Psychosis Flashcards
(93 cards)
1
Q
What is psychosis?
A
A collection of symptoms in which a patient experiences a significant alteration in perceptions, thoughts, mood and behaviour, involving an inability to distinguish between subjective experience and objective reality and characterised by a lack of insight
2
Q
What are the main symptoms psychosis?
A
Hallucinations Delusions Thought disorder Loss of insight Self-referential experiences Ideas of reference
3
Q
What is a hallucination?
A
A perception which occurs in the absence of an external stimulus
A misrepresentation of inner experience as having external origin
4
Q
What is a delusion?
A
A fixed, falsely held belief held with unshakeable conviction
5
Q
What is the difference between primary and secondary delusions?
A
Primary - arrive fully formed without need for explanation
Secondary - attempts to explain anomalous experiences
6
Q
Which is more common - primary or secondary delusions?
A
Secondary
7
Q
What are thought disorders?
A
Any disturbance in cognition that adversely affects language and thought content, and thereby communication
8
Q
What are examples of thought disorder?
A
Passivity phenomenon Thought interference Loosening of associations Knight's move thinking Neologisms Circumstantiality Tengentiality Verbigeration
9
Q
What is passivity phenomenon?
A
The feeling that the patient’s actions, feelings, urges aren’t their own
10
Q
What is thought interference?
A
The feeling that the patient’s thoughts not their own, being withdrawn, broadcast, blocked
11
Q
What is loosening of associations?
A
Speech is muddled, illogical, difficult to follow and cannot be clarified
12
Q
What is Knight’s move thinking?
A
Jumps from topic to topic with no logical connection between them
13
Q
What are neologisms?
A
An abnormality of speech in which the patient makes up a new word or phrase or uses existing words or phrases in bizarre ways which have no generally accepted meaning but which have idiosyncratic meaning to the patient
14
Q
What is circumstantiality?
A
When the patient talks around the point but gets there eventually
15
Q
What is tangentiality?
A
When the patient talks around the point and never actually gets to it
16
Q
What is verbigeration?
A
Individual words don’t connect and sentences make no sense whatsoever
17
Q
What are self-referential experiences (paranoia)?
A
The belief that external events are related to oneself
18
Q
How are persecutory thoughts different to paranoia?
A
Paranoia is when you think unrelated things are related to you
Persecutory is only when you think someone is out to get you/others
19
Q
What are ideas of reference?
A
Innocuous or coincidental events are ascribed significant meaning
20
Q
What are psychiatric causes of psychosis?
A
Schizophrenia
Scizoaffective disorder
Mania
Depression
21
Q
What are organic causes of psychosis?
A
Dementia Delirium Huntington's SLE Syphilis Hyperthyroidism Hypoglycaemia Parkinson's HIV/AIDS Syphilis
22
Q
What cause of psychosis do auditory hallucinations make more likely?
A
Schizophrenia
23
Q
What cause of psychosis do visual hallucinations make more likely?
A
Drugs
24
Q
What cause of psychosis do tactile hallucinations make more likely?
A
Delirium
Alcohol withdrawal
25
What drugs can cause psychosis?
```
Cannabis
Amphetamine
Levodopa
Steroids
Antimalarials
Anticonvulsants
Antipsychotics
Antidepressants
```
26
The withdrawal of which substances can cause psychosis?
Alcohol
| Benzodiazepines
27
What is the treatment for drug-induced psychosis?
Cessation of use of the causative drug - usually takes about 4 weeks
28
When are psychosis symptoms mood congruent?
In mood disorders
29
What are features of psychosis in depression?
Delusions of worthlessness, guilt, nihilism
Auditory hallucinations that are derogatory, insulting or threatening
Cottard's syndrome - belief that the body has already died
Typically second person
Affirming their perception of themself
30
What are features of psychosis in mania?
Delusion of grandeur, special ability, persecution, religiosity
Hallucination tend to be second person and auditory
Flight of ideas
31
What is schizoaffective disorder?
The diagnosis that bridges the gap between bipolar and schizophrenia
When psychosis and mood symptoms are present in equal measure
32
Who is schizophrenia most common in?
Men
Lower socioeconomic class
Onset in young adulthood
33
What is the aetiology of schizophrenia?
Multi-factorial neurodevelopment disorder
Genetics (80% inherited)
Environmental factors (obstetric complications, childhood CNS infection, early cannabis use)
Psychological factors (stress, adverse life events, psychoactive drug use)
34
What biological changes happen in schizophrenia?
