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Year 4 - Pysch > Psychotic Disorder > Flashcards

Psychotic Disorder Flashcards

1
Q

in what condition is psychosis common seen in?

A

schizophrenia

schizoaffective disorder

affective disorder (main, depression, can have depression induced psychosis)

organic states - dementia, pseudodementia, delium, metabolic disorders

psychoactive substance ( alcohol, drugs)

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2
Q

what has schizophrenia been called otherwise

A

splinting of the the mind

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3
Q

what is Schnieder’s first rank symptoms

A

a group of symptoms that are highly suggestive of the diagnosis of schizophrenia (no exclusive and can be observed in other conditions eg organic and affective psychoses

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4
Q

what are the different Schnider’s first rank symptoms

A

12 in total

auditory hallucination

  • third person - patient hears voices of > 1 person discussing matter between themselves
  • running commentary
  • gedankenlautwerden - thoughts are heard as they are being formulated
  • echo de la pensee - thoughts are heard shortly after they are formulated

delusions of thought control

  • insertion
  • withdrawal
  • broadcasting

delusion of control (passivity)

  • passivity of affect
  • passivity of volition (process by which a person decides upon action)
  • passivity of impulses
  • somatic passivity

delusion perception
- pt attributes delusional significance to normal percepts

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5
Q

definition for delusion

A

fixed belief that is held in face evidence to contrary and cannot be explained by culture or religion

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6
Q

definition of hallucination

A

percept that arise in absence stimulus, not subject to conscious manipulation,

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7
Q

definition of pseudo hallunicatio

A

a sensation that is considered to be hallucination but patients that it is not real

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8
Q

life-time prevalence of schizophrenia? Sex ratio

A

1 %
M = F - tends to affect young men and affect them more severely

mean men age - 28
mean women age - 32

higher in migrational population

higher in those who are born in winter

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9
Q

geography prevalence for schizophrenia?

A

tends to be higher in urban area - 2 theories, schizophrenic patients tends to move to city to get treatment or people more stress in city and so schizophrenia

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10
Q

what are the genes related to Schizophrenia

A

dysbindin (chromosome 6p)

neuregulin 1 (8p)

G72 (13q)

although genetics and environments have equal effect

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11
Q

what is the risk increased if you have a family member who has schizophrenia

A

60% of patients will not have a family history

one parent affected 10% risk
both parents affected - 40% risk
sibling - 10%

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12
Q

what is the main hypothesis aetiology of dopamine hypothesis

A

thoughts to be results from increased levels of dopamine in brain - amphetamines inc dopamine release and result in schizophrenic symptoms + effective anti-psychotics are anti-dopaminergic agents

+ve symptoms - resulted from dopamine over activity in mesolimbic system

-ve symptoms - resulted from dopamine under-activity in mesocortical system

nigrostriatal tract - extrapyramidal SEs of antipsychotic

tuberoinfundibular tract - endocrine SEs of antipsychotic

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13
Q

what are the smaller hypothesis aetiology of dopamine hypothesis

A

disconnection hypothesis - disconnection arise from within the brain and so more psychotic symptoms arise

neuro-developmental hypothesis - neurodevelopmental process rather than neurodegenerative effect eg seasonal birth effect - babies born exposed to influenza so less developed

life events and background stressors

cannabis and drug users - cannabis smoker 6x more likely to develop, other drugs also associated

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14
Q

clinical features of schizophrenia

A

insidious prodromal phase - can last several years, subtle, non specific problem in language, cognitive ability, behaviour - loss of function
have +ve and -ve symptoms

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15
Q

what are the +ve symptoms of schizophrenia

A

delusion
hallucination
thought disorder
lack of insight

same as the first rank symptoms

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16
Q

what are another name for +Ve symptoms of schizophrenia

A

acute phase symptoms

first rank symptoms

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17
Q

what is another name for -ve symptoms of schizophrenia

A

chronic symptoms

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18
Q

what are the -ve symptoms of schizophrenia

A

flat affect/blunt affect - nothing when stimulated

alogia - lack of speech

anergy

avolition - lack of drive

anhedonia

attention impairment

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19
Q

what is the condition call when it is chronic schizophrenia

A

deficit syndrome

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20
Q

what is the ICD-10 diagnostic criteria for schizophrenia

A

based up schneider’s first symptoms

min. 1 very clear symptoms from the Schnider’s first rank symptoms for > 1 month

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21
Q

what are the ICD-1o diagnostic criteria for acute-schizophrenia-like psychotic disorder

A

< 1 month during of 1 very clear Schnider’s first rank symptoms

or

2 symptoms from

  • persistent hallucination in any modality
  • breaks in train of thought resulting in incoherence (loosening of assoication , irrelevant speech, neologism)
  • catatonic behaviour - excitable and activity v.v.v inc or opposite mutism/stupor

present of -ve symptoms

significant and consistent change in overall quality of personal behaviour, loss of interest, aimless, idleness etc

