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139 Cards in this Set
- Front
- Back
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Define Psychosis |
A state of being in which a person loses touch with reality and experiences hallucinations, delusions or disorganised thinking |
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Define psychotic episdoe |
A temporary event in which a person experiences symptoms of psychosis |
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Define prodrome |
A symptom/s that appears shortly before the development of an illness. |
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Define schizoaffective disorder |
A diagnosis that includes symptoms resembling a mood disorder, together with symptoms of schizophrenia, particularly psychosis and social withdrawal. |
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What is the approx. suicide rate of schizophrenics? |
5-10% commit suicide |
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What is DSM-5? |
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition |
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What is the dopamine hypothesis? |
A theory that attributes the cause of schizophrenia or psychosis symptoms to excess dopamine transmission in the brain. |
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Define positive symptom |
Psychotic symptoms that seem to be excesses or distortions of ordinary thinking processes. *Usually responds well to unconventional / atypical antipsychotics* |
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Define negative symptom |
Psychotic symptoms that seem to be a deficit of ordinary thinking processes.
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Define catatonic behaviour. |
A marked decrease in the reactivity to the environment. |
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Define hypomania |
A period of elevated mood which has less impact on functioning than mania. |
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How much shorter is the average lifespan of a schizophrenic? |
15 years shorter |
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Define dystonia |
Symptoms that include prolonged and unintentional muscular contractions of the voluntary or involuntary muscles |
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Define tardive dyskinesia |
Symptoms that include repetitive, involuntary, purposeless movements. |
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What are some common physical illnesses associated with mental illness? |
- CV disorders (meds = weight gain => CVD) - GI disorder (Peptic ulcers, GI cancer, pancreatic cancer, IBS) - Neurological disorders (seizures, dystonia, tardive dyskinesia) - Endocrine disorders (metabolic syndrome) - infections (STI, drug use) - Musculoskeletal disorders (meds) - Respiratory disorders (Smokers & asthma) |
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Define metabolic syndrome |
Related to a set of risk factors associated with heart disease and diabetes |
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Define florid positive symptoms |
Positive symptoms of schizophrenia that are pronounced or in their fully developed form |
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What does WRAP stand for? |
Wellness Recovery Action Plan |
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Define Carer |
A person who, through family or friendship, looks after someone with a chronic illness / disability/ frail. |
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What are the 5 main 'roles' of a carer? |
Co-workers : Carers and HCP work together Consumer advocates : Carers monitor care provided by HCP Personal needs : Carers need personal, emotional and psychological support Everyday life : Carers need to provide shelter, food and clothing for the patient and themselves and maintain social networks. Co-ordination : Juggle priorities in an appropriate order |
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How is the role of a carer different to a HCP? |
Carers have little choice in their role No preparation / study No training or self directed Not supervised
May never have a break / time off No formal status / authority in a HCP team Usually only a carer for one person |
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What is another term for a first generation medication? |
A typical medication |
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What is a mode of action for a typical antipsychotic? |
D2 antagonists For positive symptoms of schizophrenia only |
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What is a depot medication? |
IMI med that takes weeks to absorb |
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What drugs are usually typical / first generation anti psychotics? |
- zine - peridol - thixol |
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What anti-psychotic drugs are normally 2nd generation? |
- pride - pine - done - zole |
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Why don't we use 1st generation anti-psychotics as much? |
Higher chance of ADRs including : Postural Hypotension Extra pyramidal side effects |
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What is the risk more associated with 2nd generation antipsychotics? |
Metabolic side effects |
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Define Akathasia |
Inability to sit |
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Define agranulocytosis |
Serious low level of WBCs |
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Define cardiomyopathy |
Deterioration of the myocardium or heart muscle |
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Define neutropenia |
Low levels of neutrophils |
