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Flashcards in Shizophrenia + Psychosis Deck (66)
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1
Q

What is psychosis

A

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

2
Q

What causes psychosis

A
Neurodevelopment
Genetic
Psychological
Childhood experience / trauma
Social - cannabis / migration / urvan
Brain structure abnormality
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
4
Q

What is pseudo-hallucination and when is it common

A

Aware that you are hallucinating

Common when grieving

5
Q

What is a delusion

A

Unshakeable idea or belief outwit person culture

Held with extra-ordinary conviction

6
Q

Types of delusions

A
Paranoid
Grandiose
Nihilistic
Hypochondrial 
Self-referential
7
Q

What is a illusion

A

Misinterpretation of external stimuli

8
Q

What else does psychosis present with

A

Thought disorder

9
Q

What illness present with psychosis

A

Schizophrenia
Delerium
Severe affective disorder
Drug induced - cocaine / steroid

10
Q

What is Charles-Bonnet

A

Persistent or recurrent hallucination in clear consciousness
Visual impairent
Insight preserved

11
Q

What are RF for Charles bonnet

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

What is Cotard

A

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

13
Q

What is De Clerambault

A

Paranoid delusions

Single women believes a famous person is in love

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
15
Q

What genes associated

A

DiGeorge 22q11
CF
Neuroregulin
Dyslondin

16
Q

What is neurochemistry in brain

A

Increased dopamine?

Decreased glutamate and GABA

17
Q

What are changes in brain structure that can be found

A

Enlarged ventricle

Decreased frontal and temporal lobe

18
Q

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

A

Motor, cognitive and social difficulty
Anxiety
Mild paranoia

19
Q

What is prodromal to an episode

A

Odd ideas and experiences

Altered affect

20
Q

What is progression of disease

A

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

21
Q

What are +ve symptoms of schizophrenia / 1st rank

A

Hallucination - auditory
Delusion
Thought disorder
Passivity

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
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

24
Q

What are 1st rank

A

Auditory hallucination
Delusional perception
Passitivity phenomena
Thought disorder

25
Q

What are auditory hallucinations

A

Thought echo
Running commentary
3rd person discussing

26
Q

What is delusional perception

A

Normal perception but misinterpreted

27
Q

What is passivity

A

Body controlled by external force

Action / impulses and feeling

28
Q

What is thought disorder

A

Thought echo
Thought insertion or withdrawal
Thought broadcasting

29
Q

What are other Sx

A
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
Q

What is thought form

A
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
Q

When is Flight more common in

A

Mania

32
Q

What are examples of Catatonia

A

Posturing - stay in position themselves
Waxy flexibility - put in position
Mutism
Stupor

33
Q

What suggests good prognosis

A
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
Q

What suggests poor prognosis

A
FH
Male 
Low IQ
SUbstance misuse
Slow insidious onset
Childhood onset
Prominent -ve symptoms
35
Q

What are DDX

A
Delerium
Organic brain e.g. lung cancer
Drug induced 
Delerium tremens
Depression 
Mania
Brain tumour / encephalitis / strok
Personality disorder
Anaemia 
SLE / Sarcoid
36
Q

What suggests more likely organic

A
Visual hallucination
Fluctuate
Distubred consciousness
Misidentify person
Persecutory and evanescent delusion
37
Q

What must you always exclude

A

Drug induced

Cocaine / steroid

38
Q

What does depression tend to have

A

Delusions of guilt / worthlessness

Derogotary hallucination

39
Q

Mania

A

Delusions of grandeur

40
Q

What investigations do you do

A
Physical exam
MMSE
Blood - FBC, U+E TFT, glucose 
Urine for drug 
CT brain 
EEG - rare
41
Q

CT brain indicated if

A

Elderly

New onset

42
Q

How do you Rx

A

See pharmacology

Anti-psychotic 1st line

43
Q

Wha can you use short term

A

Benzodiazepine

44
Q

What is synergistic

A

Mood stabiliser

45
Q

What is conservative measures

A

CBT - always offer
Social - SW / drug / housing / skills trainig
Family intervention
Address CVS risk

46
Q

Treatment resistant

A

Clozapine

47
Q

Police Place of Safety (section 136)

A

Person with mental disorder / suspicion
Risk of harm to self or others
Can take to place of safety - A+E,

48
Q

What does mental health law do

A

Power to Rx people with mental disorder
Mental illness
Personality disorder
LD

49
Q

What is emergency detention (section 4)

A

72 hours
NO RX
Used in emergency detention where only one doctor is available
Registered medical practitioner - not FY1

50
Q

What is short term (section 2)

A

28 days
Can Rx
Approved medical (GP or 2+ doctor) + mental health officer
Can’t be renewed - may need section 3 after

51
Q

What is compulsory treatment order (section 3)

A
Detention up to 6 months
Allow Rx of mental illness
Make application to tribunal 
2 approved medical inc GP
Can be renewed
52
Q

Nurses holding power (section 5)

A

3 hours

53
Q

What is criteria for detention under mental health act

A
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
Q

When do you use adults with incapacity act

A
Incapable of 
Making decision
Acting on deciisoin
Communicationg decision 
Understanding
Retaining memory
55
Q

What must you do when applying

A

Must benefit adult
Least restrictvie
Take in past and present wishes
Views of relatives / relevant other

56
Q

When do you use

A

No-one to make decision

57
Q

When can’t you use

A

Mental health

58
Q

Intervention order

A

One off power

59
Q

What is guardianship

A

Someone appointment to make decision

60
Q

POA

A

Appointed when person had capacity

61
Q

What is compulsion order

A

Same criteria as CTO

No requirement for impaired decision

62
Q

What is assessment order

A

When going through court to assess

28 days

63
Q

What does section 47 AWIA allow

A

Legalise Rx if can’t consent

64
Q

If patient with LD needs invasive Rx what do you use

A

Section 47 AWIA

65
Q

What is adult support and protection act

A

> 16
If unable to safeguard own well being
At risk of harm
Affected disability / mental or physical illness so more vulnerable

66
Q

What is informal admission

A

Patient volunteers