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22
Q

what are the different subtype of schizophrenia according to ICD-10

A 
Paranoid schizophrenia
Hebephrenic Schizophrenia 
Ctatonic schizophrenia 
Undifferentiated schizophrenia 
Postschizophrenic depression 
Residual schizophrenia 
Simple schizophrenia
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23
Q

what is the common feature of paranoid schizophrenia

A

this is the most common type of schizophrenia

stable paranoid delusions, accompanied by hallucinations and perceptual disturbances

disturbance of affect, volition and speech

catatonic symptoms not prominent

can be episodic or chronic disease

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24
Q

what is the common feature of hebephrenic schizophrenia

A

it is most commonly described as disorganised schizophrenia

most commonly occur in adolescents

pre-morbid state often shy and solitary

marked prominent effective changes (mood up and down)

presence of -ve symptoms which develop rapidlly

incongruence of mood - giggling, self-absorbed smiling, lofty manner, grimaces, mannerisms, pranks

disorganised thoughts, rambling incoherent speech

delusions, hallucination fleeting

aimless behaviour

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25
Q

what is the common feature of catatonic schizophrenia

A

alternates between extremes of hyperkinesia with mutism/stupor

prominent psychomotor disturbances

echolalia (senseless and parrot-like imitation of examiner’s speech) /echopraxia (imitation of examiner’s body language)

posturing/sterotype/mannerisms/grimancing

extreme negativism/mutism

catalepsy or stupor

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26
Q

what is the common feature of undifferentiated schizophrenia

A

diagnosis reserved for conditions meeting general diagnostic criteria but not conforming to any of the above

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27
Q

what is the common feature of post-schizophrenia depression

A

a depressive episode which prolongs or follows schizophrenia

must have schizophrenia illness in the last 12 months. have some schizophrenic symptoms still presents

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28
Q

what is the common feature of residual schizophrenia

A

must have a clear progression from an early stage
- later stage characterised by long term negative symptoms

laster stage should have lasted 12 months

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29
Q

what is the common feature of simple schizophrenia

A

insidious, pregressive development oddities of conduct and inability to meet demands, decline in total performance

-ve symtpoms schizophrenia develop wihtout being preceded by +ve psychotic symptoms, don’t usually have delusions or hallucinations and so hard to diagnose

30
Q

what are other subtypes of psychosis

A

acute and transient psychotic disorder - delusions and symptoms < 1 month

persistent delusional disorder - characterised by the development of a single delusion/ a set of related delusions that persist and life long (> 3 months)

induced delusion disorder - delusion shared by >2 people

schizoaffective disorder

31
Q

what are some organic disorders differentials for schizophrenia

A

if the acute onset of schizophrenic-like symptoms < 1 month, always excludes organic disorder first

delirium 
dementia 
stroke 
huntingtons disease 
CNS infection/head trauma 
temporal lobe epilepsy 
cushing's disease
32
Q

what are some psychiatric disorders differentials for schizophrenia

A 
psychotic depression 
vit B 12 deficiency 
SLE 
manic psychosis 
schizoaffective disorder 
personality disorder

drug induced - amphetamine, cocaine, cannabis, alcohol, LSD, L-dopa

33
Q

what is the key differentiation between depression and schizophrenia

A

in depression, they have something to worry about whereas in schizophrenia, they have ‘nothing’ to worry about

depression have volitation intact whereas schizophrenia will have no volitation

34
Q

investigation for schizophrenia?

A 
for first episode psychosis 
- full physical examination - incl neurological examiantion 
-serum/urine drug screen 
- LFT, U&amp;Es, FBC, glucose, TFTs
brain imaging if hx suggest eg trauma
35
Q

management of schizophrenia

A

biopsychoscoial

bio

  • anti-psychotic - atypical/then typical then clozapine
  • other drugs and ECT
  • psychosocial treatment (CBT) for patient and family for family intervention therapy

pharmacological use -

stage 1 - single SGA/FGA with psychological interventions

stage 2 - a trial of a single SGA or FGA different to the one used in stage 1

stage 3 - clozapine

stage 4 - clozapine + FGA/SGA (trial of up to 8-10 weeks)

stage 5 - a trial of a single SGA/FGA (ones that not tried before)

stage 6 - time limited combination therapy - SGA+FGA

36
Q

which antipsychotic will you go for if resistant schizophrenia

A

clozapine

37
Q

what is the general time scale of effect of antipsychotics

A

hours = tranquilising effect - patient falls asleep

days = side effect

weeks/months = antipsychotic effects

38
Q

what investigation must be done before starting

A

ECG to check any heart strain since antipsychotics causes inc QR intervals

39
Q

what is aripizole

A

it is a new third line agent that is thought to be more effective than other and v. good efficacy at +ve/-ve symptoms and affective symptoms. also better tolerated

SE = N+v and lightheadedness

no extra-pyramidal SE/weight gain/hyperprolactinemia

40
Q

Prognosis of schizophrenia

A

1/3 rule

1/3 recover and live normal lives
1/3 improve but continue to experience significantly symptoms
1/3 do not improve, frequently hospitalisation

41
Q

What are some of the RF for bad prognosis from schizophrenia

A 
Unmarried 
Insidious onset 
Early onset 
No precipitating factor 
-ve symptoms 
Male 
FHx 
Substance misuse 
Poor support 
Delayed treatment/non-compliance
42
Q

What are other types of schizophrenia/schizophrenia-related disorder?