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Which drug for schizophrenics requires weekly to monthly blood tests? |
Clozapine |
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What side effects are possible when on anti-psychotics? |
- T2DM - Weight gain - ECG changes (q-t interval) - Postural hypotension - Sedation - Metabolic / endocrine problems esp. prolactin (Erectile dysfunction and menstrual problems) - Sexual dysfunction (Lactating and above^) - Hepatic side effects - Lower seizure threshold - Anticholinergic effects (blurred vision, dry mouth, constipation, urinary retention, memory and cognitive impairments) - EPSEs |
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Which drug is associated with a deadly rash? |
Lamotrigine |
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Define ataxia |
Difficulty with co-ordination People become unsteady on their feet |
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What is the acronym RULE in regards to motivational interviewing? |
R: Resist (the righting reflex) |
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What is vocational therapy? |
Related to getting people back into the workforce / achieving goals |
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Define alogia |
Poverty of speech |
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Define anhedonia |
Inability to feel pleasure |
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Define avolition |
Decreased motivation to initiate and perform self-directed purposeful activities |
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Define blunted affect / affective flattening |
Refers to decreased or restricted emotional expression including facial, vocal and non-verbal expression |
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What dos TAU stand for? |
Treatment as usual |
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What does PANSS stand for? |
Positive and Negative Syndrome Scale |
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What does BPRS stand for? |
Brief Psychiatric Rating Scale |
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What are some myths about schizophrenia? |
- Is split personality - Always violent - Developmentally delayed - Have low IQ's - Schizophrenia develops quickly - is untreatable - Should all be in hospital |
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How would you describe a schizophrenic personality? |
Disintegrating and singular |
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Define prodromal |
Relating to or denoting the period between the appearance of initial symptoms |
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How much does schizophrenia cost per year? |
2.5 billion |
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What is one of the main causes of the shorter life expectancy in schizophrenics? |
Cardiovascular disease |
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What is cancer usually more often fatal in schizophrenic patients? |
Is picked up much later - not taken as seriously so more likely to have time to metastases |
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Can schizophrenic patients make their own decisions? |
Yes, usually only unable to when suffering delusions |
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Define psychosis |
•Grossly impaired understanding of reality •Devastating mental state where internal stimuli is hard to distinguish from reality |
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What are the symptoms of psychosis? |
- Hallucinations - Delusions - Thought organisational difficulties |
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What conditions can schizophrenia be present in? |
- Acute mania - Depression - Drug intoxication - Delirium - ABI (Acute Brain Injury) - Dementia - Schizophrenia (Most common) |
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What is ABI?` |
Acute Brain Injury |
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What are the 'causes' of schizophrenia? |
MULTIFACTORAL - NOT ONE SPECIFIC CAUSE! - Foetal brain injury - Season of burth (WINTER 10% More - Flu?) - Obstetric complications - Low birth weight - CT/MRI abnormalities - Cannabis
- High expressed emotion - Adverse life events (triggers) |
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What % of the population is affected by schizophrenia? |
1% of population |
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What is the peak age for the onset of schizophrenia? |
15-24 years but males tend to have earlier onset |
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Which gender usually has earlier onset of schizophrenia? |
Males |
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What are protective factors against schizophrenia? |
- Being female - Older age onset - Married - Living in a developed country - Functional premorbid personality - No previous psychiatric history - Good education and employment history - Acute onset (affective symptomes) - Medication concordance |
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Define concordance |
Agreement or consistency
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Define functional premorbid personality |
Were well / functioning before falling ill |
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What does migration have to do with schizophrenia? |
First & second generation migrants experience increased chance of developing schizophrenia |
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First & second generation migrants experience increased chance of developing schizophrenia. Why? |
