Psychosis

Question 1

Effects of psychosis

Answer 1

Confused thinking - flow of thought, concentration, perplexed
False beliefs
Perceptual abnormalities
Changed feelings
Changed behaviour

Question 2

Most common delusions

Answer 2

Persecution

Question 3

Causes of psychosis

Answer 3

Psychological severe stres s
Physical illness
Drug induced
Mental illness - schizophrenia, affective disorder, dementia

Question 4

Postiive symptoms schizophrenia

Answer 4

Delusions
Hallucinations
Thought disorder

Question 5

Schizophrenia vs psychosis

Answer 5

Psychosis is a state with many causes (most commonly schizophrenia) schizophrenia is a condition with diagnostic criteria

Question 6

What is psyschosis?

Answer 6

Conditions that affect the mind where there has been loss of contact with reality. Delusions, thought disorder. 3 in 100

Question 7

Gender and schizophrenia

Answer 7

Males develop it earlier
Women are more likely to get it
Men get it more severely

Question 8

Why are FBC important in psychosis?

Answer 8

Anaemia can cause psychosis
B12 + folate
WCC

Question 9

Why do cognitive assessment

Answer 9

Differentiate dementia and learning disabilities from psychoiss

Question 10

What to look at in bloods?

Answer 10

FBC, U+Es, LFTs, TFT, PTH, calcium, B12, CRP, lipids, glucose, prolactin
HIV, syphilis

Question 11

Why monitor PTH in psychosis?

Question 12

Why monitor prolactin in schizophrenia?

Answer 12

Antipsychotics side effect is increased

Question 13

Other investigations with psychosis

Answer 13

ECG
EEG - if concerned could be epilepsy
Brain imaging - CT/MRI

Question 14

What can see on ECG in psyh=chocis (cause)

Answer 14

QT prolongation

Question 15

Delusional disorder vs schizophrenia

Answer 15

Delusional - only have delusions, no thought disorder

Question 16

Diagnosis fro schizophrenia

Answer 16

At least one of a to d or one month
a - persisten delusions
b - Persistent hallucinations
c - Disorganised thinking
d - Experiences of influence, passivity or contol
e - negative symptoms
Grossly disorganised behaviour
Psychomotor disturbances

Question 17

What are negative symptoms?

Answer 17

Affective flattening, alogia, paucity of speech, avolition, asociality, anhedonia
Poverty of thought, affect ->
-social withdrawal
Emotional withdrawal
anhedonia
Avolition

Question 18

Psychomotor disturbances

Answer 18

Catatonic restlessness or agitation, posturing, waxy flexibility, negativis,, mutism, stupor

Question 19

Grossly disorgansied behaviour

Answer 19

Impedes goal directed activity

Question 20

Affective symptoms

Answer 20

Dysphonia
Depression

Question 21

Cognitive symptoms of schizophrenia

Answer 21

Attention
Memory - episodic and working
Executive function
Decision making

Question 22

Positive symptoms schizophrenia

Answer 22

Disorgnaised thoughts
Delusions
Hallucinations
unusual behaviour

Question 23

Differentials for psychosis

Answer 23

Delusional disorder
Narrower range of symptoms than schizophrenia
Acute and transient psychotic disorder
Time course usually shorter than schizophrenia (usually symptom duration less than one month, but can still be diagnosed if less than three months) and always more fluctuant in symptom type/intensity
Schizoaffective disorder
Mood symptoms equally prominent (either pole) and come on simultaneously with psychotic symptoms
Induced/secondary psychotic disorder
Medical condition – including antibody mediated encephalitis and SOL
Substance misuse

Question 24

Vulnerability to psychosis

Answer 24

Genetic factors
Pre-term birth - low weight, O2 starved, before 32 weeks
Early risk factors - Urban upbringing
Migration
Head injury
Childhood adversity
Stresses - drug abuse
Psychological stress

Question 25

Drugs increasing risk of psychosis

Answer 25

Amphetamine Cannabis - 4 x LSD Ecstasy

Question 26

Group 1 schizophrenia illness pattern

Answer 26

One episode only - no impairment

Question 27

Group 2 schizophrenia illness pattern

Answer 27

Severeal episodes with no or minimal impaorment

Question 28

Group 3 - schizophrenia illness pattern

Answer 28

Impairment after the first episode with subsequent exacerbation and no return to normality

Question 29

Group 4 schizophrenia illness pattern

Answer 29

Impairment increasing with each of several episodes and no return to normality

Question 30

Which antipsychotic causes myo/endocarditis?

Answer 30

Clozapine

Question 31

Which 1st gen antipsychotic can be injected once a month rather than tablets?

Answer 31

Flupenthixol

Question 32

Which gen antipsychotics are effective in treatment resistant schizophrenia? Against negative symptoms?

Answer 32

Seocnd generation eg olanzapine, quetiapine

Question 33

Additional risks of clozapine

Answer 33

Agranulocytosis -> monitoring Paralytic ileus Myocarditis/cardiomyopathy

Question 34

When do you use clozapine in schizophrneia?

Answer 34

after patient hasn't responded to 2 drugs

Question 35

Monitoring on clozapine

Answer 35

weekly FBC blood for agranulocytosis for 18 weeks

Question 36

What does being kept under section 2 mean?

Answer 36

Detained for assessment for 28 days

Question 37

Ideas of referenve

Answer 37

Belieive being mentioned on radio/papers

Question 38

EIP team

Answer 38

Early intervention for psychosis prevention team

Question 39

Vulnerability stress model schizophrenia

Answer 39

Genetically inherited factors and environmental stress

Question 39

Vulnerability stress model schizophrenia

Answer 39

Genetically inherited factors and environmental stress

Question 40

Pre term risks for psychosis

Answer 40

Before 32 weeks - 2x increase Low birth weight Lack of oxygen during birth

Question 41

Early risk factors vulnerability to psychosis

Answer 41

Urban upbringing Migration head injury Childhood adversity

Question 42

What is Acute and transient psychotic disorder

Answer 42

Time course usually shorter than schizophrenia (usually symptom duration less than one month, but can still be diagnosed if less than three months) and always more fluctuant in symptom type/intensity

Question 43

What is schizoaffective disorder

Answer 43

Mood symptoms equally prominent (either pole) and come on simultaneously with psychotic symptoms

Question 44

What is induced/secondary psychotic disorder

Answer 44

Medicacl condition - incl anitbody mediated encephalitis and SOL Substance misuse

Question 45

Assessmnet in psychosis

Answer 45

History Physical examination, including neurological MSE Consider: cognitive assessment, needs, adherence assessments, formulation General medical evaluation: Incl. FBC, U&E, LFTs, TFT, PTH, calcium, B12, CRP, lipids, glucose, prolactin ECG, EEG Urine drug screen Based on clinical suspicion: Brain imaging: CT/ MRI HIV and syphilis Consider antibodies (NMDA, VGKC…)

Question 46

What is psychosis?

Answer 46

Disturbance in perception of reality - hallucinations, delusions, impairment of thought, speech, and behaviour

Question 47

First line antipsychotic

Answer 47

Atypical Then assess side affects and effectiveness and consider changing

Question 48

Why is smoking status important in antipsychotics?

Answer 48

Esp in clozapine -> exacerbate side effects Increased cardiovascular risk alongside already increased from antipsychotics

Question 49

What antipsychotics prolong QTC?

Answer 49

Typicals eg haloperidol, some atypicals

Question 50

When is someone treatment resistant?

Answer 50

2 antipsychotics

Question 51

What are long acting medication options?

Answer 51

Depot