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Psychosis (including schizophrenia) Flashcards

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1
Q

give some examples of psychotic symptoms 6

A

hallucinations

delusions

disorganised thought

catatonia

affective distrubance

avolition

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2
Q

how can schizophrenia first rank sympotms be classified 4

A

auditory hallucinations

thought disorders

passivitiy phenomena

delusional perceptions

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3
Q

what types of auditory hallucinations are seen in schizophrenia 3

A

two or more voices discussion the patient in the third person

though echo

voices commenting on the patients behaviour

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4
Q

types of thought disorder seen in schizophrenia 3

A

thought insertion

thought withdrawal

thought broadcasting

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5
Q

describe passivity phenomena seen in schizophrenia 2

A

bodily sensations being controlled by external influence

examples:
-actions/impulses/feelings- experiences which are imposed on the individual or influenced by others

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6
Q

describe delusionsal perceptiosn seen in schizophrenia

A

two stage process
-first normal object is perceived
-then secondly there is a sudden intense delusional insight into the objects meaning for the patient

eg that traffic light is green therefore i am the king

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7
Q

other features of schizophrenia 6

A

impaired insight

incongruiting/bluding of affect (inapporpriate emotion for circumstances)

decreased speech

neologisms: made up words

catatonia-awake but does not respond to people or environment

negative symptoms
-anhedonia (inability to derive pleasure)
-alogia (poverty of speech)
-avolition (poor motivation)

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8
Q

what factors are associated with a poor prognosis in schizophrenia 5

A

strong family history

gradual onset

low IQ

prodromal phase of social withdrawal

lack of obvious precipitants

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9
Q

describe thoguht insertion

A

someone is putting ideas into the patients head

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10
Q

describe thought broadcasting

A

people overhear patients thoughts

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11
Q

describe thought withdrawal

A

thoughts are being taken out of my head

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12
Q

diagnotic criteria for schizophrenia 6

A

symptoms must last for ≥6 months
-at least 1 month of severe symptoms
-marked impairment in work or home function

must have very clear symptoms of 1 of the following or 2 or more if less clear cut:
-all the first rank symptoms:
-
auditory hallucinations

thought disorders

passivitiy phenomena

delusional perceptions

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13
Q

state the 5 schizophrenia subtypes

A

paranoid schizophenia

hebephrenic sschizophrenia

catatonic schizophrenia

undifferentiated schizophrenia

residual schizophrenia

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14
Q

define paranoid schizophrenia

A

delusions and hallucinations dominate
=most common

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15
Q

define hebephrenic schizophrenia

A

age of onset 15-25
poor prognosis
thought disorder and affective distrubance dominate

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16
Q

define catatonic schizophrenia

A

catatonia dominates
-stupor
-posturing
-waxy flexibitly
-negativism

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17
Q

define undifferenitated schizophrenia

A

no specific subtype

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18
Q

define residual schizophrenia

A

negative symptoms dominate

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19
Q

when can prodromal symptoms for schizophrenia start

A

up to 18moths before first episode of psychosis but sometimes just a few days

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20
Q

how are prodromal sympotms of schizophrenia charactereised
-examples of changes 4

A

gradual deterioration in functioning
-sometimes conceptualized as ‘altered life trajectory’

changes:
-transisent and/or lower intensity psychotic syx
-odd (out of character) thoughts, beliefs and behaviours
-concentration problems
-altered affect
-social withdrawal
-reduced interest in daily activities

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21
Q

define schizoaffective disorder

*-treatemetn

A

a vairant of schizophrenia and affective (mood) disorders
-patient exepreinves syx of mood disorder (mania or depression) and schizophrenia at the same time (within days) and of the same intensiitivty

*-manage both conditions
-antipsychotics
-mood stabilizers

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22
Q

defire schizotypal disorders

A

personality disorder
-may represent parital expression of schizophrenia
-usually treated without medication

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23
Q

define schizophreniform disorder

A

those disorders fail to meet threshold for schizophrenia (usually duration of psychosi) but have syx of schizophrenia and deitriotiation in function

