CT 3 - The Patient With Psychotic Symptoms

Question 1

What is psychosis

Answer 1

Disorder of perception, thought form or content, derangement of personality and a loss of contact with external reality causing a deterioration of normal social functioning

May be present with or without organic damage
Maybe chronic or transient

Question 2

What is a hallucination

Answer 2

Perception experienced in the absence of an external stimulus

Question 3

What are the different types of hallucination

Answer 3

Auditory

Visual

Olfactory

Gustatory

Somatic

Question 4

When assessing disorders of thought what should be looked at

Answer 4

Flow (the speed of thinking and deliverance of speech)

Form (loss of normal structure of thinking, appears muddled or illogical). includes flight of ideas which is when the content of speech moves quickly to another idea before the previous train of thought is completed)
(Commonly seen in schizophrenia are word salad, knight’s move and point thinking

Content ( what are beliefs and thoughts are. Includes delusions,obsessions, overvalued ideas and magical thinking

Question 5

What are delusions

Answer 5

False beliefs that cannot be shaken. These beliefs are not true and accepted or recognised within the persons culture or religion

Question 6

What is magical thinking

Answer 6

Belief that you can influence real world events with certain actions or rituals

Eg it is raining because I’m sad

Question 7

What are the types of delusions

Answer 7

Persecutory (being followed or are going to be harmed)

Delusions of reference (belief that events occurring in the world are aimed at them)

Delusions of control (belief that thoughts,actions and beliefs are being controlled by an external force)

Delusions of thought insertion, withdrawal and broadcast

Grandiose delusions (inflated self esteem, powerful. Or have relationship with someone famous)

Delusions of jealousy / othello syndrome (belief that partner is being unfaithful)

Delusions of guilt (something happened because of them eg someone died..)

Nihilistic delusions (belief that they are dead or their body does not belong to them, world is ending, no money etc

Hypochondrial delusions (firm belief that they are ill and diseased)

Question 8

What are signs and symptoms of psychosis

Question 9

What is schizophrenia and what are the risk factors

Question 10

What are the positive symptoms of schizophrenia

Answer 10

Presence of problematic behaviours:

Hallucinations
Delusions
Disorganised thought and nonsensical speech
Bizarre behaviours

Question 11

What are the negative symptoms of schizophrenia

Answer 11

-ve = absence of healthy behaviours

Flat affect
Reduced social interaction
Anhedonia
Avolition (less motivation, initiative+ focus)
Alogia (speaking less)
Catatonia (moving less)

Question 12

What are the three major phases of schizophrenia

Answer 12

1) prodromal (non specific symptoms can be present for weeks or months preceding first acute psychotic event)

2) active phase (psychotic symptoms - mainly positive ones. May resolve spontaneously or can continue

3) residual phase (no longer having prominent psychotic symptoms but some negative symtoms may be present such as eccentric behaviour, blunted affect and social withdrawal)

Question 13

Differential diagnoses for psychotic symptoms

Answer 13

1) rule out medical or organic causes
2) any substance misuse or withdrawal
3) schizophrenia
4) schizotypal PD
5) persistent delusional disorder
6) brief psychotic disorder
7) schizoaffective disorder
8) mood disorder with psychotic symptoms

Question 14

What biological theories explain the basis for schizophrenia

Answer 14

• genetic predisposition
• elevated levels of dopamine
• differences in Brain structure (enlarged ventricles and reduced total brain volume)
• overactive HPA axis ( can also get steroid induced psychosis)

Dopaminergic pathways:

Disruption of Mesolimbic pathway (role in motivation, emotions and rewards) —> positive symptoms of psychosis (too much dopamine)

Mesocortical pathway (role in cognition, planning, focus, emotions and affect. Lowered function of this pathway leads to negative symptoms (low dopamine)

Nigrostriatal pathway - 80% of brains dopamine. Controls motor function +movement

Serotonin levels are thought to be lower in psychosis and may contribute to -ve symtoms

Glutamate hypothesis - excitatory NT - lower levels may predispose to schizophrenia

Question 15

What does the mental health act 1983 allow for those with mental illness

Answer 15

Patients can be treated against their wishes and placed in hospital if they are a threat to themselves or anyone else. (Sectioned)

This assessment is carried out by an approved mental health professional and 2 doctors.

Question 16

What is section 2

Answer 16

Is for the assessment of what condition a patient has

Can be held for 28 days

Question 17

What is section 3

Answer 17

It is for 6 motnhs whereby a dr can treat a patient without their will for the first 3 months. After this treatment can be continued despite will if the opinion of a second doctor is present

Question 18

What is section 4

Answer 18

An emergency section that allows detainment with the approval of one dr and advanced mental health professional.
Cannot be treated without consent during this 72 hr period

Question 19

What is section 5(2)

Answer 19

A dr’s holding powers. Can hold for 72hrs

Question 20

What is section 5(4)

Answer 20

A nurses holding power. Valid for 6 hrs

Question 21

What is section 136

Answer 21

Police can issue this if patient is in a public place and pose a risk. Can move them to place of safety

Valid for 24hrs

Question 22

What is section 135

Answer 22

A warrant issued which allows police to go into a property (not public) to detain patient for maximum of 24hrs

Question 23

What is a community treatment order

Answer 23

Given to patients with recurrent admissions to hospital. Reduces need to resection patients each time. Can only be applicable for patients that were previously discharged from section 3 and 37

Valid for 6 months