–?Schizophrenia predisposes people to migrate –Elevated rates occur 10 years after migrationindicating stress, social, economical and political disadvantage are important factors in development –?Propensity form is diagnosis amongst migrants due to language barriers & cultural practices •Migrants often present at more advanced stages of illness –More diagnosis of psychosis –More frequent in patient admissions –More likely to be involuntary –More likely to have a longer in-patient stay |
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Why are migrants often present at more advanced stages of illness? |
–More diagnosis of psychosis –More frequent in patient admissions –More likely to be involuntary –More likely to have a longer in-patient stay |
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What are the prodromes for schizophrenia? |
- Changes in intensity, frequency and duration - Pre-hallucinatory perceptual abnormalities - Subtle behavioural changes - Social withdrawal - Non-specific symptoms eg/ Depression / Anxiety - Pre-thought disordered speech disturbances - Motor disturbance - Impaired tolerance to stress - Disorders of emotion, energy, concentration & memory *Adolescents who go on to develop schizophrenia often display significant issues with executive functioning in the prodrome* |
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Define executive functioning |
Issues planning ahead. |
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How does one manage the schizophrenia prodromes? |
Delaying onset of psychotic symptoms via :
- Psychotherapy (CBT) alone |
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What is CBT? |
Cognitive Behaviour Therapy |
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What is the risk in management of schizophrenia prodromes? |
- Weight gain - Side effects - Will they really develop schizophrenia? (Only 1/3rd?) |
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What is an image of a possible prodromal pathway? |
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What are the DSM 5 (2013) classifications for Schizophrenia? |
A. Two or more of the following (must include 1, 2, or 3, and be present for one month orless with treatment) 1. Delusions 2. Hallucinations 3. Disorganised speech 4. Grossly disorganised or catatonic behaviour 5. Negative symptoms B.Significant impact on work, interpersonal relations or self‐care C. Continuous disturbance lasting at least 6 months (at least 1 month active symptoms ‐or less if treated successfully) |
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What are some examples of positive (florid/productive) symptoms? |
- Delusions - Hallucinations - Grandiosity - Suspiciousness - Insomnia - Obsessed & Abnormal thoughts - Hostility - Paranoia - Agitation - Bizarre behaviour |
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What are some examples of negative symptoms? |
- Poverty of speech - Poor maintenance of ADL's - Alogia - Anergia - Affective blunting - Avolition - Apathy - Loss of warmth or vibrancy - Poverty of thought - Passive or social withdrawal |
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Define Anergia |
Abnormal lack of energy |
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Define Affective blunting |
Is a clinical term to define a lack of emotional reactivity (affect display) in an individual. It manifests as a failure to express feelings either verbally or non-verbally, especially when talking about issues that would normally be expected to engage the emotions. |
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What are secondary negative symptoms? |
- Difficulty in differentiating from primary (i.e. illness-related) & secondary sources of negative symptoms remains a challenge - Often caused by unrelieved / untreated positive symptoms, adverse effects of anti psychotics or social isolation imposed by schizophrenia - Often subside with resolution of causative factor |
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What are some examples of cognitive symptoms? |
- Disorganised thoughts - Disturbances in executive functioning - Goal-completion difficulties - Poor concentration / attention - Difficulty following instructions - Memory impairment |
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What is schizoaffective disorder? |
•A disorder characterised by symptoms of schizophrenia and major mood disorder (mania or depression) •Can be more complicated to diagnose & therefore an individual who had a diagnosis of schizophrenia or BPAD, may be re‐diagnosed to schizoaffective disorder later. |
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What is the prevalence of schizoaffective disorder? |
1 in 200 people 1/3rd as common as schizophrenia (0.3% lifetime prevalence) |
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What are risk factors for negative symptoms? |
- Depression - Prior history of schizophrenia - Social isolation / difficulties - Born in winter - People who respond poorly to anti-psychotics |
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How does DSM 5 (2013) define schizoaffective disorder? |
A. An uninterrupted period of illness during which there is a major mood episode (mania or depression) concurrent with criteria A of schizophrenia B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness C. Symptoms that meet criteria for a major mood episode a represent for the majority of the total duration of the active and residual portions of the illness D. The disturbance is not attributable to the effects of a substance or other illness •Specify if bipolar type (if manic episode is part of the presentation. MD may also occur) •Specify if depressive type (only applicable if major MD are part of presentation |
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What gender is more likely to be affected by schizoaffective disorder?
