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Psychosis Flashcards

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1
Q

Define psychosis

A

A mental state in which reality is grossly distorted, resulting in symptoms of perceptual disturbances, abnormal beliefs and thought disorder
Negative and psychomotor symptoms are also often seen

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2
Q

What are hallucinations

A

Perceptions occurring in the absence of an external physical stimulus
To the patient they appear exactly the same as a normal sensory experience
Can be experienced in any sensory modality

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3
Q

Define illusions

A

Misperceptions of real external stimuli eg dressing gown as a person
Common in healthy people, often associated with inattention or strong emotion

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4
Q

Define pseudohallucination

A

Appears to arise in the subjective inner space of the mind, not an external sensory organ
Patients describe sensations perceived within the inner eye, minds eye or ear
Common examples are flashbacks or a voice inside the head
Sometimes viewed as hallucinations that the patient has insight of

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5
Q

What are auditory hallucinations

A

Most common type of hallucination
Elementary = simple sounds eg whirring, buzzing or single words
Complex = phrases, sentences or dialogue

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6
Q

What are autoscopic hallucinations

A

Seeing oneself in external space

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7
Q

What are Lilliputian hallucinations s

A

Seeing miniature people or animals

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8
Q

What is Charles bonnet syndrome

A

Condition where people with severe visual loss describe complex visual hallucinations in the absence of any other symptoms

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9
Q

What are somatic hallucinations

A

Involve bodily sensations:
Superficial: on the skin
Visceral: deep sensations of organs throbbing or vibrating
Kinaesthetic: false perceptions of MSK sense eg arms being twisted

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10
Q

Define delusions

A

Unshakable false beliefs not accepted by other members of the patients culture
The patient cannot differentiate between delusion and normal thinking
The belief held can be true but the underlying reasoning makes it a delusion

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11
Q

What are primary delusions

A

Do not occur in response to any previous psycho pathological state
May be preceded by a delusional atmosphere where the world around them has altered, often in a sinister way

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12
Q

What are secondary delusions

A

The consequences of pre existing psychological states usually mood disorders

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13
Q

What are partial delusions

A

Beliefs previously found with delusional intensity but now held with less conviction

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14
Q

What are delusional perceptions

A

Delusions attached to a normal perception eg patient believes he is being spied on as he heard an aeroplane overhead

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15
Q

What are bizarre delusions

A

Ones which are completely impossible (characteristic of schizophrenia)

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16
Q

What are persecutory delusions

A

Belief that they are being harmed, are a victim

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17
Q

What are grandiose delusions

A

Belief of their exceptional power / importance

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18
Q

What are religious delusions

A

Beliefs with religious themes, often also grandiose

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19
Q

What are delusions of reference

A

Beliefs that external objects / people relate to them

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20
Q

Delusions of love

A

Beliefs that people are in love with them

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21
Q

Delusions of infidelity

A

Beliefs that their lover is unfaithful (othello syndrome)

