Schizophrenia And Other Psychoses Flashcards

Question

The management of schizophrenia may involve several multidisciplinary teams including who?

Answer 1

Early intervention team (initial referral after the first psychotic episode) Community mental health team (provide day-to-day support and treatment) Crisis resolution team (for patients experience an acute psychotic episode)

Answer 2

Assessing health and social needs Creating a care plan Appointing a key worker to be the first point of contact Reviewing treatment

Answer 3

D2 (dopamine) receptor antagonists - they can be divided into typical and atypical antipsychotics

Answer 4

Haloperidol Chlorpromazine Fluoentixol deconate (depot injection)

Answer 5

Olanzapine Risperidone (depot injection) Clozapine Amisulpride Quetiapine Aripiprazole

Answer 6

CBT Family therapy

Answer 7

As well as the side effects from antipsychotic medications, complications of schizophrenia may include:4 Suicide: the lifetime risk of suicide is approximately 5% Cardiovascular disease: there is an increased risk of premature death due to cardiovascular disease, in addition, patients with schizophrenia are more likely to smoke Cancer: delayed diagnosis and late presentation of cancer Substance abuse: up to one-third of patients with schizophrenia use drugs Social isolation

Answer 8

Clozapine is often used when both typical and atypical antipsychotics have been ineffective.

Answer 9

incongruity/blunting of affect anhedonia (inability to derive pleasure) alogia (poverty of speech) avolition (poor motivation)

Answer 10

strong family history gradual onset low IQ prodromal phase of social withdrawal lack of obvious precipitant

Answer 11

2 stage process Normal object is perceived and secondary there is a delusional insight into its meaning

Answer 12

Sense of external influence controlling the thoughts or actions of a person ie. thoughts and feelings have been 'put there' by someone else, patient is not producing them

Answer 13

Thought broadcasting Thought insertion Thought withdrawal

Answer 14

Third person commentary Command hallucinations Thought echo

Answer 15

High IQ Good support network Sudden onset Obvious precipitating factor Mainly positive symtpoms

Answer 16

25% never have another episode 25% improve substantially on treatment 25% have some improvement on treatment 25% treatment resistant

Answer 17

Substance induced psychotic disorder Organic psychosis caused by infection, brain injury and CNS diseases such as Wilson's disease Metabolic disorder such as hyperthyroidism and hyperparathyroidism Dementia and depression can also co-occur with psychosis

Answer 18

Paranoid schizophrenia, as with any psychotic disorder, is treated first-line with atypical antipsychotics such as Risperidone. These are preferred to typical antipsychotics such as Haloperidol, due to the reduced risk of extra-pyramidal symptoms. Sedative drugs such as Lorazepam may be used if there is acute behavioural disturbance in the presentation of paranoid schizophrenia, but this is not the first-line treatment and will not improve psychotic symptoms. NICE recommends Clozapine for children and young people whose schizophrenia has not responded to adequate doses of at least two different antipsychotics used sequentially for 6-8 weeks

Answer 19

hallucinations (e.g. auditory) delusions thought disorganisation alogia: little information conveyed by speech tangentiality: answers diverge from topic clanging word salad: linking real words incoherently → nonsensical content

Answer 20

agitation/aggression neurocognitive impairment (e.g. in memory, attention or executive function) depression thoughts of self-harm

Answer 21

schizophrenia: the most common psychotic disorder depression (psychotic depression, a subtype more common in elderly patients) bipolar disorder puerperal psychosis brief psychotic disorder: where symptoms last less than a month neurological conditions e.g. Parkinson's disease, Huntington's disease prescribed drugs e.g. corticosteroids certain illicit drugs e.g. cannabis, phencyclidine

Answer 22

Around 15-30 years of age

Answer 23

Circumstantiality is the inability to answer a question without giving excessive, unnecessary detail. However, this differs from tangentiality in that the person does eventually return to the original point.

