Psychosis Flashcards
(27 cards)
Definition of delusion?
Fixed, false, strange or irrational belief which is firmly held in spite of evidence to the contrary, and which is not normally accepted by other members of the same culture/group
What is a somatic delusion?
False belief that one’s bodily functions are abnormal- e.g. delusions of parasitosis, delusions of terminal illness
What are the three key features of psychosis?
Hallucinations
Delusions
Though disorder
Causes of increased morbidity/mortality in psychotic patients?
Suicide
T2DM (many antipsychotics cause weight gain)
Respiratory disease due to increased rate of smoking
Cardiovascular disease due to smoking, TD2M, sedation causing reduced activity, adverse lipid profile as a result of antipsychotics
Social exclusion e.g. don’t attend clinics
Psychosis is usually heralded by…
Gradual decrease in cognitive or social functioning, characterised by development of negative symptoms
Investigations which may be useful in undifferentiated suspected psychosis?
LFTs and macrocytosis might suggest alcohol misuse Urine toxicology Syphilis serology HIV serology CT head
What are the three main “categories” of psychosis?
- Affective psychosis e.g. severe depression, bipolar disorder
- Delusional psychosis e.g. schizophrenia
- Organic psychosis e.g. alcohol withdrawal
Risk factors for psychosis (5)
Early adulthood (80% age 16-30) Family history, particularly a first-degree relative Living in inner-city areas History of prolonged cannabis use BAME ethnicity
Commonest form of psychosis?
Schizophrenia
Important “organic” causes of psychosis
Drug-induced Temporal lobe epilepsy Encephalitis Dementia Delirium
First-line treatment in newly diagnosed schizophrenia?
Atypical antipsychotics e.g. risperidone, olanzapine
When should depot formulations be considered? (2)
Patient preference
Non-compliance with medication
Management of schizophrenia? (2)
Oral antipsychotic in combination with psychological therapy
Aim of treatment in schizophrenia?
Reduce acute phase symptoms and return patients to baseline level of function
Differences between first and second generation antipsychotics
2nd generation- act on a range of receptors, fewer EPSEs, lower risk of tardive dyskinesia. More likely cause weight gain and glucose intolerance
1st generation- act by blocking D2 receptors in the brain
Examples of atypical antipsychotics? (5)
Aripiprazole Risperidone Quetiapine Olanzapine Clozapine
Examples of EPSEs (4)
Parkinsonism (e.g. bradkinesia and tremor)
Dystonia
Akathisia (restlessness)
Tardive dyskinesia
a) Class of medication which can be used to reduce symptom burden from EPSE; b) example of drug
a) Anticholinergic
b) Procyclidine
Which type of EPSE is procyclidine not licensed for?
Tardive dyskinesia
Why do most antipsychotics cause hyperprolactinaemia?
Anti-psychotics are dopamine receptor antagonists, and dopamine inhibits prolactin release
Clinical manifestations of hyperprolactinaemia?
Sexual dysfunction Reduced bone mineral density Menstrual disturbance Breast enlargement Galactorrhoea Possibly increased risk of breast cancer
Cardiovascular/CVD risk side-effects of antipsychotics?
QTc prolongation
Hypotension
Weight gain and diabetes
Syndrome characterised by hyperthermia, rigidity, tachycardia, labile BP and sweating
Neuroleptic malignant syndrome
Monitoring of antipsychotics
- Baseline ECG
- Weekly weights for 6 weeks, then at 12 weeks, then yearly
- Routine bloods, fasting glucose, HBA1C and lipids at baseline, 12 weeks then yearly
