S12) Psychotic Disorders Flashcards Preview

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Flashcards in S12) Psychotic Disorders Deck (27)
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1
Q

What is psychosis?

A
  • Psychosis is the presence of hallucinations or delusions
  • It describes symptoms, not a diagnosis in itself
2
Q

What are hallucinations?

A
  • Hallucinations are a perception without a stimulus
  • It can be in any sensory modality (visual hallucinations are organic)
3
Q

What are some hallucinations experienced in the ‘normal’ population?

A
  • Hypnogogic – going to sleep
  • Hypnopompic – waking up
4
Q

What is a delusion?

A

A delusion is an abnormal belief, outside of cultural norms (unshakeable)

5
Q

Identify five organic causes of psychosis

A
  • Delirium caused by infection
  • Hypercalcaemia
  • Acute drug/alcohol intoxication
  • Post-ictal psychosis
  • Hyperthyroidism
6
Q

Identify some iatrogenic causes of psychosis

A
  • Steroids
  • L-Dopas
7
Q

Identify the first rank symptoms of schizophrenia

A
  • Auditory hallucinations
  • Passivity experiences
  • Thought withdrawal, broadcast or insertion
  • Delusional perceptions
  • Somatic hallucinations
8
Q

Distinguish between thought withdrawal, broadcast and insertion

A
  • Thought withdrawal – thoughts are being taken out of the mind
  • Thought broadcast – thoughts are being made known to others e.g. via radio
  • Thought insertion – thoughts implanted by others
9
Q

Identify some positive symptoms of schizophrenia

A

Positive symptoms – added symptoms:

  • Delusions
  • Hallucinations
  • Thought disorder
  • Lack of insight
10
Q

Identify some negative symptoms of schizophrenia

A

Negative symptoms – symptoms that take away from the patient:

  • Underactivity
  • Low motivation
  • Social withdrawal
  • Emotional flattening
  • Self neglect
11
Q

In the ICD10 diagnosis of schizophrenia, a patient with schizophrenia must present with at least one of which symptoms?

A

A) Thought echo, insertion, withdrawal, broadcast

B) Delusions of control, influence or passivity

C) Hallucinatory voices

D) Persistent delusions that are culturally inappropriate and completely impossible

12
Q

In the ICD10 diagnosis of schizophrenia, a patient with schizophrenia must present with at least two of which symptoms?

A

E) Persistent hallucinations in any modality, occurring every day for at least one month

F) Neologisms, breaks or interpolations in the train of thought, resulting in incoherent/irrelevant speech

G) Catatonic behaviour

H) Negative symptoms e.g. marked apathy, paucity of speech, incongruity of emotional responses

13
Q

Identify the different types of schizophrenia

A
  • Paranoid schizophrenia
  • Simple schizophrenia
  • Hebephrenic schizophrenia
  • Undifferentiated schizophrenia
  • Catatonic schizophrenia
14
Q

What is paranoid schizophrenia?

A

Paranoid schizophrenia – delusions or hallucinations prominent

15
Q

What is simple schizophrenia?

A

Simple schizophrenia:

  • Loss of drive and interest, aimlessness, idleness, self absorbed attitude and social withdrawal
  • No hallucinations/delusions
16
Q

What is hebephrenic schizophrenia?

A

Hebephrenic schizophrenia – definite and sustained flattening or shallowness of affect or incongruity/inappropriateness of affect, aimless and disjointed behaviour or thought disorder affecting speech

17
Q

What is undifferentiated schizophrenia?

A

Undifferentiated schizophrenia – insufficient symptoms to meet criteria of any subtypes or so many symptoms fit more than one criteria

18
Q

In the pathophysiology of schizophrenia, which two brain pathways are thought to change?

A
  • Mesolimbic pathway – thought to be overactive in schizophrenia
  • Mesocortical pathway – thought to be underactive in schizophrenia
19
Q

Describe the course of the mesolimbic pathway

A
  • From: ventral tegmental area
  • To: limbic structures (amygdala, septal area, hippocampal formation) and nucleus accumbens
20
Q

Describe the course of the mesocortical pathway

A
  • From: ventral tegmental area
  • To: frontal cortex and cingulate cortex
21
Q

Describe the brain changes observed in schizophrenia

A
  • Enlarged ventricles
  • Reduced hippocampal formation, amygdala, parahippocampal gyrus and prefrontal cortex
22
Q

What are the two options for treating schizophrenia?

A
  • Typical antipsychotics
  • Atypical antispychotics
23
Q

Describe the mechanism of action of typical antipsychotics in the treatment of schizophrenia

A
  • Block D2 receptors in all CNS dopaminergic pathways
  • Main action as antipsychotics is on mesolimbic and mesocortical pathways
24
Q

Describe the mechanism of action of atypical antipsychotics in the treatment of schizophrenia

A
  • Low affinity for D2 receptors
  • Milder side effects as dissociate rapidly from D2 receptor
25
Q

What is drug induced psychosis?

A

Drug induced psychosis is a form of psychosis induced by a psychoactive substance

26
Q

Provide examples of drugs that can induce psychosis

A
  • Methamphetamine
  • Cannabis
  • Cocaine
  • Amphetamines
  • Ketamine
27
Q

What is the ICD10 criteria for drug induced psychosis?

A
  • Onset of psychotic symptoms during or within two weeks of substance use
  • Persistence of the psychotic symptoms for more than 48 hours
  • Duration of the disorder ≤ six months