • Thought withdrawal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the 4 main negative symptoms of psychosis?

A
  • Alogia
  • Avolution / Apathy
  • Anhedonia / Asociality
  • Affective flattening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Define Alogia (2).

A
  • Paucity of speech, little content
  • Slow to respond
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Define Avolution / Apathy (3).

A
  • Poor self-care
  • Lack of persistence at work / education
  • Lack of motivation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Define Anhedonia / Asociality (3).

A
  • Disengaged interest and pleasure within conducting activities
    • Few close friends
    • Few hobbies/interests
    • Impaired social functioning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Define Affective flattening (5).

A
  • Unchanging facial expressions
  • Few expressive gestures
  • Poor eye contact
  • Lack of vocal intonations
  • Inappropriate affect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the 2 main forms of disorganisation symptoms?

A
  • Bizarre behaviour
  • Thought disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is classified as bizarre behaviour (4)?

A
  • Bizarre social behaviour
  • Bizarre clothing / appearance
  • Aggression / agitation
  • Repetitive / sterotyped behaviours
21
Q

What is classified as thought disorder (5)?

A

Lack of logical connection between thoughts
- Circumstantial thought (lots of extra irrelevant information)
- Tangential thought (goes of in a tangent)
- Flight of ideas (loosely connected train of thought/ connected by sounds, rhyming…)
- Derailment/loosening of association (string of random words)
- Word salad

22
Q

How is psychosis diagnosed (2)?

A
  • Psychiatric History
  • Mental State Examination (MSE)
23
Q

What is included in a psychiatric history (5)?

A
  • History of presenting concern (HPC)
  • Past psychiatric history (PPH)
  • Background history (family, personal & social)
  • Past medical history and medicine (PMH)
  • Corroborative history (Requires consent)
    • Educational, occupational history, relationships, separation, childhood illness
24
Q

What is included in a social history (4)?

A
  • Living arrangements
  • Financial issues
  • Alcohol and illicit drug use
  • Forensic history
25
Q

What is included in a mental state examination (6)?
ABC PTSD

A
  • Appearance and behaviour
  • Cognition
  • Perceptions
  • Thoughts
  • Speech
  • Disposition (Mood)
26
Q

What additional sources of information are available to support a diagnosis of psychosis (2)?

A
  • Collateral history from family, friends and work
  • Healthcare records: GP, Mental health services
27
Q

What is insight in terms of assessing a patient’s mental state (4)?

A
  • Awareness of onself as presenting phenomena that other people consider abnormal
  • Recognition that these phenomena are abnormal
  • Acceptance that these abnormal phenomena are caused by mental illness
  • Awareness that treatment is required
28
Q

What difficulties are encountered when treating someone with very poor insight into their psychosis (3)?

A
  • Concordance with treatment
  • Attendance at follow-up
  • Would not stay in hospital
29
Q

What are the differentials for psychosis (6)?

A
  • Delirium
  • Schizophrenia
  • Personality disorder
  • Dementia
  • Drugs
  • Encephalitis (behavioural changes)
30
Q

What are the 3 types of psychosis management?

A
  • Pharmacological
  • Psychological (CBT and avatar therapy)
  • Social support
31
Q

What is the pharmacological management of psychosis (1)?

A
  • Antipsychotic medications

Depends on patient

32
Q

What is the psychological management of psychosis (2)?

A
  • CBT for psychosis
  • Newer therapies also available (i.e. avatar therapy)
33
Q

What is the social support management of psychosis (3)?

A
  • Supportive environments, structures and routines
  • Housing, benefits
  • Support (i.e. budgeting / employment)
34
Q

What are some of the causes of psychosis?

A

Genetics - Genes predisposing to SCZ must also confer significant advantage

Developmental adversity/abuse - Biased cognitive schemas, sensitised striatal dopaminergic system, high expressed emotion - “double-bind” family dynamic

Neurodevelopmental - Prematurity, hypoxia, infection, winter/spring births

Life stressors - Stress-vulnerability model

Relationship with recreational drugs - Around 25% of psychosis

35
Q

In PET scans and post-mortem studies of someone with schizophrenia, what is there an excess of?

A

Striatal presynaptic dopamine

36
Q

What type of drugs usually are antipsychotics?

A

dopamine antagonists (but aripriprazole is a partial antagonist)

37
Q

Give the three dopamine pathways in neuroanatomy

A
  • Cerebrum- cortic and limbic
  • Striatum
  • Pituitary
38
Q

What is the effect of dopamine agonists like those used in parkinsons?

A

psychotic symptoms

39
Q

What is one of the main issues with dopiminergic drugs?

A

many side effects
(act on many neurotransmitters including serotonin, acetylcholine, histamine)

40
Q

what are the side effects of antipsychotics?

A
  • constipation
  • parkinsonism
  • akathisia
  • tardive dyskinesia
  • agranulocytosis, neutropenia
  • increased appetite, weight gain, diabetes
  • dysrhythmia, long QTc
  • hyperprolactinaemia
41
Q

Extrapyramidal side effects of antipsychotics

A

post-synaptic dopamine blockade in the extrapyramidal system (parts of the brain that enable us to maintain posture and tone)

Causes:
• Parkinsonism
• Acute Dystonia
• Tardive Dyskinesia
• Akathisia

42
Q

What is Parkinsonism?

A

• rigidity
• slow and shuffling gait
• Lack of arm swing in gait (early sign)
• ‘pill-rolling’ tremor

43
Q

What is dystonia?

A

• Increased motor tone -> sustained
abnormal posture

44
Q

What is Tardive dyskinesia?

A

• repeated oral/ facial/ buccal/ lingual
movements

45
Q

What is Akathisia?

A

• Inner restlessness
• Feel compelled to move, but does
little to alleviate

46
Q

Do Typical or Atypical antipsychotics cause extreme pyramidal side effects?

A

‘Typical’ antipsychotics commonly
cause extrapyramidal side effects

47
Q

First line medical treatment for
psychosis

A

• Avoid typical antipsychotics in the first place: atypical antipsychotics usually first-line
• Change medication
• Anticholinergic medications can help e.g. procyclidine

48
Q

What is Neuroleptic malignant syndrome?
How is it treated?

A

A medical emergency that typically occurs shortly after starting a new antipsychotic medication - stop medication and give dantrolene and benzodiazepines with IV fluids and dialysis.

BRS PSYCHIATRY (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions