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Year 3 Psychiatry Block > Psychosis > Flashcards

Psychosis Flashcards

1
Q

Define Psychosis

A

a mental state in which reality is greatly distorted

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2
Q

Name the three prevalent features of Psychosis

A
  1. Delusions
  2. Hallucinations
  3. Thought Disorder
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3
Q

Define Delusions

A

fixed false beliefs despite being contradicted by reality

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4
Q

How many types of common delusions are there? Name and explain them.

A

7
1. persecutory - most common, person fears they will be harmed (they are being spied upon or poisoned)
2. grandeur - believes they are much greater or more influential than they really are (really rich or president of the USA)
3. jealousy - fear spouse/partner is being unfaithful, more common in men, go to severe extents to find out if they are unfaithful (spying/detectives/ UNFAITHFUL).
4. love/erotomania - believes the person they are fixated with is massively in love with them, stalks them, jealousy and aggression can occur, usually with celeb or unknown person (STALKER).
5. somatic - tactile (feel bugs) or physical thing wrong with them (body part not working, think they smell funny)
6. Hypochondriasis - cough = tuberculosis = death
7. mixed - more than one of the previously mentioned delusions

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5
Q

What other types of delusions are there?

A
  • delusions of reference: TV is talking about them
  • delusion of control: external forces controlling thoughts, feelings or behaviours.
  • delusion of thought insertion, thought withdrawal & thought broadcasting (believes others can hear thoughts)
  • delusions of guilt
  • nihilistic delusions: believe they’re dead, lost organs etc.
  • bizarre: alien invasion
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6
Q

Name three ways of classifying delusions

A
  1. Cause
    - primary vs secondary (primary:occuring in the mind, no preceding reasons, secondary: can be understood due to the abnormality of another mental state issue)
  2. Mood
    - congruent vs incongruent (happy mood = mania, sad mood = depression/depressive thoughts, guilt etc.)
  3. Plausibility
    - bizarre vs non-bizarre (physically impossible beliefs vs potentially correct beliefs, being an alien vs being cheated on)
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7
Q

Name four organic causes of psychosis

A
  • drug induced
  • iatrogenic (steroids)
  • dementia
  • delirium (UTI)
    (Lyme disease/other medical conditions may induce psychosis)
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8
Q

define schizophrenia

A

The most common form of psychosis characterised by hallucinations, delusions, and thought disorders which lead to functional impairment

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9
Q

Give three PREDISPOSING risk factors for schizophrenia

A
  1. Substance misuse
  2. Family history
  3. Neurochemical imbalance (dopamine increased, GABA decreased).
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10
Q

Give two PRECIPITATING risk factors for schiophrenia

A
  1. Smoking cannabis
  2. Adverse life events
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11
Q

Give three PERPETUATING risk factors for schizophrenia

A
  1. Substance misuse
  2. Poor medication compliance & doses
  3. Lack of social support
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12
Q

What are Schneider’s First Rank Symptoms for Schizophrenia?

A
  1. Delusional perception
  2. Third-person auditory hallucinations (he looks awful today - talking about the pt.)
  3. Thought Interference (insertion, withdrawal & broadcasting)
  4. Passivity phenomenon (they have no control)
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13
Q

when can +ve symptoms be seen in schizophrenia?

A

all the time but normally in acute phases

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14
Q

Delusions Held Firmly Think Psychosis - this mnemonic stands for?

A

D - delusions
H - hallucinations
F - formal thought disorder (inability to continue conversations fluently)
T - thought interference (insert, withdrawal broad).
P - passivity phenomenon

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15
Q

When are negative symptoms normally seen?

A

chronic phase schizophrenia

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16
Q

Give six features of Negative Symptoms

A
  1. flat affect (no emotion in the face)
  2. reduced social interaction
  3. anhedonia
  4. avolition (less motivation/focus)
  5. alogia (speaking less)
  6. catatonia (moving less)
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17
Q

how many main subtypes of schizophrenia are there?

A

7

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18
Q

Name the subtypes of schizophrenia

A
  1. paranoid
  2. hebephrenia
  3. post schizophrenic depression
  4. catatonic
  5. simple
  6. undifferentiated
  7. residual
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19
Q

Define paranoid schizophrenia?

