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Psychiatry > Shizophrenia + Psychosis > Flashcards

Shizophrenia + Psychosis Flashcards

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1
Q

What is psychosis

A

Inability to differentiate between symptoms of delusion / hallucination / disordered thinking from reality

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2
Q

What causes psychosis

A 
Neurodevelopment
Genetic
Psychological
Childhood experience / trauma
Social - cannabis / migration / urvan
Brain structure abnormality
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3
Q

What is a hallucination and in what senses

A 
Experience with full force and clarity of true perception with 
No stimuli 
Auditory = most common
Visual = associated with organic cause 
Tactile = drug 
Olfactory
Gustatory
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4
Q

What is pseudo-hallucination and when is it common

A

Aware that you are hallucinating

Common when grieving

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5
Q

What is a delusion

A

Unshakeable idea or belief outwit person culture

Held with extra-ordinary conviction

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6
Q

Types of delusions

A 
Paranoid
Grandiose
Nihilistic
Hypochondrial 
Self-referential
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7
Q

What is a illusion

A

Misinterpretation of external stimuli

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8
Q

What else does psychosis present with

A

Thought disorder

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9
Q

What illness present with psychosis

A

Schizophrenia
Delerium
Severe affective disorder
Drug induced - cocaine / steroid

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10
Q

What is Charles-Bonnet

A

Persistent or recurrent hallucination in clear consciousness
Visual impairent
Insight preserved

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11
Q

What are RF for Charles bonnet

A 
Age
Visual - macular / glaucoma / cataract 
Isolation
Decreased sensory
Decreased cognition
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12
Q

What is Cotard

A

Patient believe they are dead so stop E+D
Very difficult to treat
Associated with severe depression

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13
Q

What is De Clerambault

A

Paranoid delusions

Single women believes a famous person is in love

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14
Q

Aetiology of Schizophrenia / R

A 
M=F
15-35
Genetics / FH = biggest RF 
Cannabis smoking
Childhood stress 
Life event may trigger 
Migration
Urban environment
Isolation
Social class
High EE family
Malnurition 
Obstetric complication
Maternal Flu
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15
Q

What genes associated

A

DiGeorge 22q11
CF
Neuroregulin
Dyslondin

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16
Q

What is neurochemistry in brain

A

Increased dopamine?

Decreased glutamate and GABA

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17
Q

What are changes in brain structure that can be found

A

Enlarged ventricle

Decreased frontal and temporal lobe

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18
Q

What is pre-morbid phase (notice when you look back)

A

Motor, cognitive and social difficulty
Anxiety
Mild paranoia

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19
Q

What is prodromal to an episode

A

Odd ideas and experiences

Altered affect

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20
Q

What is progression of disease

A

Single acute psychotic episode = 20%
Multiple = 40%
Chronic impairment = 40%
Increased risk of suicide

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21
Q

What are +ve symptoms of schizophrenia / 1st rank

A

Hallucination - auditory
Delusion
Thought disorder
Passivity

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22
Q

What are -ve symptoms (often chronic and poor response to Rx)

A 
Apathy 
Poverty of speech
Anhedonia
Irritable
Decreased attention
Occupation and cognitive decline
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23
Q

What is needed to make Dx

A

> 1 month
Absence of organic / affective
At least one of 1st rank Sx
AND at least two of other Sx

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24
Q

What are 1st rank

A

Auditory hallucination
Delusional perception
Passitivity phenomena
Thought disorder

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25
What are auditory hallucinations
Thought echo Running commentary 3rd person discussing
26
What is delusional perception
Normal perception but misinterpreted
27
What is passivity
Body controlled by external force | Action / impulses and feeling
28
What is thought disorder
Thought echo Thought insertion or withdrawal Thought broadcasting
29
What are other Sx
``` Persistent hallucinations / delusions of any type Thought form disorder Catatonic behaviour - stopping voluntary movement Negative Sx Cognition Mood disturbance Circadian rhythm disturbance Occupational and social withdrawal ```
30
What is thought form
``` Flight of ideas - usually link Loosening of ideas - no link 'Knights' Neologism Ideas of reference - make events personal Clang - link words through sound Worrd salad - makes no sense ```
31
When is Flight more common in
Mania
32
What are examples of Catatonia
Posturing - stay in position themselves Waxy flexibility - put in position Mutism Stupor
33
What suggests good prognosis
``` No FH Good pre-morbid Female Clear precipitant Late onset Acute Mood disturbed No -ve symptoms Prompt Rx No PMH No substance misuse Lack of life stressor Maintenance of initiative / motivation Good adherence to medication ```
34
What suggests poor prognosis
``` FH Male Low IQ SUbstance misuse Slow insidious onset Childhood onset Prominent -ve symptoms ```
35
What are DDX
``` Delerium Organic brain e.g. lung cancer Drug induced Delerium tremens Depression Mania Brain tumour / encephalitis / strok Personality disorder Anaemia SLE / Sarcoid ```
36
What suggests more likely organic
``` Visual hallucination Fluctuate Distubred consciousness Misidentify person Persecutory and evanescent delusion ```
37
What must you always exclude
Drug induced | Cocaine / steroid
38
What does depression tend to have
Delusions of guilt / worthlessness | Derogotary hallucination
39
Mania
Delusions of grandeur
40
What investigations do you do
``` Physical exam MMSE Blood - FBC, U+E TFT, glucose Urine for drug CT brain EEG - rare ```
41
CT brain indicated if
Elderly | New onset
42
How do you Rx
See pharmacology | Anti-psychotic 1st line
43
Wha can you use short term
Benzodiazepine
44
What is synergistic
Mood stabiliser
45
What is conservative measures
CBT - always offer Social - SW / drug / housing / skills trainig Family intervention Address CVS risk
46
Treatment resistant
Clozapine
47
Police Place of Safety (section 136)
Person with mental disorder / suspicion Risk of harm to self or others Can take to place of safety - A+E,
48
What does mental health law do
Power to Rx people with mental disorder Mental illness Personality disorder LD
49
What is emergency detention (section 4)
72 hours NO RX Used in emergency detention where only one doctor is available Registered medical practitioner - not FY1
50
What is short term (section 2)
28 days Can Rx Approved medical (GP or 2+ doctor) + mental health officer Can't be renewed - may need section 3 after
51
What is compulsory treatment order (section 3)
``` Detention up to 6 months Allow Rx of mental illness Make application to tribunal 2 approved medical inc GP Can be renewed ```
52
Nurses holding power (section 5)
3 hours
53
What is criteria for detention under mental health act
``` Mental disorder Sig impairment in decision making for Rx Sig risk to health / safety / welfare of person or other Treatment available Order necessary and least restrictive ```
54
When do you use adults with incapacity act
``` Incapable of Making decision Acting on deciisoin Communicationg decision Understanding Retaining memory ```
55
What must you do when applying
Must benefit adult Least restrictvie Take in past and present wishes Views of relatives / relevant other
56
When do you use
No-one to make decision
57
When can't you use
Mental health
58
Intervention order
One off power
59
What is guardianship
Someone appointment to make decision
60
POA
Appointed when person had capacity
61
What is compulsion order
Same criteria as CTO | No requirement for impaired decision
62
What is assessment order
When going through court to assess | 28 days
63
What does section 47 AWIA allow
Legalise Rx if can't consent
64
If patient with LD needs invasive Rx what do you use
Section 47 AWIA
65
What is adult support and protection act
>16 If unable to safeguard own well being At risk of harm Affected disability / mental or physical illness so more vulnerable
66
What is informal admission
Patient volunteers

Psychiatry (11 decks)

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