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22
Q

What is capgras syndrome

A

Belief that a person has been replaced with an imposter

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23
Q

What is fregoli syndrome

A

Belief that a complete stranger is known to them

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24
Q

Thought insertion

A

Ideas inserted into the mind by an external power

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25
Thought withdrawal
Ideas extracted by an external power
26
Thought broadcasting
Ideas are being broadcast to other so they know what the person is thinking
27
What is circumstantial thinking
Speech that is delayed in reaching its goals due to over-inclusion of details and diversions. If allowed to finish, the speaker will eventually reach their final goal
28
What is tangential thinking
Similar to circumstantial thinking but more indicative of pathology, with the speaker diverting from their initial train of thought but never returning to the original point, jumping from one topic to the next
29
What is flight of ideas
Thinking is markedly accelerated, resulting in a stream of connected concepts, which may or may not be relevant to goal of the conversation
30
What is loosening of association
Patients train of thoughts shifts suddenly to a very loosely / unrelated idea - characteristic of schizophrenia and at its worse form it becomes word salad
31
What is thought blocking
Sudden cessation to the flow of thought, often in mid sentence and patients have no recall of what they were saying
32
What are neologisms
New words created by the patient
33
What is idiosyncratic word use
Attributing a non-recognised meaning to recognised words
34
What is perseveration
An initially correct response is unnecessarily repeated Highly suggestive of organic disease
35
What is echolalia
Patients senselessly repeat words like a parrot
36
Positive symptoms of psychosis
Delusions Hallucinations Loosening of associations Bizarre behaviours
37
Negative symptoms of psychosis
Marked apathy, blunted affect Poverty of thought / speech Social isolation, poor self care Cognitive deficits
38
When are psychomotor effects common in schizophrenia
In developed countries mainly as side effects of medication but can occur in the absence of medication
39
What is catatonic rigidity
Maintaining a fixed position and resisting movements
40
What is catatonic posturing
Adopting and maintaining an unusual posture
41
What is catatonic stupor
42
What is catatonic rigidity
Maintaining a fixed position and resisting movement
43
What is catatonic posturing
Adopting and maintaining unusual posture
44
What is catatonic stupor
Complete lack of movement, voice or responsiveness in an otherwise alert patient
45
What is catatonic waxy flexibility
Patient can be moved into a position but will not move from there
46
What is echopraxia
Repetition or mimicking of actions of those around them
47
7 risk factors of schizophrenia
- family history (40% if both parents affected, 15% if one) - urban living - immigration - cannabis use - obstetric complications - late winter / early spring birth (influenza exposure during neuronal development) - advanced paternal age at conception
48
What is the dopamine hypothesis
Theorises that schizophrenia is caused by dopamine Overactivity in the brain
49
What is evidence for the dopamine hypothesis
All effective antipsychotics block dopamine (D2) receptors - dopamine agonists can cause psychotic symptoms - schizophrenia sufferers have been shown to have excess D2 receptors
50
What is evidence against the dopamine hypothesis
Normal dopamine metabolite levels in CSF of sufferers - 30% do not respond to conventional medicines - clozapine has less D2 blocking activity than conventional antipsychotics (yet is more effective)
51
What can antipsychotics be effective at treating
Psychosis Mood disorders Anxiety disorders Insomnia Rapid tranquilisation Nausea and vomiting Hiccups Tics in Tourette’s
52
Name the 3 dopaminergic pathways
Tuberoinfundibular - blockage can cause hyperprolactinaemia Mesocortical / Mesolimbic - blockage is the MOA of antipsychotics Nigostriatal - blockage can cause EPS
53
What should be checked when commencing antipsychotics
ECG Weight / height BP FBC U&Es Prolactin Glucose / HbA1c Fasting lipids
54
What is the MOA of typical antipsychotics
dopamine receptor 2 antagonism
55
Neurological side effects of typical antipsychotics
Neuroleptic malignant syndrome Seizure threshold lowered Sedation EPS
56
Autonomic side effects of typical antipsychotics
Blood pressure Temperature
57
Endocrine side effects of typical antipsychotics
Raised prolactin due to blockage of the tuberoinfundibular pathway
58
Psychiatric side effects of typical antipsychotics
Apathy Confusion Depression
59
What are the 4 EPSE
