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Phase II - Psychiatry > Psychosis > Flashcards

Flashcards in Psychosis Deck (51):

What is psychosis?

Mental state where reality is greatly distorted.


What are delusions?

Fixed false belief that is firmly held despite contrary evidence and goes against the individual's normal social and cultural belief system.


What are hallucinations?

Perception in the absence of external stimulus.


What is a thought disorder?

Impairment in the ability to form thoughts from logically connected ideas.


What is the incidence of psychosis in England?



What is schizotypal disorder?

Eccentric behaviour, suspiciousness, unusual speech, deviation of thinking, affect similar to schizophrenia. No delusions or hallucinations.


What is persistent delusional disorder?

Single or set of delusions for 3 months + where delusion is the main symptoms with thought and function preserved. Delusion is persecutory, grandiose, hypochondriacal. Related to life situation.


What is acute and transient psychosis?

Psychotic episode as with schizophrenia by lasts <1 month.


What is induced delusional disorder?

Uncommon disorder where 2+ individuals have similar delusions.


What is imposee in induced delusional disorders?

One person is dominant and forms the belief during a psychotic episode and imposes it on the other person.


What is simultanee type of induced delusional disorder?

Two people have their own psychotic symptoms but influence each other so the delusions line up.


What is schizoaffective disorder?

Schizophrenic symptoms + mood disorder symptoms in same illness. Mood symptoms meet criteria for depression or manic episodes + 1 or 2 typical schizophrenic symptoms.


What are mood disorders with psychosis?

Psychosis secondary to depression or mania.


What is puerperal psychosis?

Acute onset of manic or psychotic episodes after childbirth <2 weeks.


What is late paraphrenia?

Late-onset schizophrenia, hallucinations and delusions prominent but thought disorders and catatonic symptoms are rare.


What are the organic causes of schizophrenia?

Drugs, iatrogenic, complex partial epilepsy, delirium, dementia, Huntington's disease, SLE, syphilis, endocrine disturbance, metabolic disorders.


Which factors are involved in developing schizophrenia?

Biological and environmental factors.


What is the dopamine hypothesis for schizophrenia?

Secondary to over-activity of mesolimbic dopamine pathways in the brain -> drugs block D2 receptors. Drugs that potentiate these pathways cause psychotic symptoms.


What is the expressed emotion theory?

Relatives that are over involved or make hostile/critical comments make relapses more likely.


What is the stress-vulnerability model?

Schizophrenia is due to environmental factors interacting with genetic predisposition so people need different levels of exposure to environmental factors to become psychotic.


What are the biological predisposing factors to schizophrenia?

Genetics, neurochemical (increased dopamine, decreased glutamate, serotonin, GABA), neurodevelopmental (intrauterine infection, premature birth, foetal brain injury, obs complications), aged 15-35 years, very young or very old parents.


What are the psychological predisposing factors to schizophrenia?

Family history, childhood abuse.


What are the social factors predisposing to schizophrenia?

Substance misuse, low SE status, migrants, urban area living.


What are the precipitating factors for schizophrenia? (Biopsychosocial).

Bio - smoking cannabis, psychostimulant use.
Psycho - adverse life events, poor coping style.
Social - adverse life events.


What are the perpetuating factors for schizophrenia?

Bio - substance misuse, poor compliance.
Psycho - adverse life events.
Social - poor social support, expressed emotion.


What are the positive symptoms of schizophrenia?

'Delusions Held Firmly Think Psychosis'
= delusions, hallucinations, formal thought disorder, thought interference, passivity phenomenon.


What are delusions?

Fixed false belief that's firmly held despite evidence to the contrary and goes against the individual's normal social and cultural belief system.


What are ideas of reference?

A patients thinks common events refer to them directly, e.g. newspaper articles.


What are hallucinations?

Perception in the absence of external stimulus.


What is the normal hallucination form in schizophrenia?

Third person auditory, sometimes running commentary.


What is formal thought disorder?

Abnormalities in the way thoughts are linked together.


What is thought interference?

Thought insertion, withdrawal, or broadcast.


What is passivity phenomenon?

The belief that actions, feelings, or emotions are being controlled by an external force.


What are the negative symptoms of schizophrenia?

Avolition, asocial behavious, anhedonia, alogia, affect blunted, attention.


What is avolition?

Decreased motivation and reduce ability to initiate and persist in goal-directed behaviour.


What is alogia?

Poverty of speech.


What is paranoid schizophrenia?

Positive symptoms of hallucinations and delusions.


What is hebephrenic schizophrenia?

Thought disorganisation, early onset 15-25 years, poorer prognosis.


What is catatonic schizophrenia?

1+ catatonic symptoms (abnormality of tone, posture, movement from disturbed mental state - excessive or decreased motor activity).


What is undifferentiated schizophrenia?

Meets schizophrenic criteria but no particular type.


What is post-schizophrenic depression?

Depression predominates with schizophrenic illness in past 12 months, some symptoms persist.


What is residual schizophrenia?

1 year of chronic negative symptoms after clear-cut psychotic episode.


What is simple schizophrenia?

Rare form with negative symptoms and no psychotic symptoms.


What are the ICD-10 criteria for diagnosing schizophrenia?

One of group A + 2 or more from group B for 1 or more months. No organic brain disease.
Group A - thought echo/insertion/withdrawal/broadcast; delusions of control, influence, passivity phenomenon; running commentary auditory hallucinations; bizarre persistent delusions
Group B - hallucinations in other modalities that are persistent; thought disorganisation; catatonic symptoms; negative symptoms.


What are the features of schizophrenia on MSE?

Appearance - normal or inappropriate with poor self-care (-ve).
Behaviour - preoccupied, restless, noisy, suspicious (+ve) or withdrawn, poor eye contact and apathy (-ve).
Speech - reflect thought disorder, interruptions to flow of thought, poverty of speech (-ve).
Mood - incongruity of affect or mood changes (depression, anxiety, irritability) or flattened (-ve).
Thoughts - delusion, thought insertion/withdrawal/broadcast, formal thought disorder (+ve).
Perception - hallucinations (+ve).
Cognition - normal orientation or attention and concentration impaired (+ve) or cognitive deficits (-ve).
Insight - poor.
Risk - needs assessing.


What are the investigations needed for schizophrenia?

Bloods - FBC, TFTs, glucose, HbA1c, serum Ca, U+Es, LFTs, cholesterol, vitamin B12, folate. Urine drug test. ECG to check QT interval. CT to rule out organic causes. EEG to rule out temporal lobe epilepsy.


What is the management plan for schizophrenia? (Summary of all aspects).

Early intervention in psychosis team used in first presentation to reduce duration of untreated psychosis.
Bio - antipsychotics,adjuvants, ECT.
Psycho - CBT, art therapy, social skills training.
Social - support groups, peer groups, supported employment programmes.


What are the poor prognostic factors for schizophrenia?

Strong family history, gradual onset, decreased IQ, premorbid history of social withdrawal, no obvious precipitant.


What are the pharmacological steps to managing schizophrenia?

Antipsychotics - atypical first line then clozapine third line for treatment-resistant schizophrenia.
Adjuvants - benzodiazpines for short-term behavioural relief.
ECT - if resistant to all or catatonic.


What are the psychological steps in managing schizophrenia?

CBT to reduce residual symptoms.
Family intervention for persisting symptoms.
Art therapy to alleviate negative symptoms.
Social skills training for interpersonal, self-care, and coping skills.


What are the social steps in managing schizophrenia?

Support groups.
Peer groups - support worker has recovered from psychosis and schizophrenia is stable.