A

usually characterised by stable delusions, hallucinations (usually auditory), and perceptual disturbances.

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20
Q

Define Hebephrenic schizophrenia (disorganised)

A

aimless, disorganised behavior, rambling, incoherent speech, fleeting hallucinations and delusions, negative symptoms & inappropriate emotions (diagnosed in adolescence)

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21
Q

Define post-schizophrenic depression

A

schizophrenia in the last 12 months but not now, depressed. some positive symptoms may still be present but won’t dominate the picture

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22
Q

Define catatonic schizophrenia

A

dominated psychomotor disturbances, stupor and hyperkinesis and hyper excitement at some points and can have maintained postures

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23
Q

Define undifferentiated schizophrenia

A

meet the threshold but don’t fit into other categories

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24
Q

Define Residual Schizophrenia

A

chronic phase of schizophrenia, less prominent positive symptoms and more prominent negative symptoms

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25
Q

Define Simple Schizophrenia

A

inability to function within society, loss of volition, and blunt affect (prominent negative symptoms related to SS), develop and proceed over psychotic symptoms.

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26
Q

What are the four symptoms in ICD10 Group A criteria of Schizophrenia

A

one or more required:
- hallucinatory voices
- thoughts echo, thought insertion/withdrawal, thought broadcasting (body limb thoughts)
- delusions of control, influence, or passivity
- persistent delusions that are culturally inappropriate and completely impossible, religion, political, superhuman powers

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27
Q

What are the five symptoms in ICD-10 Group B criteria of Schizophrenia

A

2 or more of the following:
- persistent hallucinations in any form
- breaks or interpolations in the train of thought
- catatonic behaviour
- negative symptoms
- a significant and consistent change in the overall quality of personal behvaiour (anhedonia etc.)

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28
Q

interpolations meaning

A

insertions of something irrelevant into a sentence

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29
Q

what is required to diagnose schizophrenia from ICD10 categories?

A

1 from group A, 2 from group B

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30
Q

Name 4 lab investigations to diagnose schizophrenia

A
  1. liver
  2. prolactin
  3. urine drug
  4. urine dip
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31
Q

name 4 other investigations to diagnose schizophrenia

A
  • BP
  • ECG
  • BMI
  • head CT
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32
Q

What type of pharmacological Tx is available for schizophrenics

A

typical and atypical antipsychotics

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33
Q

what does the typical and atypical drugs target

A

dopaminergic neurons in the nigostriatal, mesolimbic & tuberoinfundibular

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34
Q

4 examples of typical older drugs

A
  1. chlorpromazine (tablets, liquids, injections, suppositories)
  2. haloperidol (haldol) - rapid tranq
  3. flupentixol (depixol) - tablets, depot
  4. zuclopenthixol (clopixol) - tablets, depot
35
Q

What ion does GABA receptors respond to and what ions influx to cause a reduce in membrane potential

A

GABA and chloride

36
Q

Akathisia meaning?

A

Restlessness

37
Q

Tardive dyskinesia meaning?

A

Typically involves the face and involves repetitive involuntary withdrawing movements (lip smacking, tongue protrusion and grimacing)

38
Q

Parkinsonism meaning?

A

General term that mimics Parkinson’s disease (bradykinesia, cogwheel rigidity and shuffling gait)

39
Q

Catatonia meaning?

A

Appear to be in stupor, maintain odd postures and appear awake but unresponsive to external stimuli

40
Q

What suggests mania over Hypomania

A

Psychotic symptoms, 7 days or more - delusions of grandeur
Several functional impairment
Mood and irritability in both

41
Q

First line treatments for bipolar (3)?

A

Psychological interventions, lithium and valproate

42
Q

First line option of treatment for ADHD

A

Methylphenidate or lisdexamfetamine

43
Q

Underlying cause of Korsakoff’s syndrome?

A

Untreated thiamine deficiency

44
Q

What is WE (Wernickes encephalopathy)?how does it manifest? (4)

A

Acute deterioration in neurological function manifesting as nystagmus, ataxia, opthalmoplegia and/or encephalopathy

45
Q

Persistent, recurrent WE can lead to what?