Changes in dopamine signalling pathways in the brain
Lack of gliosis (reactive change of glial cells in response to damage to the central nervous system)
Ventricular enlargement and alteration fo CSF flow
Decrease in white matter volume
35
What are the 'first rank' symptoms of schizophrenia?
3rd person auditory hallucinations
Thought insertion, broadcast or removal
Passivity phenomenon
Delusions
36
Describe the hallucinations of schizophrenia?
3rd person auditory hallucinations that give a running commentary or discussion of the patient
37
Describe the delusions of schizophrenia?
Persistent
| Culturally inappropriate or completely impossible
38
What are the additional symptoms of schizophrenia? (other than first rank ones)
```
Other types of hallucinations
Incoherent or irrelevant speech
Neologisms
Breaks or interruptions in train of thought
Catatonic behaviour
Negative symptoms
```
39
What symptoms of schizophrenia are 'positive' symptoms?
Delusions
Hallucinations
Thought disorder
Passivity phenomena
40
What symptoms of schizophrenia are 'negative' symptoms?
```
Apathy
Social withdrawal
Self neglect
Poverty of thought
Reduced social performance
Blunted and incongruent affect
Reduced motivation
```
41
What is a 'blunted' affect?
Reduced outward display of emotions
42
What is an 'incongruent' affect?
React inappropriately to social circumstance
43
What are the prodromal symptoms of schizophrenia?
```
Gradual onset
Non-specific symptoms
Odd ideas and experiences
Eccentricity
Altered affect
```
44
What is the diagnostic criteria for schizophrenia?
At least 1 first rank
Or at least 2 additional symptoms
Present for at least 1 month
Not explained by another cause
45
When is schizophrenia diagnosed if the patient also meets the criteria for a manic or depressive episode?
If the schizophrenic symptoms were present before the disturbance of mood developed
46
What are the subtypes of schizophrenia?
```
Paranoid
Disorganised/hebephrenic
Catatonic
Simple
Undifferentiated
Residual
```
47
What is pathetic most common subtype of schizophrenia?
Paranoid schizophrenia
48
What is paranoid schizophrenia?
3rd person auditory hallucinations and delusional beliefs about self, with these often being persecutory
49
What is disorganised/hebephrenic schizophrenia?
Affective changes are prominent
Delusions and hallucinations are fleeting
Behaviour irresponsible and unpredictable
The mood is shallow and inappropriate, thought is disorganised, speech is incoherent
A tendency to social isolation and negative symptoms
50
What is catatonic schizophrenia?
```
Movement disorder predominates - characterised by unusual, limited and sudden movements
Mutism, stupor
Posturing
Negativism
Command automatism
```
51
What is posturing?
Maintenance of odd postures
52
What is negativism?
Resistance to command or attempts to be moved
53
What is command automatism?
The patient will do whatever you ask them to
54
What is simple schizophrenia?
Negative symptoms are most predominant early and worsen
Positive symptoms are rarely experienced
Rare
55
What is undifferentiated schizophrenia?
Some signs of paranoid, hebephrenic or catatonic but not obviously fitting into one type alone
56
What is residual schizophrenia?
When there is a history of psychosis but the patient currently only experiences the negative symptoms
57
What are good prognostic indicators for schizophrenia?
Female
Older age of onset
Family history of mood disorder
Marked mood disturbance, especially elation
58
What are bad prognostic indicators for schizophrenia?
```
Male
Early age of onset childhood, adolescence)
Insidious onset
Prolonged duration of undiagnosed psychosis
Poor premorbid adjustment in life
Co-morbid substance misuse
Social isolation
Cognitive impairment
Disorganised subtype
Multiple first rank symptoms
```
59
What is the mainstay of treatment for schizophrenia?
Antipsychotics (typical or atypical)
60
What are examples of typical antipsychotics?
Haloperidol
| Chlorpromazine
61
What is the mechanism of typical antipsychotics?
Block dopamine D2 receptors - they are dopamine antagonists
Results in inhibition of the mesolimbic and nigrostriatal pathways - where delusions, hallucinations, thought disorders arise
Reduce symptoms and prevent relapse
62
What are the side effects of antipsychotics?