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Females |
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What time of life is the typical onset age for schizoaffective disorder? |
Early adulthood |
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What is BPAD? |
Bi-polar Affective Disorder |
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What is the treament of schizophrenia spectrum disorders? |
Anti-psychotic medications - Dopamine antagonists (lower dopamine in brain) - Typical / conventional / 1st generation agents - Atypical / unconventional / 2nd generation (novel) agents MOST COMMON - Atypical / unconventional / 3rd generation agents
- CBT - ACT - ECT - Strengths recovery perspective |
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What does LAI stand for? |
Long Acting Injection |
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What does CBT stand for? |
Cognitive behaviour therapy |
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What does ACT stand for? |
Acceptance & Commitment Therapy |
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What is Strengths recovery perspective? |
Psychological Recovery or recovery model or the recovery approach to mental disorder or substance dependence emphasizes and supports a person's potential for recovery. Recovery is generally seen in this approach as a personal journey rather than a set outcome, and one that may involve developing hope, a secure base and sense of self, supportive relationships, empowerment, social inclusion, coping skills, and meaning. |
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What is CBT? What is it's aims? |
Aims to develop an individual account of the development and maintenance of currently distressing experiences that is less threatening than the beliefs that are currently held. •Helps an individual make sense of their perceptual experiences by making links between emotional states, thoughts and earlier life events. |
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Which drugs are the biggest offenders of metabolic syndrome? |
Olanzapine (Zyprexa) and Clozapine |
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What is metabolic syndrome exacerbated by? |
–Increased sedation (Inactivity) –Appetite stimulation –Thirst & hyper-salivation –Negative symptoms –Poverty (Junk is cheaper and easy) –Access to healthcare |
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What is metabolic syndrome characterised by? |
–Abdominal obesity / BMI / waist measurements –Elevated triglycerides –High density cholesterol levels –Elevated fasting glucose –Hypertension |
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What is the normal dose for risperidone? |
4-8mg |
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What is the normal dose for quetiapine (Seroquel)? |
150-750mg |
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What is the normal dose for Aripiprazole (Abilify)? |
10-30mg |
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Which is the only drug that REQUIRES consent for a mental health patient to take? |
Clozapine as it is very dangerojus |
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What is the normal dose for olanzapine (zyprexa)? |
10-30mg |
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What is the normal dose for clozapine (clopine)? |
200-900mg - usually 600mg |
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What is the normal dose for amisulpride (solian)? |
400-1200mg |
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What is the normal dose for cholropromazine (largactil / thorazine)? |
25-2000mg |
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What is the normal dose for pericyazine? |
5-300mg |
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What is the normal dose for haloperidol (haldol / serenance)? |
1-100mg |
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What are the typical / 1st gen meds most commonly used? |
- Choloropromazine - Haloperidol - Pericyazine |
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What percentage of schizophrenic patients are on LAI? |
30% are on LAIs |
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What are the depot meds? |
- All decanoates - Risperdal consta - Zyprexa relprevv (MUST monitor after done!) - Sustenna |
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What is the dose for LAI |
200-400mg every 2-4 weeks |
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What is the dose for LAI fluphenazine ecanoate? |
12.5-75mg every 4 weeks |
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What is the dose for LAI flupenthixol decanoate? |
20-80mg every 2-4 weeks |
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What is the dose for LAI haloperidol decanoate? |
Up to 300mg every 2-4 weeks |
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What is the dose for LAI risperidal consta? |
Up to 50mg every 2 weeks |
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What is the dose for LAI olanzapine pamoate? |
Up to 300mg every 2-4 weeks |
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What is the dose for LAI paliperidone? |
25-150mg monthly |
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Why change a patients antipsychotics? |
Poor treatment response
Intolerable adverse effects On request of the patient / carers |
