- Mental disorder in the family - History of abuse, addiction, suicide - At home environment - Family relationship

Psychosis Flashcards by jessica wilcox

What is psychosis?

Difficulty perceiving and interpreting reality

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What 3 domains are symptoms classed into?

Positive symptoms
Negative symptoms
Disorganisation

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What is a hallucination?

Percepts in the absence of a stimulus

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What is a delusion?

Fixed, false beliefs, out of keeping with social/cultural background

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What are positive symptoms?

An aspect added onto their usual perception/experience

hallucinations and delusions

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What are negative symptoms?

The loss of an aspect of their perception of day to day living
(the 4 As)

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The 4As of negative symptoms?

Alogia
Anhedonia/asociality
Avolition/apathy
Affective flattening

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What are disorganisation symptoms?

Bizarre behaviour

- Thought Disorders

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What is the onset of psychosis?

can occur at any age
peak incidence in adolescence (early 20s)
tends to peak later in women

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What is the course of psychosis?

Often chronic and episodic

- Very variable (person to person)

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What is the morbidity of psychosis?

Substantial

both from the disorder and increased risk of common health problems
Large impact of education, employment and functioning

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What impact does psychosis have on mortality?

Substantial

loss of 15 years from life expectancy
High risk of suicide in schizophrenia - 28% (in excess)

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What to know about previous hospital admissions?

Whether the patient consented to the admission (were they detained by the mental health act)

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Family history?

Mental disorder in the family
History of abuse, addiction, suicide
At home environment
Family relationship

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Which drugs increase the risk of psychosis?

Skunk

- Cannabis

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Impact of steroids on mental health?

Very large and significant possible impact

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Corroborative history?

(Needs consent to divulge)

- Informants

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Mental State Examination?

Appearance + Behaviour
Speech
Mood
Thoughts
Perceptions
Cognition
Insight

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How to determine if there is pressure of speech?

Can you interrupt them?

If not, pressure of speech is indicated

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What comes first in psychotic depression?

The extreme depression causes the psychosis

unable to be challenged

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When should a cognition exam during a psychotic episode?

treat them first, then assess cognition

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What is involved in the long term management of psychosis?

community follow up
managing anti-psychotic side effects
health promotion/education

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What are the side effects of anti-psychotics?

CNS:
- EPSEs
- Sedation
Haematological
- Agranulocytosis
- Neutropenia
Metabolic
- Increased appetite
- Weight gain 
- Diabetes
Cardiac
- Dysrhythmia
- Long QT complex
Pituitary
- increased prolactin
GI
- Constipation

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What is Tardive dyskinesia?

Repeated oral/facial/buccal lingual movements

initially subtle - progesses to: tongue involvement, lip smacking

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What increases the risk of tardive dyskinesia?

- Long term antipsychotics | - Female

What causes ESPEs (extrapyramidal side effects)?

antipsychotics can cause a post-synaptic dopamine blockade in the extrapyramidal system (responsible for posture and tone)

What are the 4 main types of ESPEs?

- Parkinsonism - Acute Dystonia - Tardive Dyskinesia - Akathisia

What is Parkinsonism?

- Rigidity ('cog-wheeling') - Slow and shuffling gait - Lack of arm swing in gait (early sign) - 'pill-rolling' tremor (slow 4-6Hz movement of the thumb across the other fingers)

What is the difference between 'typical' and 'atypical' antipsychotics?

'typical' antipsychotics tend to cause ESPEs at therapeutic doses.

What is the management of ESPEs?

- avoidance (atypical antipsychotics first line) - change medication - anticholinergic medications can help

What is Dystonia?

- increased motor tone > sustained abnormal posture - can occur shortly after a dopamine antagonist - can be: acute, frightening, painful and fatal (laryngeal dystonia)

What is Akathisia?

- Inner restlessness - Feel compelled to move, but little/no relief - can lead to overt, relentless movement - most often affects legs

What causes reality distortion in psychosis?

Increased dopamine activity | elevated presynaptic dopamine in the striatum

What are most antipsychotics classed as?

Dopamine antagonists | occasionally partial agonists

What drugs can cause psychotic symptoms?

Dopamine agonists used to manage Parkinsons disease

What are the main 3 forms of treatment?

- Pharmacological - Psychological - Social support

What does psychological support of psychosis involve?

- CBT for psychoanalysis | - newer therapies (like avatar therapy)

What does social support involve after a psychotic break?

- supportive environments, structures and routines - housing, benefits - financial support

What is Insight?

- awareness and recognition that the presenting phenomena is abnormal - Acceptance that the abnormal phenomena is caused by mental illness - awareness that treatment is required and different treatment recommendations

What is cognition?

- Consciousness - Orientation (can they get to an appointment?) - Memory - Attention - Language functioning

What is the syndrome associated with visual hallucinations?

Charles Bonnet Syndrome

What is a pseudohallucination?

- When the mode of the hallucination does not mimic the real and locial action of the real mode of sensory input (eg: hearing)

What is involved in the Thoughts part of a mental exam?

- flight of ideas, association loss - Morbid thoughts, suicidal thoughts - primary and secondary delusions - obsessional thoughts and compulsions

What is the difference between primary and secondary delusions?

Primary: occurs suddenly Secondary: arises from previous abnormal idea/experience

What is the term used to describe a shared delusion?

folie à deux

Thoughts to flag?

- paranoia - grandiose/expansive - jealousy - obsessive control - possession of thought (insertion, withdrawal or broadcasting)

What are obsessional thoughts commonly associated with?

- dirt/contamination - orderliness - sex - religion

What do compulsions normally involve?

- checking - cleaning - counting - dressing rituals

Flags in mood?

- Emotional lability/incontinence - Reduced reactivity/blunting/flattening - Increased irritability - Congruity (happy when describing sad events?)

Flags in Speech?

``` Quantity - less/more/mutism Rate Latency Volume ```

Flags in appearance?

- neglect - weight loss - posture - facial expressions - movements - social behaviour

What does neglect indicate?

- alcoholism - addiction - dementia - depression - schizophrenia

What does weight loss often indicate?

- anorexia nervosa - depression - cancer - hyperthyroidism - financial distress

What does overactive/restless movements suggest?

mania/manic episode

What does inactive/slow movements suggest?

depression

What is involves in a past medical history?

- any regular medications? - compliance/adherence? - over the counter? - interactions?

What is involved in a personal history?

- birth difficulties? - early development, childhood trauma? - education and job history? - intimate relationships?

What is in a past psychiatric history?

- any known diagnosis? - any treatment? - known to a community team? - previous hospital admissions

What is Alogia?

- paucity of speech | - slow responses

What is Anhedonia/Asociality?

- few close friends - few hobbies and interests - impaired social function

What is Avolution/Apathy?

- poor self-care - lack of persistence at work/education - lack of motivation

What is Affective Flattening?

- Unchanging facial expressions - Few expressive gestures - Poor eye contact - lack of vocal intonation

What is bizarre behaviour?

- bizarre social behaviour - odd clothing/appearance - aggression/aggitation - repetitive/stereotypes behaviour

What is thought disorder?

- derailment - circumstantial speech - pressured speech - distractibility - incoherent/illogical speech

Psychosis Flashcards

(64 cards)