Psychosis Flashcards
(44 cards)
1
Q
Outline the prevelance of delirium (5).
A
- 20% of acute hospital patients > 65 have delirium on admission
- 30% of patietns on wards have delirium
- 80% of patients in intense care have delirium
- 50% of delirium patients are hypoactive
- 50% of delirium patients go undetected
2
Q
What are the predisposing factors of delirium (9)?
A
- Impaired activities of daily living
- Dementia
- Urinary catheterization
- Sensory impairement
- Advanced age
- Malnutrition
- Immobility
- Depression
- Alcohol
3
Q
What are the causes of delirium (14)?
A
- Infection (urine / pneumonia / cellulitis / wound etc.)
- Change in environment (ITU / HDU / ward)
- Medication (opiates / anticholinergics / steroids)
- Liver / Renal impairement
- Alcohol withdrawl
- Hyponatraemia
- Surgery
- Pain
- Hypoxia
- Encephalitis
- Constipation
- Dehydration
- Urine detection
- Stroke
4
Q
How is delirium managed (6)?
A
- Anticipate
- Early diagnoses
- Treat the causes
- Modify risk factors if possible
- Medication
- Good nursing (Single room / Well lit / Familiar staff & family)
5
Q
What is stigma?
A
- Refers to challenges faced by people with mental illness related to knowledge, attitudes and behaviour of people they meet
6
Q
What are the causes of stigma (3)?
A
- Poor understanding of mental health
- Negative attitude
- Social exclusion
7
Q
What are the 3 types of stigma?
A
- Intrapersonal stigma
- Interpersonal stigma
- Structural stigma
8
Q
What is intrapersonal stigma (2)?
A
- Direct effect on the individual
- Internalised discrimination
9
Q
What is interpersonal stigma (3)?
A
Stigma from:
- Family
- Friends
- Colleagues
10
Q
What is structural stigma (2)?
A
- Poor resources & funding
- Access to physical healthcare
11
Q
What is delirium?
A
- Organic syndrome characterised by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion and the sleep-wake schedule
- The duration is variable and the degree of severity ranges from mild to very severe
12
Q
What is psychosis?
A
- A group of mental illnesses that features a difficulty perceiving and interpreting reality
13
Q
Which type of mental illnesses are associated wit psychosis (7)?
A
- Schizoaffective disorder
- Bipolar I
- Schizophrenia (1%)
- Delusional disorder
- Depression with psychotic features
- Substance related
- Due to other medical condition
14
Q
What is the epidemiological onset of psychosis?
A
- Can occur at any age
- Peak incidence in adolesence / early 20s
- Peak later in women
15
Q
Outline the course of psychosis.
A
- Often chronic & episodic
- Very variable
16
Q
Outline the morbidity of psychosis (2).
A
- Increased risk of common health problems (e.g. heart disease)
- Significant impact on education, employment & functioning
17
Q
Outline the mortality of psychosis (2).
A
- All - cause mortality 2.5 time higher (~15 years of life expectancy lost)
- High risk of suicide in schizophrenia ~ 28% of excess mortality
18
Q
What are the genetic risk factors for psychosis & schizophrenia?
A
- Schizophrenia is highly heritable
- Psychosis is highly polygenic
19
Q
What are the environmental risk factors for psychosis (6)?
A
- Cannabis and drug use
- Maternal infections
- Migrant status
- Socioeconomic deprivation
- Childhood trauma
- Prenatal / birth complications
20
Q
What type of symptoms typically precede psychosis?
A
-
Prodromal symptoms
- Changes in social behaviour, social withdrawal and impairments in functioning
21
Q
What are the 3 domains of psychosis symptoms?
A
- Positive symptoms
- Negative symptoms
- Disorganisation
22
Q
What are the 2 main positive symptoms of psychosis?
A
- Hallucinations (Percepts in absence of stimulus)
- Delusions (Fixed, false believes, out of keeping with social / cultural background)
23
Q
What are hallucinations in psychotic patients (6)?
A
- Auditory
- Voices commenting on you
- Voices talking to each other
- Visual
- Somatic/tactile
- Olfactory
24
Q
What are delusions in psychotic patients (11)?
A
- Persecutory
- Control
- Reference
- Mind reading
- Grandiosity
- Religious
- Guilt / Sin
- Somatic
- Thought broadcasting
- Thought insertion
- Thought withdrawal
25
What are the 4 main negative symptoms of psychosis?
* Alogia
* Avolution / Apathy
* Anhedonia / Asociality
* Affective flattening
26
Define Alogia (2).
* Paucity of speech, little content
* Slow to respond
27
Define Avolution / Apathy (3).
* Poor self-care
* Lack of persistence at work / education
* Lack of motivation
28
Define Anhedonia / Asociality (3).
* **Disengaged interest** and **pleasure within conducting activities**
* Few close friends
* Few hobbies/interests
* Impaired social functioning
29
Define Affective flattening (5).
* Unchanging facial expressions
* Few expressive gestures
* Poor eye contact
* Lack of vocal intonations
* Inappropriate affect
30
What are the 2 main forms of disorganisation symptoms?
* **Bizarre** behaviour
* Thought **disorder**
31
What is classified as bizarre behaviour (4)?
* Bizarre **social** behaviour
* Bizarre clothing / **appearance**
* **Aggretion** / agitation
* **Repetitive** / sterotyped behaviours
32
What is classified as thought disorder (5)?
* **Derailment**
* **Circumstantial** speech
* **Pressured** speech
* **Distractibility**
* **Incoherent** / illogical speech
33
How is psychosis diagnosed (2)?
* Psychiatric History
* Mental State Examination (MSE)
34
What is included in a psychiatric history (5)?
* History of presenting concern **(HPC)**
* Past psychiatric history **(PPH)**
* **Background history** (family, personal & social)
* Past medical history and medicine **(PMH)**
* **Corroborative history** (Requires consent)
* Educational, occupational history, relationships, separation, childhood illness
35
What is included in a social history (4)?
* **Living** arrangements
* **Financial** issues
* **Alcohol** and **illicit** **drug** use
* **Forensic** history
36
What is included in a mental state examination (6)?
* Appearance and behaviour
* Speech
* Mood
* Thoughts
* Perceptions
* Cognition
37
What additional sources of information are available to support a diagnosis of psychosis (2)?
* **Collateral history** from family, friends and work
* **Healthcare records:** GP, Mental health services
38
What is insight in terms of assessing a patient's mental state (4)?
* **Awareness of onself** as presenting phenomena that other people consider abnormal
* **Recognition** that these **phenomena** are **abnormal**
* **Acceptance** that these **abnormal phenomena** are **caused by mental illness**
* **Awareness** that **treatment** is **required**
39
What difficulties are encountered when treating someone with very poor insight into their psychosis (3)?
* **Concordance** with treatment
* **Attendance** at follow-up
* Would **not stay in hospital**
40
What are the differentials for psychosis (6)?
* Delirium
* Schizophrenia
* Personality disorder
* Dementia
* Drugs
* Encephalitis (behavioural changes)
41
What are the 3 types of psychosis management?
* **Pharmacological**
* **Psychological** (CBT and avatar therapy)
* **Social** support
42
What is the pharmacological management of psychosis (1)?
* Antipsychotic medications
| Depends on patient
43
What is the psychological management of psychosis (2)?
* CBT for psychosis
* Newer therapies also avaialble (i.e. avatar therapy)
44
What is the social support management of psychosis (3)?
* Supportive environments, structures and routines
* Housing, benefits
* Support (i.e. budgeting / employment)