treated with antipsychotics

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24
Q

who gets schizophrenia4

A

strong genetic compoenet

later onset in women

lower socioectomic

higher incidence in immigrants/minority ethic groups

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25
biological risk factors for schizophrenia 4
familial geentic risk structual brain cahges intelecual impaired substance use
26
psychiligcal risk factors for schizophrenia 2
probelm with learning. attention, planning biases in emotional and reasoning processes
27
social risk factors for schizophrenia 3
urban birth and rearing social adversity and trauma migration and stressful life events all increase
28
dopamine abnormalites in schizophrenia 2
nigrostriatal pathways -excessive dopamie transmission assoc w positive syx mesocrotical & mesolimbic -reduced dopamine transimson-> impaired cognition and possible negative syx
29
brain changes in schizophrenia
cortex, hippocampus/amygdal reduced ventircles enlarged decreased blood flow in areas involved in frontal lobe in tests of executive function
30
acute manaegmnt of schizophrenia 5
risk assessment phsyucial health chekc drug treatmetn education family education + support psychosocial interventions
31
aspects of maintanence managemtn for schizophrenia 4
MDT approach co-morbitidy checks side effect monitoring social/occupational recovery
32
describe the role of psychological interventiosn for schizophrenia 5
recommned in all managemtn plans -prmote quick recovery and relapse prevention -strong evidence for EARLY CBT -general or targeted at auditory hallucinations address acute syx first then residual syx if concurrent substances missue - abstiennce improves overall prognosis work with family
33
before starting an antipsychotic what needs to be checked
ask about personal and FHx of: -DM -HT -CVD give advice on weight, diet and excersies perform: -BP -weight -BM -lipid profile FBC
34
what needs to be completed before a patient is started on clozoapine
ECH
35
what needs to be monitored when on an antipsychotic and how ofeter
6 monthly monitoring of: -LFT -U&Es -Prolactin -weight -HbA1c
36
what is first line for schizophrenia (drug class)
second generation antipsychotics
37
examples of second generation antipsychotics 5 -why are they preferred
5HT2A and D2 antagnoists amisulpride (D2) olanzapine (D2) quetiapine (D2) repseridone (D2) clozapine (5HT2A) lower risk of extrapyramidal side effects compared to 1st generation APs but more metabolic side effects: -weight gain -hyperglycaemia -dyslipidaemia
38
exaamples of 1st generation antipsychotics 2 -why are they second line for treatment of schizophrenia
D2 antagnoists chlorpromazine haloperidol -can extrapyridmal side effects -often the reason patients stop taking their tablets
39
an example of third generation antipsychots 1
dopamine partial agnoists only licensed TGA is aripiprazole
40
when is clozapine used -why can it be dangerous
used for treatment-resistnat schizophrenia has associated decreased sucicde risk - agranulocytosis risk in first year -needs specialist monitoring
41
state some examples of extrapyrmidal side effects and how to treat these 4
parkinsonism -decrease dose -change to 2nd gen AP acute dystonia -uncontrolled muscle movements (can occur within hours of starting AP) -give procyclidine IM/IV -may take up to 30 minutes to work akathisia (subjective sense of psychomotor restlessness) -within hours to weeks of starting AP -decrease dose or change to 2nd gen AP may need propanolol ± cyproheptadine tardive dyskinesia (chewing, grimaces, choreoathetoisis(episodes of unwanted, uncontrollable movements, often of the muscles in the arms, legs, face, and body.)) -can be irreversible -try tetrabenzine
42
regarding antipsychotic side effects -side effects of dopamine blockades 2
EPSEs TD
43
regarding antipsychotic side effects -side effects of alpha adrenergic blockage 2
dizziness hypotension
44
regarding antipsychotic side effects -side effects of histamine blockade 2
drowsieness weight gain
45
regarding antipsychotic side effects -side effects of muscarinic blockade 3
dry mouth constipation urine retention
46
common co morbitities to schizophrenia 6
alcohol/substance missure social anxiety/ anxiety disordeers trauma/PTSD low confidence/self esteme mood disorder aspergers
47
whn are outcomes worse with schizoprhenia 4
men substance misure low IQ long duration of untreated psychosis
48
lifestyle issues with antipsychotic use and how to combat 3
hunger after taking medication -consider bedtime dose increased thirst -suggest water or sugar free alternative smoking- -induces metbalisisma dn thus reduces antispychoitc plasma level -increase dose and review if they quit include targeted health promotion -diet -physical exercise -smoking cessation
49
common side effects of antipsychotic drugs 6
extrapyrmaidal side effects hyperprolactinaemia sexual dysfunction weight gain DM CV effects daytime drowsiness
50
another name for substance induced psychosis
toxic psychosis or drug induced psychosis
51
what is an important point regarding substance induced psychosis
25% of people with substance induced psychosis go onto be diagnosed with schizoprhenia
52
examples of substances that can cause substance induced psychosis 7
alcohol opiods cannabinoid benzos stimulants: amphetamines cocaine hallucinogens volatile inhalants
53
what medications can cause substance induced psychosis 3
fluoroquinolone dextromorpha certainhigh dose antihistamines
54
management of substance induced psychosis 2
hospitlaisation for detoxification and possible antipyshcoitcs/benzo for symptom control
55
define delusiounal disorder
firmly held false belief (delusions) persist for at least 1 month -without other syx of psychosis
56
how is delusional disorder distinguied from schizophrenia
precense of delusions without any other syx of psychosis
57
how are delusions distinguished from mistkaen belifed s
remain unchnaged in face of clear, resonable evidence to the contrary
58
define bizzare vs nonbizarre delusison
non-bizzare- invovle situations that could occur eg being followed, infected bizarre- implausible situations such as believing someone removed internal organs with no scar
59
who gets delusional disorder
relatively uncommon -onset involutional -middle or late adult life patients may have a pre-exisitng paranoid personality disorder -pervasive distrust & suspicion of others -can begin in early adulthood
60
what is delusional disorder in older patients
sometimes called paraphrenia -can coexist with mild dementia
61
give a brief overview of the subtypes of delusional disorder 5
erotomaitc-patinets beleive another person is in love with them grandiose -great talent or important discovery jealous- spouse/lover is unfaithful persecutory -being plotted against, spied on or harassed somatic - bodily function -have physical deformity, odor, parasite
62
diagnosis of delusional disorder
clinical evaluation and assessement rule out other specific conduction assoc w delusions
63
managemnt of delusional disorder
estabilish effective patient doctor relationship manage complications sometimes antipyschotics
64
define puerperal psychosis
a rare complication of post partum depression
65
risk factors for postpartum psychosis
Hx of bipolar, schizoaffective disorder FHx or personal Hx of postpartum psychosis first rpegnnacy discontinnuation of psych meds for pregnancy
66
management of postpartum psychosis 3
medical emergency -need inpatinet care and for baby use of antipsychotics and mood stabilizers ECT shows good evidence

Psychiatry (21 decks)

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