A

Korsakoff syndrome

46
Q

Korsakoff is what?

A

Deficits in anterograde (no new memory) and retrograde memory that can lead to confabulation

47
Q

What are key signs of psychotic depression

A

Mood-congruent delusions

48
Q

Typical antipsychotics MOA

A

D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways = increased dopamine

49
Q

Adverse effects of typical antipsychotics

A

Extrapyramidal side-effects, hyperprolactinaemia

50
Q

Examples of typical antipsychotics

A

Haloperidol, chlorpromazine

51
Q

Atypical antipsychotics MOA

A

Act on a variety of recpetors D2, D3, D4, 5-HT)

52
Q

Adverse effects of atypical antipsychotics

A

Extrapyramidal side effects and hyperprolactinaemia less common, metabolic effects

53
Q

Examples of atypical antipsychotics

A

Clozapine, risperidone, olanzapine,

54
Q

Examples of EPSEs

A

Parkinsonism
Acute dystonia
Akathisia
Tardive dyskinesia

55
Q

Examples of antimuscarinic side effects

A
  • dry mouth, blurred vision, urinary retention, constipation
56
Q

Atomoxetine MOA

A

Norepinephrine reuptake inhibitor

57
Q

Zopliclone is what type of drug? MOA?

A

Non-benzo hypnotic acting on the alpha2-subunit of the GABA receptor

58
Q

What are Z drugs

A

Zolpidem, zopiclone, zaleplon non-benzos that act on alpha 2 subunit gaba receptors

59
Q

3 most common signs of ptsd

A

Re-experiencing
Avoidance
Hyperarousal (hypervigilance, sleep issues)

60
Q

MOA behind the medication that leads to Tardive dyskinesia

A

Long term dopamine receptor blockade causing hypersensitivity of dopamine receptors in the nigrostriatal pathway

61
Q

2 common medications that cause hyperprolactinaemia

A

Haloperidol and risperidone

62
Q

What is the best management for OCD

A

ERP and CBT

63
Q

What is an elementary hallucination

A

Buzzing, whistling etc

64
Q

Guilty delusions are a symptom of what?

A

Psychotic depression

65
Q

Persecutors delusions are suggestive of what?

A

Schizophrenia

66
Q

When is lorazepam preferred over chlordiazepoxide?

A

Patients with hepatic failure

67
Q

Flumazenil opposes the action of what?

A

Benzodiazepines

68
Q

Alcohol withdrawal symptoms start?

A

6-12 hrs - sweating, tremor, tachy and anxiety
36 - seizures
48-72 - coarse tremor, confusion, delusion, auditory and visual halllucinations, fever tachy

69
Q

First line treatment for patients with alcohol withdrawal

A

Long acting benzos - chlordiazepoxide or diazepam (lorazepam for hepatic failure pts)
Carbamazepine
Phenytoin is said not to be as effective in the tx of alcohol withdrawal seizures

70
Q

Section 2?

A

Held for 28 days for review

71
Q

Section 3?

A

6 months detained for review, can be viewed for further 6 months then another 12 months

72
Q

Section 4

A

72 hours

73
Q

Section 5

A

Holding powers, 6 hours and 72 hours

74
Q

Benzos main side effect is?

A

Respiratory depression

75
Q

Thiamine is vit what ?

A

Vit b1

76
Q

Tuberoinfundibular pathway is related to what symtpoms

A

hyperprolactinaemia

77
Q

Mesolimbic pathway is related to?

A

Positive symptoms

78
Q

mesocortical pathways related to?

A

Negative symptoms

79
Q

Nigrostriatal pathway is related to?

A

Parkinson’s

80
Q

Corticospinal tract?

A

Movement

81
Q

Explain how a D2 antagonist works

A

Block dopamine receptors reducing dopamine transmission and then dopamine levels

82
Q

Precipitating meaning?

A

Trigger

83
Q

Predisposing meaning?

A

Past relevant history

84
Q

Perpetuating meaning?

A

Ongoing events not helping the behaviour

Year 3 Psychiatry Block (2 decks)

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