Answer 24

Tangentiality refers to wandering from a topic without returning to it.

Answer 25

Neologisms are new word formations, which might include the combining of two words.

Answer 26

Clang associations are when ideas are related to each other only by the fact they sound similar or rhyme.

Answer 27

Word salad describes completely incoherent speech where real words are strung together into nonsense sentences.

Answer 28

Knight's move thinking is a severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another. It is a feature of schizophrenia.

Answer 29

Flight of ideas, a feature of mania, is a thought disorder where there are leaps from one topic to another but with discernible links between them.

Answer 30

Perseveration is the repetition of ideas or words despite an attempt to change the topic.

Answer 31

Echolalia is the repetition of someone else's speech, including the question that was asked.

Answer 32

The conversation moves randomly from one topic to another.

Answer 33

A lack of spontaneous speech.

Answer 34

Thought blocking involves sudden cessation of thought, typically mid-sentence, with the patient being unable to recover what was previously said. Questions which may be useful to explore thought blocking include: “Do you feel able to think clearly?” “Do you ever experience your thoughts suddenly stopping as though there were no thoughts left?” “What is it like? How do you explain it?”

Answer 35

Formal thought disorder refers to disorganised thinking as evidenced in speech. They are especially associated with schizophrenia and psychosis.

Answer 36

Circumstantiality Derailment Poverty of speech Perseveration Thought blocking Clang associations Word salad Flight of ideas Tangentiality Knight's move Echolalia Neologisms Thought withdrawal Thought insertion Thought broadcasting

Answer 37

A hallucination is a perception in the absence of an external stimulus that has qualities of real perception.

Answer 38

Auditory hallucination Somatic hallucinations Visual Olfactory Tactile

Answer 39

Elementary e.g. flashes of light, noises Complex e.g. faces, scenes, music

Answer 40

A perception of being touched in the absence of a sensory stimulus is termed a somatic hallucination. This may result in hallucinations of being touched, assaulted or that insects are beneath the skin.

Answer 41

Thought withdrawal refers to a patient’s belief that thoughts can be removed from their mind by others. Questions which may be useful to explore thought withdrawal include: “Is there anything like hypnosis or telepathy going on?” “Is there anyone or anything taking thoughts out of your head?”

Answer 42

Thought insertion refers to a patient’s belief that thoughts can be inserted into their mind by others. Questions which may be useful to explore thought insertion include: “Are your thoughts your own?” “Is there anyone/anything putting thoughts into your head that you know are not your own?” “How do you know they aren’t yours? Where do they come from?”

Answer 43

Thought broadcasting refers to a patient’s belief that others can hear their thoughts. Questions which may be useful to explore thought broadcasting include: “Can anyone hear your thoughts? For example, can I hear what you are thinking right now?” “Do you ever hear your own thoughts echoed or repeated?”

Answer 44

Delusions are firm, fixed beliefs based on inadequate grounds, not amenable to a rational argument or evidence to the contrary and not in sync with regional and cultural norms. These may include persecutory delusions, in which the patient erroneously believes another individual or group is trying to harm them or ideas of reference, in which the individual incorrectly believes specific events relate to them. Questions which may be useful to explore delusional perception include: “Do you sometimes have thoughts that others tell you are false?” “Do you have any beliefs that aren’t shared by others you know?” “Do you ever feel that people are out to do you harm?” “Do you ever feel that specific events in the world are related to you in some way?” “When you watch the television/listen to the radio/hear something, do you feel that the stories are referring to you or something that you have done?”

Answer 45

People who experience passivity do not feel in control of their actions, thoughts and perceptions, believing them to influenced by an external agent. Questions which may be useful to explore passivity include: “Do you ever feel as though you are being controlled by someone or something?” “Do you ever think that someone or somebody is controlling you?” “Are your thoughts/mood/actions under your control or is someone forcing you to behave in this way?”

