28 - agression and violence , 33 - hallucinations

Question 1

predisposing factors to schitz

Answer 1

inner city
childhood abuse
drug ad alcohol use
migration

Question 2

Negative and positive sx of schitz

Answer 2

Negative symptoms: apathy, social withdrawal, self-neglect, blunting affect, catatonia (rare),

Positive symptoms: paranoia, auditory hallucinations (auditory most common), thought disorder, delusions, passivity phenomena

Question 3

Types of thought disorder

Answer 3

echo, insertion, broadcast, withdrawal.

Question 4

What is a hallucination

Answer 4

perceptions in the absence of an external corresponding stimulus.

Question 5

What are delusions

Answer 5

are fixed beliefs held without external evidence.

Question 6

Mx of psychosis?

What to do in extreme?

Answer 6

anti-psychotic (olanzipine) and sedative (lorazepam)

Reserve Haloperidol for extreme cases, not to be used for remission therapy.

Question 7

1st / 2nd /3rd line mx of schitz

Answer 7

Antipsychotic drug therapy, can be depot.
First line: Olanzipine, Risperidone, (usually atypicals first)

Second line: Quetiapine, Aripiprazole, chlorpromazine,

Third line: Haloperidol or clozapine (plenty of unpleasant side effects)

Question 8

Egs and Side effects of 1st / 2nd gen antipsychotics

Answer 8

1st Generation (typical): zuclopenthixol, chlorpromazine, haloperidol,

Side effects usually extrapyramidal movement problems: dry mouth, muscle stiffness, movement disorders (tardive dyskinesias and parkinsonism)

2nd Generation (atypical): olanzapine, risperidone, quetiapine, aripiprazole

Side effects usually endocrine and cortisol related: weight gain, increased appetite, cardiovascular disease. Evidence says most effective.

Question 9

Section 2 MHA 
How long?
Who?
Can it be renewed?
Treatment?

Answer 9

Assessment order
Admission for 28 days for assessment.
Requires one Section 12 approved psychiatrist (must be trained and F2 and above) and one other doctor.
Cannot be renewed
Doesn’t go on record
Can treat against patient’s will

Question 10

Section 3 MHA? 
How long?
Who?
Can it be renewed? 
Treatment?

Answer 10

Treatment order
Admission for treatment, 6 months.
Requires an AMP, a ST4+ psychiatrist, a GP who is familiar with the patient.
Can be renewed.
Can treat involuntarily but not with ECT or psychosurgery (not amended currently for tDCS or TMS).

Question 11

Section 4? 
How long? 
Who?
Treatment? 
Can it be renewed?

Answer 11

Section 4 is the emergency order. 
Lasts 72 hours. 
A doctor and an AMP, gives time to find another doctor. 
No treatment under this order.
 Converted to a section 2.

Question 12

5:2 MHA?

Answer 12

Doctor’s holding power.

Detain anyone admitted to hospital consensually for 72 hours. Holds a patient for further assessment

Question 13

5:4 MHA?

Answer 13

Nurse’s holding power.

6 hours.

Question 14

Section 135 / 136 MHA?

Answer 14

Section 135: Police section. Enter a patient’s premises and remove to a place of safety for 72 hours. Can use force. Social worker must obtain a warrant. Cannot treat against patient’s will.

Section 136: same as above but for a public place. Don’t need a warrant.

Question 15

What is a community treatment order?

Answer 15

Basically a Section 3 in the community.

Patient must turn up to appointments and take their treatment or will be returned to hospital (if Section 2) or remanded in police custody (if a forensic section).

Question 16

What age does the MCA apply to?

What is it for (name 3 things)?

Answer 16

Applies to everyone over the age of 16.

Provides the legal framework to make decisions for those who lack capacity to do so themselves

Protects people who lack capacity

Empowers individuals who may have reduced capacity to still make decisions for themselves.

Allows creation of advanced directives and power of attorney.

Question 17

Principles of MCA ? Name 3 at least

Answer 17

Assume capacity until proven otherwise

Judge by a time and decision basis: - just because someone has capacity for one decision doesn’t mean this applies to all situations.

Poor decisions are still valid.

Maximise decision making capabilities

Act in patient’s best interests

Question 18

Criteria for capacity ?

Answer 18

Is the patient able to understand information needed to make the decision?

Are they able to retain this information long enough to make the decision?

Are they able to weight up the pro’s and con’s of a decision?

Are they able to communicate their decision?

Question 19

3 clusters of personality disorders?

Answer 19

CLUSTER A ‘eccentric’: paranoid, schizoid, schizotypal

CLUSTER B ‘dramatic’: antisocial, emotional unstable, narcissistic, histrionic

CLUSTER C ‘anxious’: avoidant, dependent, obsessive compulsive

Question 20

Cluster A

Paranoid / schitzoid / schitzotypal Basics

Answer 20

Paranoid: mistrust and irrational suspicion of others

Schizoid: lack of interest and apathy of others (negative Sz symptoms)

Schizotypal: distorted ideas and perceptions (positive Sz symptoms)

Essentially: Schizoid + Schizotypal = Schizophrenia phenotype

Someone having all three concurrently would appear to have paranoid schizophrenia.

Question 21

Managing aggression? Drug mx?

Answer 21

Talk patient down if possible (usually is)
Maintain non-threatening posture.

If you must use a chemical cosh then use lorazepam (oral then IM) x2

If this still doesn’t work then consider an antipsychotic. Promethazine or Haloperidol.