1
Q
What is psychosis?
A
Mental state in which reality is greatly distorted.
*Can think of it as person is experiencing a reality different to everyone else
2
Q
ICD-10 classification categorises psychiatric disorders into 10 categories; one of these categories in Schizophrenia, schizotypal and delusional disorders.
State 8 conditions in this category
A
3
Q
What is the most common psychotic disorder?
A
Schizophrenia
4
Q
There is a lower prevalence of psychosis in black and other ethnic minorities in the UK; true or false?
A
FALSE; higher prevalence
5
Q
Psychosis typically presents with one or more of 4 symptoms; state these symptoms
A
- Delusions
- Hallucinations
- Formal thought disorder
- Fragmentation of boundaries of the self
6
Q
Define a delusion
A
Fixed, usually false belief that is firmly held despite evidence to the contrary and goes against an individual’s sociocultural norms.
7
Q
Discuss how we can classify delusions
A
Can classify in terms of:
- Cause
- Primary: unconnected to previous ideas or events
- Secondary: arise from previous ideas and events and are unstandable in context with history
- Association with mood
- Plausibility
- Bizarre: not in keeping with reality, completely impossible
- Non-bizarre
- Content/type of delusion
8
Q
Delusions can be classified based on their content, state at least 6 types of delusion in terms of content
A
9
Q
Define a hallucination
A
A perception in the absence of an external stimulus
10
Q
State the 5 types of hallucinations someone can experience
A
- Auditory
- Visual
- Olfactory
- Gustatory
- Somatic
11
Q
Define formal thought disorder
A
An impairment in the ability to form thoughts from logically connected ideas
12
Q
Causes of psychosis can be organic or non-organic; state at least 4 examples of each
A
13
Q
Schizophrenia is the most common psychotic disorder; state some other causes of psychosis
*HINT: use mneumonic Schizophrenia And Schizoaffective Persist For >1 Month, Paraphrenia Presents Late
A
- Schizotypal disorder
- Acute & transient psychotic disorders
- Shcizoaffective disorder
- Persistent delusional disorder
- Induced delusional disorder (Folie a deux)
- Mood disorders with psychosis
- Puerperal Psychosis/Post-Partum psychosis
- Late paraphrenia
14
Q
For schizotypal disorder, discuss:
- What it is also called
- What it is/how it is characterised
- Who is at increased risk
A
15
Q
Define/exaplain what acute and transient psychotic disorders are?
A
16
Q
For schizoaffective disorder, discuss:
- What it is
- What critera must be met
A
17
Q
For persistent delusional disorder, discuss:
- What it is
- What type of delusions are common
A
18
Q
For induced delsuional disorder (Folie a deux) discuss:
- What else it is known as
- Whether it is common or uncommon
- What Folie imposee is
- What Folie simultanee is
A
19
Q
What do we mean by mood disorders with psychosis?
A
20
Q
For Puerperal psychosis discuss:
- What it is
- When it develops
- How common it is
A
21
Q
What is late paraphrenia?
A
22
Q
Defiine schizophrenia
A
Psychotic condition characterised by psychotic epidsodes with hallucinations, delusions & thought disorders alongside negative symptoms such as asocial behaviour, blunted affect etc.. all of which impair function.
It occurs in absence of organic disease, alcohol or drug related disorders and is not secondary to elevation or depression of mood.
23
Q
What is the worldwide prevelance of schizophrenia?
What age does schizoophrenia usually present?
Men or females more affected?
A
0.75-1%
15-35yrs (males tend to present earlier)
Male = female (but men tend to be affected earlier and have mroe severe illness)
24
Q
Aetiology of schizophrenia is both biological and environmental factors; state 3 biological and 2 environmental factors
A
Biological
- Genetics
- In monozygotic twins, if one twin has schizophrenia other twin as 48% chance
- Increased chance if FH
- Dopamine hypothesis (schizophrenia is secondary to over-activity of mesolimbic dopamine pathways)
- Factors that negativley impact early neurodevelopment
- Obstetric complications
- Fetal injury
- Low birth weight
Environmental
- Adverse life events causing psychological stress
- Expressed emotion theory (contribute to relapse)
25
What is the **expressed emotion theory**?
Theory that pts with schizophrenia who's relatives are either over-involved or make hostile or excessive critical comments are more likely to relapse
26
What is the **stress-vulnerability model**?
Predicts that mental disorders occurs due to **environmental factors interacting with genetic predisposition** and that **we all have different vulnerabilities** hence different people need to be **exposed to different levels of environmental factors** to become ill with a mental disorder.
