Case-lateonsetpsychosis

Question 1

Front

Answer 1

Back

Question 2

Task Description

Answer 2

Assess Mrs. Gwendoline Eames, a 74-year-old woman with new onset psychotic symptoms, focusing on disturbances of thought and perception.

Question 3

Case Synopsis

Answer 3

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.

Question 4

Onset of Symptoms

Answer 4

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.

Question 5

Persecutory Ideation

Answer 5

Suspicious and hostile towards neighbors. Believes they are sending smoke, pumping gas, contaminating food, and watching her with cameras.

Question 6

Behavioral Changes

Answer 6

Staying on the side of the house furthest from neighbors, stopped using fridge freezer, only eating food from sealed containers.

Question 7

Olfactory Hallucinations

Answer 7

Noticed an odd smell in the house, believes neighbors are pumping gas into her house. Moved belongings to other side of the house.

Question 8

Gustatory Hallucinations

Answer 8

Food tastes sour, believes neighbors are contaminating her food. Stopped using some kitchen appliances, only eats food from sealed containers.

Question 9

Auditory Hallucinations

Answer 9

Hearing neighbors’ voices saying she is ill and ‘it won’t be long now’. Turned off electricity to stop the voices.

Question 10

Explanations for Hallucinations

Answer 10

Believes gas is being pumped into her property or electronic devices are installed around her house.

Question 11

Screening for Hallucinations

Answer 11

Screen for any other unusual thoughts, delusions, or hallucinatory phenomena.

Question 12

Thought Disorder

Answer 12

Screen for evidence of thought disorder, alienation, or passivity phenomena.

Question 13

Insight Assessment

Answer 13

Assess the patient’s insight, challenge their beliefs. Identify lack of insight, unable to consider alternative explanations, rejects notion of mental illness.

Question 14

Mood Screen

Answer 14

Carry out a brief mood screen to determine signs of depressed or elated mood.

Question 15

Risk Assessment

Answer 15

Enquire about direct risks to self and any risk to the patient’s neighbors. No extensive risk assessment required.

Question 16

Approach

Answer 16

Approach the patient in a sensitive and understanding manner to best elicit their psychotic symptoms.

Question 17

Development of Symptoms

Answer 17

Identify evidence of further symptoms development over the course of the station.

Question 18

Delusional Perception

Answer 18

Identify delusional perception with persecutory ideation occurring immediately after seeing neighbors’ new pond.

Question 19

Impact on Social Interaction

Answer 19

Persecutory delusional ideation leading to behavioral change in terms of social interaction with neighbors.

Question 20

Characteristics of Hallucinations

Answer 20

Elicit characteristics of olfactory, gustatory, and auditory hallucinations and how the patient has responded to them.

Question 21

Patient’s Responses

Answer 21

Identify how the patient has responded to hallucinations, e.g., moving belongings, turning off electricity.

Question 22

Challenge Beliefs

Answer 22

Appropriately challenge the patient’s beliefs to assess their insight and understanding of their experiences.

Question 23

Reading Notes - Good Candidates

Answer 23

Identify second-person hallucinations, olfactory and gustatory hallucinations, delusional ideas of infidelity, misinterpretation of benign actions.

Question 24

Mood Symptoms

Answer 24

Screen for mood symptoms and identify depressive or elated mood.

Question 25

Potential Risks

Answer 25

Identify potential risks to self and others due to patient’s beliefs and hallucinations.

Question 26

Patient’s Explanations

Answer 26

Elicit patient’s explanations for hallucinatory phenomena, e.g., gas, electronic devices.

Question 27

Good Candidates - Insight

Answer 27

Identify lack of insight, acknowledge a problem but unable to consider alternative explanations, reject notion of mental illness.