Psychosis Flashcards
what are the positive symptoms of schizophrenia
delusions
hallucinations
disorganized speech and thinking
what is the term where a patient feels that the TV or radio is sending him messages?
delusion of reference
OSCE: questions to explore a patient’s auditory hallucination
how many voices are there?
are they there all the time? How foten are there?
are they male or female?
what role do they adopt?
what do they say?
are there any command hallucinations?
are there any persecutory hallucinations?
what are the negative symptoms of schizophrenia?
lack of motivation poor self care blunted affect reduced speech output social withdrawal impaired cognitive function: impaired planning, reduced mental flexibility, impaired memory, impaired social cognition
what is the DSM-5 criterion for schizophrenia
2 or more of the following symptoms for > 1 mth period that affects individual's premorbid level of functioning in occupational and relationship: delusions hallucinations abnormal speech (has to have at least 1 of the above) disorganized behaviour negative symptoms
what is the treatment of first psychotic episode?
a. Further investigations: FBE, UEC, CMP, fasting blood glucose, lipids, TFT, prolactin, urine toxicology, CT/MRI of brian
b. Assess for self harm, harm to others
c. Assess need for hospitalization
d. Oral treatment:
i. Low dose oral second generation antipsychotics that is not sertindole or clozapine such as olanzapine, quetiapine, risperidone
ii. Can give low dose diazepam for anxiety, agitation, insomnia
what is the maintenance treatment of psychotic episode?
continue pharmacological treatment to adequate duration: maintain for 2 years if possible, and then taper over at least 3 months and monitor for relapses for the next 12 months
support with broadly based treatment programme: therapeutic alliance with patient, involving GP, case management, assertive community treatment
manage co-morbidities such as CVS, weight gain, hyperlipidemia, other preventive health measures
work with family and carers
what medications are useful for the treatment of negative symptoms of schizophrenia if initial medication
amisulpride OR clozapine OR olanzapine OR second generation anti-psychotics + anti-depressant clozapine + anti-depressant clozapine + lamotrigine
smelling burnt rubber, making chewing movements, funmbling with clothes, turning his head and upper body to the right.
partial complex seizure
what lobe of the brain is involved in the production of an olfactory hallucination?
temporal lobe (also causes derealization, mood lability, irritability, intermittent anger, behavioural dyscontrol)
what lobe of the brain is involved in the production of a visual hallucination?
occipital lobe
3 - 4 days hospitalized salesman, with no previous history of hallucinations, experiencing auditory hallucinations.
delirium tremens (from alcohol withdrawal)
what is the tx of akathisia?
propanolol / lorazepam NOT benztropine
what are good prognostic factors for schizophrenia
early onset acute onset females middle to high SES stable occupational records presence of precipitating factors rapid onset of disease
what are features of delusional disorder?
delusions lasting a month
no deterioration of psychosocial functioning
absence of bizarre or odd behaviour
can have hallucination (tactile, olfactory) but has to relational to the delusion
does not fit the criterion of schizophrenia