*\*can be used to help understand many disorders including schizophrenia*
27
State some predisposing factors for schizophrenia, include:
* Biological
* Psychological
* Social
28
* State some precipitating factors for schizophrenia, include:
* Biological
* Psychological
* Social
29
Symptoms of schizophrenia can be positive (acute syndrome) or negative (chronic syndrome); state 5 positive symptoms
*\*Hint: mneumonic Delusions Held Firmly Think Psychosis*
* Delusions
* Hallucinations
* Formal thought disorder
* Thought interference
* Passitivity phenomenon *(actions, feelings or emotions are being controlled by an external force)*
30
What kinds of delusions are common in schizophrenia?
What kinds of hallucinations are common in schiophrenia?
* Persecutory, grandiose, nihilisitic, religous, ideas of reference
* Third person auditory hallucinations (may be running commentary in nature)
31
State 6 negative symptoms of schizophrenia
*\*HINT: think the A factor*
32
There are numerous different types of schizophrenia; which is most common?
Paranoid schizophrenia
33
State the 7 types of schizophrenia
*\*HINT: mnuemonic Paranoid Psychotic Humans Can't Supply Understandable Reasoning*
* Paranoid schizophrenia
* Postschizophrenic depression
* Hebephrenic schizophrenia
* Catatoinic schizophrenia
* Simple schizophrenia
* Undifferentiated schizophrenia
* Resdiual schizophrenia
34
Describe each of the 7 types of schizophrenia:
* Paranoid shcizophrenia
* Postschizophrenic depression
* Hebephrenic schizophrenia
* Catatonic schizophrenia
* Simple schizophrenia
* Undifferntiated schizophrenia
* Residual schizophrenia
* **Paranoid schizophrenia**: *dominated by positive symptomsv (e.g. delusions & hallucinations) but speech and emotion may be unaffected*
* **Postschizophrenic depression:** *depression predominates but there has been schizophrenic illness in past 12 months with some schizophrenic symptoms remaining*
* **Hebephrenic (disorganised) schizophrenia:** *thought disorganisation predominates. May also have disorgansied behaviours (such as odd mannerisms) & speech so can be hard to understand them. Have reduced affect. Tendancy to remain solitary & behaviour seems empty of purpose & feeling. Poorer prognosis due to rapid onset of negative symptoms like flat affect and avolition.*
* **Catatoinic schizophrenia:** *rare form characterised by one or more catatonic symptoms*
* **Simple schizophrenia:** *rare form in which negative symptoms develop without psychotic symptoms. Pt's may appear odd, are unable to function in society*
* **Undifferentiated schizophrenia:** *meets diagnostic criteria for schizophrenia but doesn't fit any of subtyepes*
* **Resdiual schizophrenia:** *one year of chronic negative symptoms preceded by clear cut psychotic episode.*
35
State some symptoms of catatonia?
36
The onset of clinical features of schizphrenia may be preceded by prodromal period; what clinical features/symptoms may pt experience in prodromal period
* Reserved/asocial
* Anxious
* Suspicious
* Oversensitive
* Irritable
* Disturbance in normal every day functioning
37
Discuss the ICD-10 criteria for schizophrenia, include:
* Group A and group B symptoms
* Number of symptoms required
* How long symptoms required for
c. ) Hallucinations can be running commentary in nature or 3rd person in which voices are referring to pt in the third person
* \*NOTE: there is symptom i which belongs to category B "a significant and consistent change in the overall quality of some aspects of personal behaviour, manifest as loss of interest, aimlessness, idleness, a self-absorbed attitude, and social withdrawal." but this only applies to diagnosis of simple schizophrenia*
38
Schneider's first rank symptoms are an alternative way, other than ICD-10, of diagnosing schizophrenia. State Schneider's first rank symptoms and explain each
*\*HINT: there is 5 key areas/topics (which may have subdivisions)*
* **Delusional perception:** *new delusion forms in response to a real perception e.g. traffic light turned red so I am chosen one*
* **Auditory hallucinations**
* Hearing one's thoughts spoken out loud
* Third person hallucinations in which voices speaking about them in 3rd person
* Running commentary
* **Thought interference**
* **Thought insertion:** *thoughts inserted*
* **Thought broadcast:** *thoughts heard out loud by others*
* **Thought withdrawal:** *thoughts removed*
* **Passitivity phenomenon:** *actions, feelings or emotions controlled by external force*
* **Somatic hallucinations:** hallucination of physical experience within body
39
If a pt presents wtih schizophrenic like symptoms but they have lasted less than 1 month, what would you diagnose as (in the meantime)?
Diagnose in the first instance as acute **schizophrenia-like psychotic disorder** and reclassify as schizophrenia if the symptoms persist for longer periods
40
What scale can be used to assess severity of schizophrenia?
PANSS (positive and negative syndrome scale)
41
History taking tips for psychotic pt's
42
What might you find on MSE of pt with shcizophrenia?
43
What investigations might you consider in pt with or with suspected schizophrenia?