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Why should we NOT change a patients anti-psychotics? |
- There are (or will be) benefiting from the medication - Those who are stable with a history of instability off their meds - Those on LAI with poor prior adherence to oral medication |
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What are some serious side effects of anti-psychotics? |
- NMS - TD - EPSEs |
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What does EPSE stand for? |
Extra Pyramidal Side Efeects |
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What does TD stand for? |
Tardive dyskinesia |
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What does NMS stand for? |
Neuroleptic malignant syndrome |
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What are some characteristics of poor treatment response? |
- Acute illness relapse despite adherance- Persisting & impairing positive or negative symptoms - Persisting & impairing mood or cognitive symptoms - Little or no improvement in psychosocial functioning - replace or clinical instability due to poor adherence in otherwise treatment -respoinsive patient (suggest LAI) - Ongoing high suicide risk despite otherwise adequate anti-psychotic therapy |
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What are some characteristics of intolerable adverse effects? |
- Severe effects leading to threatened or actual non-adherence - Aggravation of general medical condition by anti-psychotic agent - Adverse-effect burden clearly increased as a result of specific drug/drug interactions |
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What are the symptoms of NMS? |
- Hyperthermia (42c+) - Rigidity - Impaired ventilation - Tremor - Altered consciousness - Tachycardia - Diaphoresis - Hypersalivation - Death |
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What are some characteristics of NMS? |
- Potentially lethal - More common in typical high potent anti-psychotics (haloperidol) - Usually occurs within 1 week of treatment |
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What are some characteristics of tardive dyskinesia? |
- Late occuring movement disorder - Can be irreversible - Embarrassing and troublesome symptoms ; tongue writhing & protrusion ; teeth grinding ; lip smacking ; course tremor ; spasm-like movements (Used more in the past so higher chance in older people) |
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What are some characteristics of oculogyric crisis?
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- Contracted positioning of the eyes upward - Initially restlessness - Agitation - Fixed stare |
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What are some characteristics of neuroleptic-Induced torticollis? |
- Contracted positioning of the neck - Gradual development - Neck and head pain - Twisting and sustained muscle spasm - Uncommon |
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What are some characteristics of Psuedoparkinsonism? |
- Blank mask-like presentation - Tremor in limbs - Muscle rigidity - Cogwheel rigidity - Stiffness - Shuffling gait - Drooling |
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What are some characteristics of akathisia? |
- Restless legs - 'Jittery' feeling - Nervous energy - Pacing, agitation - Alternating between sitting & standing - Very common and has poor responses to medication |
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What anti-psychotic drug usually has a lower amount of side effects? |
Amisulpride |
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What drug cause post-injection syndrome? |
Olanzapine parnoate (Zyprexa relprevv) |
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What are some examples of EPSEs'? |
- Akathisia - Psuedoparkinsonism - Acute dystonias (Oculogyric crisis, neuroleptic induced torticolis, retrocolosis, glossospasm) |
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What is glossospasm? |
Spasmodic contraction of the muscles of the tongue |
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Define Retrocollis |
Spasmodic torticollis in which the head is drawn back |
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How do we manage anti-psychotic side effects? |
- Busiprone (Buspar) - Anxiolytic (without risk of dependance) - Anti-histamines (e.g. Benedryl) - Benzodiazepines & Hypnotics (ADDICTIVE) - Propranolol - Anticholinergics |
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What is the rate of relapse for schizophrenic patients? What are the causes? |
50-70% relapse rate Also affected by 'trivial' side effects > leads to non-adherence |
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What are the early warning signs of a relapse for a schizophrenic patient? |
- Changes to sleeping patterns (hyper/hypo somnia) - Straying from treatment plans - Tension, agitation, irritability - Alterations in eating habits (Hyperphagia or anorexia - Concentration issues - Anxiety / Restlessness - Increased feelings of fear or apprehension - Decline in personal hygiene and/or living environment - Social withdrawal - Unusual / disturbing / recurring thoughs |
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What percentage of mental illness sufferers would be institutionalised pre 21st century? |
95% institutionalised |
