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Psychiatry > Schizophrenia and Psychotic Disorders > Flashcards

Schizophrenia and Psychotic Disorders Flashcards

1
Q

The 3 principle psychotic disorders

A

Delirium
Schizophrenia
Affective psychosis

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2
Q

Definition of psychosis

A

Represents an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality

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3
Q

Main symptom of schizophrenia

A

lack of insight

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4
Q

What does a predisposing factor mean?

A

putting you at risk

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5
Q

What does a precipitating factor mean?

A

something that starts it

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6
Q

What does a perpetuating factor mean?

A

keeping it going

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7
Q

Presentation of psychosis

A 
Hallucinations
- full force and clarity of true perception 
- located in external space
- no external stimulus 
- not willed or controlled 
Delusional beliefs 
- grandiose
- paranoid (correctly persecutory)
- hypochondrial 
- self referential 
Lacks insight
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8
Q

5 special senses of hallucinations

A 
Auditory 
Visual 
Tactile (touching you)
Olfactory 
Gustatory (Taste)
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9
Q

Definition of delusion

A

An unshakable idea or belief which is out of keeping with the persons social or cultural background; it is held with extraordinary conviction

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10
Q

Illnesses that have psychotic symptoms

A

Schizophrenia
Delerium
Severe affective disorder

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11
Q

What is severe affective disorder?

A

Either
- depressive episode with psychotic symptoms
OR
- manic episode with psychotic symptoms

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12
Q

Differential diagnosis of psychosis

A 
Delerium 
Acute organic brain syndrome
Depressive episodes with psychotic symptoms 
Manic episodes with psychotic symptoms 
Schizophrenia 
Making it up e.g. in a police case
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13
Q

Features of psychosis caused by delirium or acute organic brain syndrome

A

Prominent visual experience, hallucinations and illusions
Affect of terror
Delusions are persecutory and evanescent (quickly disappear)
Fluctuating worse at night

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14
Q

Definition of an illusion

A

Abnormal perception of a real thing

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15
Q

Features of psychosis caused by depressive episode with psychotic symptoms

A

Delusions of guilt, worthlessness and persecution

Derogatory and auditory hallucinations

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16
Q

Features of psychosis caused by a manic episode with psychotic symptoms

A

Delusions of grandeur; special powers or messianic roles
Gross overactivity, irritability and behavioural disturbance
Manic excitement

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17
Q

Treatment of psychosis

A

Early intervention - family and psychological
Community treatment
Antipsychotics
Treatment to prevent relapse during remission
CBT
Cognitive remediation
Social skills training

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18
Q

Definition of schizophrenia

A

A severe mental illness affecting thinking, emotion and behaviour

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19
Q

What is the most common cause of psychosis?

A

Schizophrenia

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20
Q

Who gets schizophrenia?

A

M = F

onset 15-35 years

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21
Q

Possible biological causes of schizophrenia

A 
genetics
neurochemistry (glutamate, GABA)
obstetric complications
maternal influenza
malnutrition and famine
winter birth 
substance misuse e.g. cannabis
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22
Q

Symptoms of schizophrenia

A 
Positive
- hallucinations
- delusions
- disordered thinking
Negative
- apathy 
- lack of interest
- lack of emotions
- alogia 
- disturbed attention
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23
Q

What is a “positive” symptom?

A

A dramatic, more obvious symptom

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24
Q

ICD-10 Criteria for schizophrenia

A

> 1 month in the absence of organic or affective disorder
At least 1 of the following
- alteration of thought; echo, thought insertion, thought withdrawal, thought broadcasting
- delusions of control, influence or passivity (other people controlling you), clearly referred to body or limb movements - actions or sensations
- hallucinatory voices giving a running commentary on patients behaviour, or discussing him between themselves or other voices coming from somewhere in the body
- persistent delusions that are culturally inappropriate and completely impossible (e.g. controlling weather)
And OR at least two of the following
- persistent hallucinations of any modality, when occurring every day for at least 1 month
- Neologisms, breaks or interpolations in train of thought, resulting in incoherence or irrelevant speech
- Catatonic behaviour, such as excitement, posturing or wavy flexibility, negativism, mutism and stupor

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25
Q

Good prognostic factors for schizophrenia

A 
Absence of FH
Good premorbid function 
Clear precipitant 
Acute onset
Mood disturbance
Prompt treatment 
Maintenance of initiative, motivation
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26
Q

Poor prognostic factors for schizophrenia

A 
Slow, insidious, early onset
Prominent negative symptoms
Starts in childhood
Male 
Unmarried 
Non paranoid type
Negative / catatonic symptoms 
Absence of affective symptoms 
FH
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27
Q

5 criteria for detention under the Mental Health Act

A 
Mental illness
Risk 
Treatment
SIDMA - severely impaired decision making 
Least restrictive option/necessary
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28
Q

Once detained under the mental health act, what happens?

A

Investigations to rule out organic cause
May need 24 hour observation by e.g. nurse
Start antipsychotic

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29
Q

What type of symptoms do patients experience when they have their 1st presentation?

A

+ve symptoms

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30
Q

What is the most common symptom of schizophrenia?