Answer 46

Certain symptoms as being characteristic of schizophrenia and therefore exhibiting a “first-rank” status in the hierarchy of potentially diagnostic symptoms. However first rank symptoms can occur in other disorders such as mania or delirium which is why their isolated presence is not sufficient for a diagnosis of schizophrenia.

Answer 47

Delusional perception Passivity Delusions of thought interference Auditory hallucinations

Answer 48

Delusions can be defined as a belief that is held in spite of superior evidence to the contrary. They are seen in a number of psychiatric conditions, such as schizophrenia, bipolar disorder and psychotic depression. Delusions may be bizarre, non-bizarre and mood congruent or mood-neutral.

Answer 49

Nihilistic delusions Delusions of grandeur/grandiose delusions Delusions of control Persecutory delusions

Answer 50

Negative delusions that are typically mood-congruent and see in depressed patients.

Answer 51

Delusions with a strong positive affect where patients believe they have highly positive traits e.g "I'm rich" "I'm the Prime Minister". Associated with mania.

Answer 52

To a sensation that an external party is controlling an individuals thoughts or actions. Seen in psychosis.

Answer 53

A set of delusional conditions in which the patient believes they are being persecuted. May be seen in psychosis.

Answer 54

Cotard syndrome is a rare mental disorder where the affected patient believes that they (or in some cases just a part of their body) is either dead or non-existent. This delusion is often difficult to treat and can result in significant problems due to patients stopping eating or drinking as they deem it not necessary. Cotard syndrome is associated with severe depression and psychotic disorders. It can also appear as a result of parietal lobe lesions.

Answer 55

De Clerambault's syndrome, also known as erotomania, is a form of paranoid delusion with an amorous quality. The patient, often a single woman, believes that a famous person is in love with her.

Answer 56

Delusional parasitosis is a relatively rare condition where a patient has a fixed, false belief (delusion) that they are infested by 'bugs' e.g. worms, parasites, mites, bacteria, fungus. This may occur in conjunction with other psychiatric conditions or may present by itself, with patients often otherwise quite functional despite the delusion.

Answer 57

A pseudohallucination is a false sensory perception in the absence of external stimuli when the affected is aware that they are hallucinating. An example of a pseudohallucination is a hypnagogic hallucination which occurs when transitioning from wakefulness to sleep. These are experienced vivid auditory or visual hallucinations which are fleeting in duration and may occur in anyone. These are pseudohallucinations as the affected person is able to determine that the hallucination was not real. The relevance of pseudohallucinations in practice is that patients may need reassurance that these experiences are normal and do not mean that they will develop a mental illness. Pseudohallucinations commonly occur in people who are grieving.

Answer 58

A patient repeats the last syllable of a word or phrase.

Answer 59

Increased quantity and speed of speech. Common in mania.

Answer 60

A preoccupation with a single subject to a pathological degree.

Answer 61

Othello syndrome is a strong delusional belief that their spouse or partner is unfaithful with little or any proof to back up their claim. It is associated with alcohol abuse, psychosis and right frontal lobe damage.

Answer 62

Ekbom's syndrome is a delusional belief where a patient feels that they are infested with parasites. They often complain of feeling "crawling" in the skin. It can appear as part of a psychotic illness or a secondary organic disease such as B12 deficiency, hypothyroidism and neurological disorders.

Answer 63

Capgras delusion refers to a delusion that either oneself or another person has been replaced by an exact clone. It may be part of a psychotic illness or as a result of trauma to the brain.