```
Extrapyramidal side effects
Sedation
Neuroepileptic malignant syndrome
Hyperprolactinaemia
Akathisia
Anti-cholinergic effects
QT prolongation
Increased appetite and weight gain
```
63
What are the different extrapyramidal side effects?
Acute dystonia
Parkinsonism
Tardive dyskinesia
64
What is acute dystonia?
Painful, sustained contractions of muscles, usually in the eyes, jaw or neck
Occurs within a few minutes-hours of starting treatment
65
What is used to treat acute dystonia?
Procyclidine
66
What are the symptoms of parkinsonism?
```
Resting tremor
Shuffling gait
Reduced facial expressions
Cogwheel rigidity
Bradykinesia
```
67
What is tardive dyskinesia?
Repetitive, uncontrollable, involuntary contraction of the muscles of the face, tongue and upper body
Typically presents as excessive blinking, lip smacking, facial grimaces
Seen with long term use and is non-reversible
68
Are extrapyramidal side effects of antipsychotics seen more often with typical or atypical antipsychotics?
Typical
69
What is neuroleptic malignant syndrome?
Rare serious complication of typical antipsychotics
70
What is the presentation of neuroleptic malignant syndrome?
```
Increased muscle tone and bradykinesia
Pyrexia
Changing pulse/BP swinging from increased to decreased
> Rhabdomyolysis
> Acute renal failure
> Coma
> Death
```
71
What do blood tests show in neuroleptic malignant syndrome?
Raised WCC
| CK in the thousands
72
What is the management of neuroleptic malignant syndrome?
Stop antipsychotic
Rapid cooling, renal support
Skeletal muscle relaxants - e.g. dantrolene
Dopamine agonists - e.g. bromocriptine
73
Why do anti-psychotics cause hyperprolactinaemia?
Prolactin release inhibited by dopamine so dopamine antagonists cause increased release of prolactin
74
What are the symptoms of hyperprolactinaemia?
Women: galactorrhea, decreased libido, decreased arousal, anorgasmia, amenorrhoea, anovulation
Men: gynaecomastia, erectile dysfunction, oligospermia, decreased libido
Decreased bone mineralisation
Decreased bone density
Fractures
75
What is akathisia?
Restlessness
Pacing and unable to stand still
Leads to poor sleep
76
How is akathisia treated?
Beta blockers
| Benzodiazepines
77
What are anti-cholinergic side effects?
Dry mouth
Blurred vision
Constipation
78
What are examples of atypical antipsychotics?
```
Olanzapine
Quetiapine
Aripiprazole
Risperidone
Amisulpride
Clozapine
```
79
What is the mechanism of atypical antipsychotics?
Block D2 dopamine receptors
| And receptors for other neurotransmitters
80
Which side effects are most common in atypical antipsychotics?
```
Weight gain
Sedation
Hyperprolactinaemia
Sexual dysfunction
Increased risk of seizures
Extrapyramidal side effects
```
81
Which is the most effective antipsychotic?
Clozapine
82
When is clozapine used, and why?
Treatment resistant schizophrenia
| Bad side effects
83
What are the side effects of clozapine?
```
Agranulocytosis
Myocarditis
Weight gain
Sedation
Hypersalivation
Cardiomyopathy
PE
Constipation that can lead to gastric paresis, obstruction and perforation
```
84
What is treatment resistant schizophrenia?
Illness that does not respond to two adequate trials (6 weeks) of two different anti-psychotics, one of which was an atypical
85
What is needed for patients on clozapine?
Regular blood testing because of agranulocytosis
Hyoscine hydrobromide for treatment of hypersalivation
Titration to therapeutic dose
86
What type of antipsychotics are first line?
Atypical - but differs depending on which side effects are appropriate/inappropriate for different patients
87
What antipsychotic would you give to avoid extrapyramidal side effects?
An atypical
88
What antipsychotic would you give to avoid sedation?
Haloperidol
| Risperidone
89
What antipsychotic would you give to provide sedation?
Olanzapine
| Chlorpromazine
90
What antipsychotic would you give to avoid weight gain?
Haloperidol
| Aripiprizole
91
What antipsychotic would you give in treatment resistant schizophrenia?
Clozapine
92
What antipsychotic would you give if compliance is an issue?
Depot risperidone
93
Which other situations can antipsychotics be used in?
Anxiety - olanzapine
Bipolar as a mood stabiliser or for acute depression or mania
Rapid tranquilisation