A 
Schizotypal disorder 
Brief psychotic disorder 
Schizoaffective disorder 
Persistent delusional disorder 
Schizophreniform disorder 
Late parephrenia 
Induced delusional disorder
43
Q

Description of schizotypal disorder

A

Personality disorder

Eccentric behaviour anomalies thinking and affect similar to those in schizophrenia but less severe

First degree relatives of patients with schizophrenia are at an inc risk

44
Q

Description for brief psychotic disorder

A

Like acute schizophrenia episode, prominent +ve symptoms < 1 month

Complete recovery often the case

Onset rapid, sudden typically proceeded by stress

45
Q

Description of schizophreniform disorder

A

Stable psychotic symptoms that fulfill the criteria for 1-6 months

46
Q

Description of late paraphrenia disorder

A

Late onset schizophrenia

Prominent hallucination, delusion are common

-ve / catatonic symptoms are rare

47
Q

What is schizoaffective disorder

A

When symptoms of both schizophrenia and affective disorder are present

Splits into 3 types
Manic type
Depressive type
Mixed type

48
Q

How do you differentiate between major depressive psychosis and schizoaffective disorder

A

Schizoaffective disorder occurs when symptoms to schizophrenia occurs > 2 weeks before the onset of affective symptoms

Symptoms of affective disorders must also be present for a significant length of time of the illnesses

49
Q

What are some differentials for schizoaffective disorder

A 
Drug induced (cannabis) 
Organic disorder (hypothyroidism, delirium, HIV) 
Medication SE
50
Q

What must you exclude before diagnosis of schizoaffective disorder

A

Depression ie any major life/emotion event which could cause depression

51
Q

Ix for schizoaffective disorder

A 
FBC
CRP 
Urine/blood screen for toxicology 
CXR for elderly who might be in delirium due to pneumonia 
TFT 
HIV
52
Q

Management of schizoaffective disorder?

A

Urgent hospital admission

Biopsychosocial treatment - same as schizophrenia

53
Q

How common is delusional disorder

A

Uncommon but not rare 1-2%

54
Q

What is delusional disorder

A

It is unshakable believes despite evidence without any signs of thought disorder, hallucinations and mood disturbance or significant of flattering of affect > 3months (ICD-10)

55
Q

What are the different types of delusional disorder

A

Monothematic - associated to have delusion about a single topic

Polythematic - associated to have delusions associated with multiple of topics

56
Q

What are the aetiology of delusional disorder

A

Distinctly different to affective or psychotic disorder

Biology - excess of dopamine and reduce of ACh, brain trauma

Psycho - defence mechanism

Social - stress, distrust/suspicious, jealousy, lowered self-esteem

57
Q

What acre some of the questions you can ask to distinguish between delusions and over-valued ideas

A

Degree of plausibility
Evidence of systemisation, complexity and persistence
Impact of belief on behaviour
Allowing for the possibility that they might be culturally beliefs

58
Q

What are the clinical features of delusional disorder

A

Level f consciousness unchanged
No thought disorder - although can be circumscribed to a single subject
Normal affect - no flattening/blunt of affect
Non-blizzard delusions
Hallucinations might occur but generally no prominent and reflect delusional ideas

59
Q

What must you do when assessing for delusional disorder

A

Risk assessment to prevent one to harm oneself or others

60
Q

Management of delusional disorder

A

Although there is a degree of dopamine affectance - antipsychotic of limited use, SSRI limited use, Benzo when mixed with anixety

Separation from source of delusion if possible

CBT, supportive therapy

61
Q

what is induced delusional disorder

A

delusional disorder that is shared by 2 or more people

62
Q

what are the different types of delusional disorder

A

Folie impose

folie a communique

folie simultante

folie induite

63
Q

what is folie impose

A

when pt A suffer from primary psychotic disorder - if seperated patient B will lose delusion

64
Q

what is folie a communique

A

only A suffers from the primary psychotic disorder but B continues even after separation

65
Q

what is folie simultante

A

both A and B have primary delusional disorder but happen to have the same delusion

66
Q

what is folie induite

A

A and B both suffer and transfer delusions to each other

67
Q

what is othello delusion

A

very jealous, delusional belief that the partner is cheating despite zero evidence. interpret every little minor/major detail

v/ high risk of stalking and violence

68
Q

what is De Clerambaults delusion

A

when a person delusionalise someone famous is in love with oneself and can not contact them directly but do so with secret signals

69
Q

what is fregolis delusions

A

when one believe that they are several people but change their appearance

70
Q

what is capgras delusion?

A

when one believes that someone close to them has been replaced bt an imposter

71
Q

what is cotards sydnrome

A

it is when one believe that one has dead or non-existence, feel as thought part of their body has gone missing or are rotting

associated with depressin

72
Q

what is ekbomas

A

delusional parasitosis

feel as though they have bugs crawling underneath the skin, risk of self-harm trying to ‘get rid’ of the bug crawling under skin

Year 4 - Pysch (6 decks)

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