Answer 64

mental disorder in which thought and emotions are so impaired that contact is lost with external reality 'out of touch with reality'- the person is experiencing a reality that is not true lack of insight

Answer 65

Hallucinations Delusions Formal thought disorder Passivity phenomena

Answer 66

Hallucination: outside space, clear boundaries, vivid colour, exists independentof pt, 3D - rotate, light Imagery: Inside, blurred, grey, only when pt imagines it,'flat'

Answer 67

2nd person hallucination - associated with affective disorders 3rd person hallucination, including commands - associated with schizophrenia

Answer 68

Frontal lobe

Answer 69

Organic causes e.g. delirium

Answer 70

May be normal Temporal lobe problem

Answer 71

Primary (true delusions) Secondary delusions (associated with some other experiences - i.e. belief someone is going to kill them secondary to an auditory hallucination saying someone is going to kill them)

Answer 72

Where should the patient most safely be managed? RISK? Rule out organic (medical) causes e.g. delerium Considering sectioning if neded Consider drug misuse (stimulants) Treatment - follow biopsychosocial method Antipsychotics, psychological support, social and drug issues

Answer 73

In both schizoaffective disorder and schizophrenia, hallucinations and delusions tend to occur Psychotic symptoms in schizophrenia tend to be persistent, while a person with schizoaffective disorder will generally have briefer episodes of psychotic symptoms that come and go A person who has schizophrenia can become depressed or manic, but these mood disorder symptoms are not generally a prominent or persistent part of their condition.4 Conversely, a person with schizoaffective disorder will experience chronic and persistent mood symptoms. A diagnosis of schizophrenia is more likely if the individual experiences at least two of the following symptoms: Confused thinking or speech Delusions Hallucinations Negative symptoms, such as lack of expression Unusual body movements

Answer 74

Othello's syndrome is pathological jealousy where a person is convinced their partner is cheating on them without any real proof. This is accompanied by socially unacceptable behaviour linked to these claims.

Answer 75

Stopping of voluntary movement or staying still in an unusual position

Answer 76

Routine refferal to CMHT

Answer 77

Delusions – fixed false beliefs – e.g. Persecutory delusions/paranoia, Delusions of control/passivity phenomena (thoughts, actions or sensations). Hallucinations – tend to be auditory hallucinations (third person or running commentary) in Paranoid Schizophrenia. Thought echo, insertion, withdrawal or broadcast. Negative symptoms including apathy, paucity of speech and blunted affect. Catatonic symptoms. Mood symptoms e.g symptoms of depression or mania.

Answer 78

Referral to a CPN/Early Intervention Psychosis team for support and monitoring in the community. Psychology referral, for example, for CBT or family therapy. Occupational groups or support groups locally. Education about lifestyle factors, e.g. recreational drug use, cardiometabolic health, smoking. Support with finances e.g. benefits or employment support.

Answer 79

This is a short-term disturbance that involves the sudden onset of at least 1 positive psychotic symptom. Positive symptoms include delusions, hallucinations, disorganised speech, and grossly disorganised or catatonic behaviour. Brief psychotic disorder often resolves with a return to baseline functioning

Answer 80

• Treat as for any other mania – usually antipsychotic first-line • Liaise with oncology team, patient and family re risk/benefit of continuing steroid and whether to gradually reduce • May or may not require MHA assessment and inpatient psychiatric care • Long term psychiatric follow up in outpatients, gradual reduction of antipsychotic. • Psychoeducation re. relapse indicators of future mood episodes for both patient and family

Answer 81

two or more voices discussing the patient in the third person thought echo voices commenting on the patient's behaviour

Answer 82

While a person experiencing an idea of reference will change his or her mind when evidence dictates he/she must, a person experiencing a delusion will believe something refers back to him or her even in the face of strong evidence to the contrary.

Answer 83

Palilalia is the automatic repetition of one's own words, phrases or sentences.

Answer 84

Knight's move thinking there are illogical leaps from one idea to another, flight of ideas there are discernible links between ideas

Answer 85

Pareidolic illusions are vivid illusions that occur from indistinct stimuli, like seeing a face in burn marks. They occur as a result of fantasy and vivid visual imagery and can occur without conscious effort, although they often intensify if the person concentrates. They are not related to affect (state of mind).

Schizophrenia And Other Psychoses Flashcards

(109 cards)