*\*Split your answers into bedside, bloods & imaging/other*
_Bedside_
* Urine drug test: *illicit drugs can exacerbate psychosis*
* ECG: *antipsychotics can prolong QT interval*
_Bloods_
* FBC:*anaemia or infection*
* TFTs: *thyroid dysfunction can present with psychosis*
* U&Es: *assess renal func before give antipsychotics*
* LFTs: *assess liver func before give antipsychotics*
* HbA1c: *atypical antipsychotics can cause metabolic syndrome*
* Cholesterol: *atypical antipsychotics can cause metabolic syndrome*
* Vit B12: *deficiency can cause psychosis*
* Folate: *deficiency can cause pyschosis*
_Imaging/other_
* CT scan: rule out organic causes e.g. lesion
* EEG: rule out temporal lobe epilepsy as is possible cause of psychosis
44
Management of schizophrenia is based on the biopsychosocial model; alongside this state some other areas/factors in management to consider
* **Risk assessment**
* Do you need to use **MHA**?
* **Care programme approach** (lots of professionals involved e.g. GP, CPNs, CRHT, social workers etc...)
* If first presentation of psychosis, **early intervention in psychosis team** should be involved as they provide interventions aimed to reduce duration of untreated psychotic episode (strong prognostic indicator)
* **Inform DVLA**
45
Management of schizophrenia is based on biopsychosocial model; discuss the biological management of schizophrenia
**_Antipsychotics_**
* **First line= atypicals** (e.g. risperidone, olanzapine). *Can give depot formulations*
* **Clopazine** is most effective antipsychotic and used for treatment resistant schizophrenia
**_Adjuvants_**
* **Benzodiazepines:** short term relif of behaviour disturbance, insomnia, aggression & agitation
* **Antidepressants** (add on to antipsychotic treatment)
* **Lithium** (add on to antipsychotic treatment)
**_ECT_**
* If **resistant to pharmacological agents**
* Effective for catatonic schizophrenia
46
What do we mean by treatment-resistant schizophrenia?
Failure to respond to two other antipsychotics
47
Management of schizophrenia is based on biopsychosocial model; discuss the psychological management of schizophrenia
* **CBT:** *helps reduce residual symptoms*
* **Family intervention:** *most useful for families of pts with persisting symptoms; psychoeducation helps families reduce high levels of expressed emotion (emotional overinvolvement, hostility etc...) which reduces relapse rates (emotion theory)*
* **Art therapy:** *e.g. music, dancing, art as it can help alleviate negative symptoms*
* **Social skills training:** *behavioural approach to help pts improve interpersonal, self care and coping skills for every day life*
48
Management of schizophrenia is based on biopscyhosocial model; discuss the social management of schizophrenia
* **Support groups & information:** *e.g. Rethink, SANE... can help rehabilitation into community*
* **Peer support:** *peer support worker who has recovered from psychosis and remained stable*
* **Support employment programmes:** *help pts return to work*
* **Support with housing, benefits etc...**
49
Summarise how you go about initiating antipsychotics in pts with schizophrenia, consider:
* What dose you give
* How long you assess pt for to see if drug is working
* What to do if drug is effective, ineffective, poor compliance or not tolerated
50
Discuss the prognosis of schizophrenia
* Most people make good recovery following first episode of psychosis
* The most common course is initial improvement of symptoms with ongoing recurrent acute psychotic episodes or relapses over many years.
* Life expectancy for adults with psychosis or schizophrenia is **between 15 and 20 years less** than for people in the general population. This may be because people with psychosis or schizophrenia often hav**e physical health problems, including cardiovascular and metabolic disorders**, such as type 2 diabetes, that can be exacerbated by the use of antipsychotics. Tend to have **poor lifestyles.**
51
State some poor prognostic factors for schizophrenia
* Strong family history
* Gradual onset
* Premorbid history of social withdrawal
* No obvious precipitant
* Low IQ
* Low socioeconomic status
* Longer duration of untreated psychosis
* Male symptoms
* Negative symptoms
52
Discuss the dopamine hypothesis of schizophrenia
* **Overactivity of mesolimbic system** causes positive symptoms of schizophrenia
* **Underactivity of mesocortical system** causes negative, cognitive and affective symptoms of schizophrenia
Yr4: Psychiatry
flashcards
Decks in class (17)
# Cards
-
Psychiatry Basics/Introduction17
-
Psychiatric History Taking & MSE44
-
Affective Disorders75
-
Schizophrenia & Psychoses52
-
Anxiety Disorders101
-
Personality Disorders23
-
Substance Misuse64
-
Eating Disorders65
-
Self Harm & Suicide26
-
Psychotherapies36
-
Psychopharmacology: Antidepressants & Antipsychotics80
-
Psychopharmacology: Mood Stabilisers, Anxiolytics & Others46
-
Legal Aspects of Psychiatry34
-
Child & Adolescent Psychiatry63
-
ECT16
-
Liason Psychiatry8
-
Psychological Problems Presenting with Physical Symptoms31
