Case-lateonsetpsychosis Flashcards
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Task Description
Assess Mrs. Gwendoline Eames, a 74-year-old woman with new onset psychotic symptoms, focusing on disturbances of thought and perception.
Case Synopsis
Mrs. Gwendoline Eames, 74, referred to mental health clinic by GP after family concerns about her neighbors. Convinced neighbors are acting against her, experiencing delusions and hallucinations.
Onset of Symptoms
Symptoms started 4 months ago after neighbors built a pond while she was on holiday. Became convinced they were planning to take over her house.
Persecutory Ideation
Suspicious and hostile towards neighbors. Believes they are sending smoke, pumping gas, contaminating food, and watching her with cameras.
Behavioral Changes
Staying on the side of the house furthest from neighbors, stopped using fridge freezer, only eating food from sealed containers.
Olfactory Hallucinations
Noticed an odd smell in the house, believes neighbors are pumping gas into her house. Moved belongings to other side of the house.
Gustatory Hallucinations
Food tastes sour, believes neighbors are contaminating her food. Stopped using some kitchen appliances, only eats food from sealed containers.
Auditory Hallucinations
Hearing neighbors’ voices saying she is ill and ‘it won’t be long now’. Turned off electricity to stop the voices.
Explanations for Hallucinations
Believes gas is being pumped into her property or electronic devices are installed around her house.
Screening for Hallucinations
Screen for any other unusual thoughts, delusions, or hallucinatory phenomena.
Thought Disorder
Screen for evidence of thought disorder, alienation, or passivity phenomena.
Insight Assessment
Assess the patient’s insight, challenge their beliefs. Identify lack of insight, unable to consider alternative explanations, rejects notion of mental illness.
Mood Screen
Carry out a brief mood screen to determine signs of depressed or elated mood.
Risk Assessment
Enquire about direct risks to self and any risk to the patient’s neighbors. No extensive risk assessment required.
Approach
Approach the patient in a sensitive and understanding manner to best elicit their psychotic symptoms.
Development of Symptoms
Identify evidence of further symptoms development over the course of the station.
Delusional Perception
Identify delusional perception with persecutory ideation occurring immediately after seeing neighbors’ new pond.
Impact on Social Interaction
Persecutory delusional ideation leading to behavioral change in terms of social interaction with neighbors.
Characteristics of Hallucinations
Elicit characteristics of olfactory, gustatory, and auditory hallucinations and how the patient has responded to them.
Patient’s Responses
Identify how the patient has responded to hallucinations, e.g., moving belongings, turning off electricity.
Challenge Beliefs
Appropriately challenge the patient’s beliefs to assess their insight and understanding of their experiences.
Reading Notes - Good Candidates
Identify second-person hallucinations, olfactory and gustatory hallucinations, delusional ideas of infidelity, misinterpretation of benign actions.
Mood Symptoms
Screen for mood symptoms and identify depressive or elated mood.
Potential Risks
Identify potential risks to self and others due to patient’s beliefs and hallucinations.
Patient’s Explanations
Elicit patient’s explanations for hallucinatory phenomena, e.g., gas, electronic devices.
Good Candidates - Insight
Identify lack of insight, acknowledge a problem but unable to consider alternative explanations, reject notion of mental illness.