Akathisia - restlessness including pacing, rocking, repeatedly crossing legs Parkinsonism- tremor rigidity and bradykinesia Acute dystonia - involuntary muscle spasms which produce briefly sustained abnormal postures Tardive dyskinesia - abnormal involuntary hyperkinetic movements. Is potentially irreversible. Inc abnormal tongue movements, pouting, smacking of lips, chewing, head nodding
60
What are the features of metabolic syndrome
Central obesity Insulin resistance Impaired glucose regulation Hypertension Raised plasma triglycerides Raised LDL cholesterol level
61
What are the features of neuroleptic malignant syndrome
Hyperthermia Muscle rigidity Confusion Tachycardia Hyper/hypotension Tremor Raised creatinine kinase Low pH
62
Which typical antipsychotics can you give as a depot
Haloperidol Flupentixol Zuclopenthixol Fluphenazine
63
Which atypical antipsychotics can you give as a depot
Risperidone Olanzapine Aripiprazole
64
Describe the profile of aripiprazole
Partial dopamine agonist (limits maximum response) Dose usually 5-30mg Long half life Side effects: nausea, restlessness, insomnia, initial exacerbation of psychosis, least weight gain, minimal metabolic effect
65
Describe the profile of olanzapine
Treats psychosis and also used in rapid tranquilisation - IM Usually oral dose 5-20mg Side effects: sedation, weight gain, raised triglycerides, pro glycaemic, dizziness, anti cholinergic
66
Describe the profile of quetiapine
Requires titration Usually dose 300-600mg/day in 2 doses Also effective in bipolar Side effects: sedation, weight gain, less metabolic disturbance than olanzapine, possible QT prolongation
67
Describe the profile of risperidone
Usual dose 4-6mg Depot available Side effects: sedation, weight gain, hyperprolactinaemia, sexual dysfunction, EPSE
68
Describe the profile of clozapine
Indicated in treatment resistant schizophrenia Improved efficacy over other antipsychotics Positive effect on symptomology and suicide risk Is a D4 blockade Side effects: myocarditis / cardiomyopathy, orthostatic hypotension, agranulocytosis
69
What is Schizoaffective disorder
Presentation of both schizophrenic and mood symptoms at the same time The mood symptoms must meet the criteria for a depressed or manic episode, and patients should have at least one of the first rank schizophrenic symptoms Mood symptoms present first, then psychotic symptoms
70
What is delusional disorder
Development of delusions for at least 3 months with no / few other symptoms Usually onsets in middle age and delusions may persist throughout life Delusions can be persecutory, grandiose or hypochondriacal (doesnt include thought control) Hallucinations will only be brief if present, and some depressive symptoms may also be evident Affect / speech / behaviour / social function are generally normal
71
What is schizotypal personality disorder
Eccentric behaviour and peculiarities of thinking / appearance without any clear psychotic symptoms
72
List some organic causes of psychosis
Delirium Medication induced eg steroids Endocrine disorders eg cushings Neurological disorders eg temporal lobe epilepsy Systemic diseases eg SLE, porphyria Psychoactive substance abuse Alcohol withdrawal
73
Describe the biological approach for management of schizophrenia
1st line is atypical antipsychotics Benzodiazepines can be used in short term for relief of behavioural disturbance, insomnia, aggression and agitation Antidepressants / lithium sometimes used in treatment resistant cases ECT used rarely where symptoms are severe and not responding to initial therapy
74
Describe the psychological approach to treating schizophrenia
Psychotherapy with drug treatment CBT shown to reduce some symptoms and help patients gain insight Family therapy reduces relapse rates Psychoeducation Psychiatric rehabilitation eg social skills and budgeting
75
Describe the social approach to managing schizophrenia
Social benefits Accommodation Social supports Support groups Reduce any social stress that might induce relapse
76
What is treatment resistant schizophrenia
Lack of satisfactory clinical improvement despite sequential use of 2 antipsychotics for 6-8 weeks Check concordance and confirm diagnosis is correct Check psychological therapy progress and comorbid substance use Treat with clozapine
77
What factors are associated with good schizophrenia prognosis
Female sex Marriage Older age of onset Abrupt onset Precipitated by life stress Absence of negative symptoms Good Premorbid functioning
78
Describe the prognosis of schizophrenia
20% have a single lifetime episode and no relapses 30% have poor outcomes characterised by continuous symptoms and repeated psychotic episodes 10% will die by suicide Most at risk are young, educated men with a high degree of insight
79
What are poor prognostic factors of schizophrenia
Significant family history High carer expressed emotion Substance misuse Poor compliance and long prodrome / duration of untreated psychosis
80
Management of acute dystonia secondary to antipsychotics
Procyclidine

Psychiatry (6 decks)

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