A

Auditory hallucinations

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31
Q

Definition of alogia

A

Poverty of speech

32
Q

Can treatment for schizophrenia be given under the mental health act?

A

Yes

33
Q

Complications of schizophrenia

A

Suicide (4 - 10%)

Social and occupational decline

34
Q

What is the drug most associated with schizophrenia?

A

Cannabis

35
Q

When do men present in comparison to women?

A

Men present on average 5 years earlier

36
Q

What can trigger a presentation of acute schizophrenia?

A

Big life stress

37
Q

Differentials for psychosis

A

Schizotypical, schizoaffective and other delusional disorders
Mania
Delerium
Drug abuse / medications
Cerebral tumour / infarct / TLE / infection
Endocrine disease (thyroid, chronic hypoglycaemia, cushings, addisons)
Anaemia / carcinoma / sarcoid

38
Q

Type of hallucinations, delirium vs schizophrenia

A

Delerium - visual

Schizophrenia - auditory

39
Q

What % of people with schizophrenia have 1 episode only?

A

20%

40
Q

Types of schizophrenia

A 
Paranoid
Hebephrenic (disorganised)
Catatonic (motor)
Simple
Residual 
Post schizo depression 
Not otherwise specified
41
Q

What is the most common type of schizophrenia?

A

Paranoid

42
Q

What happens in paranoid schizophrenia?

A

Systemised delusions and hallucinations

43
Q

What happens in hebenephric schizophrenia?

A

Delusions, thought form disorder, disturbed affect

44
Q

What is the treatment for catatonic schizophrenia?

A

Lorazepam

45
Q

What happens in residual schizophrenia?

A

Predominately -ve symptoms

46
Q

What happens in simple schizophrenia?

A

Only -ve symptoms

47
Q

What are 1st rank symptoms strongly suggestive of?

A

Schizophrenia

48
Q

Where can 1st rank symptoms be seen?

A

Schizophrenia
Organic disorders
Mood disorders

49
Q

Types of delusions

A

Paranoid / persecutory
Grandeur
Nilhilistic
Reference

50
Q

What is an over valued idea?

A

Less than a delusion as not fully convicted

51
Q

Definition of a pseudohallucination

A

Persons thoughts become alienated from them inside their head etc in trauma. They often know it is their own thoughts causing this

52
Q

What is circumstantiality?

A

The inability to answer a question without giving excessive, unnecessary detail

53
Q

What are clang associations?

A

Describes speech in which topics are related to each other only by sounding something similar

54
Q

What are flight of ideas?

A

Describes speech in which there is rapid changing of subjects, unrelated to one another

55
Q

What is preservation?

A

Describes repetition of speech on the same subject, despite attempting to change the subject

56
Q

What is tangentiality?

A

Describes speech that wanders from a topic, without returning to it

57
Q

What are neologisms?

A

New word formations, which might include the combining of two words

58
Q

What is word salad?

A

Completely incoherent speech where real words are strung together into nonsense sentences

59
Q

What is knights move?

A

Severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another

60
Q

What is knights move a feature of?

A

Schizophrenia

61
Q

What is flight of ideas a feature of usually?

A

Mania

62
Q

What is echolalia?

A

A repetition of someone elses speech, including the question that was asked

63
Q

What may antipsychotics cause?

A

Akathisia

64
Q

What is akathisia?

A

Severe restlessness

65
Q

Which atypical antipsychotic has the most tolerance S/E profile, particularly for prolactin elevation?

A

Aripriprazole

66
Q

What treatment is now first line for schizophrenic patients?

A

Atypical antipsychotics

67
Q

What is the main advantage of atypical agents?

A

They have a significant reduction in extrapyramidal S/Es

68
Q

S/Es of atypical antipsychotics

A

Weight gain
Clozapine - agranulocytosis
Hyperprolactinaemia

69
Q

What risks are there for using antipsychotics in the elderly population?

A

Increased risk of

  • stroke
  • VTE
70
Q

Examples of atypical antipsychotics

A 
Clozapine
Olanzapine
Risperidone
Quetiapine
Amisulpride
Arirpiprazole
71
Q

S/Es of clozapine

A

Agranulocytosis (1%) and neutropenia (3%)
Reduced seizure threshold (can induce seizures in up to 3% of patients)
Constipation
Myocarditis (ECG before starting Tx)
Hypersalviation

72
Q

Due to clozapines S/Es, what does this mean in terms of treatment?

A

Only used in patients who are resistant to other antipsychotic medication

73
Q

When may the dose of clozapine have to be adjusted?

A

If smoking is stopped or started during the treatment

74
Q

Patients with poor oral compliance of anti-psychotics can be switched to what?

A

Once monthly IM antipsychotic depot injections

75
Q

What is used to assess the severity of schizophrenia?

A

Positive and negative syndrome scale (PANSS)

76
Q

What does tardive dyskinesia present as a S/E of and how does it present?

A 
Due to late onset abnormal involuntary choreoathethoid movements in patients on conventional antipsychotics
Can present as 
- chewing
- jaw pouting
- excessive blinking
77
Q

What is it important to do if a patient is on clozapine and develops an infection?

A

FBC - as need to exclude neutropenia due to clozapine

Psychiatry (18 decks)

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