Introduction To Psychiatry Flashcards
What is psychosis?
Individual experiencing a reality different to everyone else.
‘Out of touch with reality’
‘The dreamer awake’
What is a psychotic episode?
Sudden or gradual
Lasting days, weeks, months
Individual doesn’t realize they are psychotic- lack insight so don’t realise something is wrong.
Behaviour should be assessed
How do we assess a psychiatric patient?
Work out if the patient is psychotic or not
Take a full Hx
MSE
How does the mind work?
Sense data-> translate it as an object in space-> think about it and get a meaningful object.
The world is our data -> perception -> thought
What are the symptoms of psychosis?
Hallucinations
Delusions
Formal thought disorder
Fragmentation of the boundaries of the self
What are hallucinations?
Perception of an object in the absence of an external stimulus i.e. thinking something is there when it isn’t.
These can affect any of the five sense but in psychosis the most common to have is auditory- can be 2nd or 3rd person.
Visual hallucinations are more common in delirium.
Olfactory hallucinations are commonly frontal lobe pathology i.e. medial meningioma.
Can also have gustatory or tactile hallucinations.
I.e. why is she following me, following me to work etc. can hear voices of a woman following her.
When a patient hears voices but recognises the stimulus is in their mind, this is referred to as a pseudohallucination.
When are hallucinations accepted as non-pathological?
Hypnagogic (before sleeping) and hypnopompic (before waking) hallucinations are not pathological.
What are delusions?
Fixed, firmly held belief which is usually false, cannot be reasoned away, out of keeping with persons sociocultural norms.
If the belief arises with no predisposing events/experiences, it is a primary delusion- suggestive of schizophrenia.
Otherwise, through history can suggest secondary delusions.
Can have different content i.e. persecutory, hypochondrial, nihilistic, grandiose etc.
Problem in the thought processing- normal things are interpreted wrong.
Challenging the thought with ‘what makes you think that?’, ‘could it just be…?’ Pts won’t feel doubt about their idea, will be adamant on their thought.
What is formal thought disorder?
Speech problem/flow of thought.
Each sentence/phrase doesn’t follow from the last.
Very suggestive of schizophrenia. But can be present in psychotic conditions.
What are disorders of the self?
Normally can understand you as the same you from 5 minutes ago, as the same you sitting down on a chair, as the same you through an experience.
Disorders of the self, can no longer distinguish yourself from the world.
Passivity phenomena- ‘I’m not moving my arm someone else is moving it.’
Thought broadcast- ‘Everyone can hear what I’m thinking in my head.’
Thought insertion- ‘The thoughts in my head are not mine, someone else put them there.’
What are organic differentials of psychosis?
Delirium Dementia Infection Endocrine i.e. Cushings Temporal lobe pathology
What is schizophrenia?
Schizo- split
Phrenia- mind
Split function of the mind, no longer working coherently, mind is falling apart.
What are three types of functional psychosis?
Schizophrenic- Bizarre, persecutory, 3rd person.
Manic- Grandiose (you’re amazing, you’re the best), 2nd person
Depressive- Guilt, poverty, nihilism (useless/hopeless), 2nd person
What are the outcomes of a psychotic episode?
One stand alone epsiode
Have recurrent episodes
Have personality changes and recurrent episodes
How common is psychosis and schizophrenia?
1% prevalence
Incidence 15/100000
Higher in afro-carribbean
Role of family? Upbringing? Illicit drugs? Genetics? (Higher in identical twins)
Increased mortality 10-20yrs (but could this include suicide)
How is psychosis/schizophrenia managed?
Where is the patient safetly managed? Dependent on their risk to self and others. Also dependent on their insight (won’t comply if they dont realise theyre ill).
Inpatient# should they be sectioned or informal?
Behaviour assessment
Exclude orgnanic causes
How is psychosis and shcizophrenia assessed?
Bio- blood tests, drug tests, CT. Check compliance
Psycho- Full Hx, MSE, collateral history.
Social- consult carers, people they live with etc
How is psychosis/schizophrenia treated?
Bio- antipsychotics
Psycho- supportive counselling, family therapy (role in schizo)
Social- debts, benefits, housing, OT, CPN, SW
A woman 56yrs is admitted to the ED after she has taken a deliberate O.D of 26 paracetamol tablets.
What are the reasons for people to overdose?
How would you assess the seriousness of intent to end her life?
Self harm, escape, suicide, accidental (dementia) etc.
Has this happened before?
How many times?
Was this planned? (Organise will, organise pet care, make sure children are not there)
What did she think would happen by taking the tablets? If expected death then greater risk
Where did she access the tablet?
How does she feel about it now? Any remorse?
Does she still have any suicidal thoughts?
Where was she when she took the overdose?
Was she drinking any alcohol? (Poor inhibition, both affect the liver)
Who found her?
How do you feel about the future?
A woman 56yrs is admitted to the ED after she has taken a deliberate O.D of 26 paracetamol tablets.
What other aspects would you focus on when you assess this lady?
Past psychological history- may influence her decision
Is she suffering from any mental health issues now?
What is her living situation like?
Risk factors and protective factors Relationships Occupation Financial situation Future plans
NB we are better at treating depression compared to physical disorders.
Mrs L has been married for 30yrs. She has a part time admin job and has 2 children who are 30 and 32yrs old. She has always been shy and not very confident, but in general she gets on with life. Her marriage has had good episodes, but she describes her husband as a quite domineering and ‘he doesn’t always understand’ her. She loves her husband and she ‘knows’ he loves her. She gets on well with her children.
She lost her mother 4 months ago since that time she has ‘not been feeling well’.
Get the patient in a room on her own first, without the husband. Then again with the husband.
What does she mean by domineering?
Does she feel safe?
Has there been any episodes of domestic violence in the marriage?
What does she mean by not feeling well?
Mrs L has been married for 30yrs. She has a part time admin job and has 2 children who are 30 and 32yrs old. She has always been shy and not very confident, but in general she gets on with life. Her marriage has had good episodes, but she describes her husband as a quite domineering and ‘he doesn’t always understand’ her. She loves her husband and she ‘knows’ he loves her. She gets on well with her children.
Normally enjoys her job but has been off for last 2wks.
Tried overdosing then called her husband.
Had a miscarriage previously.
How would you assess her mood?
How has your mood been over the last 2wks?
What are your hobbies and interest? Have you lost interest in these?
What has your energy levels been like?
How has your sleep been like?
Do you feel hopeless?
Sometimes when people feel depressed they feel suicidal. Have you ever felt like this? If they have then important to ask what has stopped you?
Have you had any thoughts about harming yourself recently?
Do you experience any hallucinations? Do you ever hear voices?
Patient denies overdose because of the distress to her husband. She admits feeling depressed but no longer suicidal. How would you manage this patient in the E.D?
Speak to her and husband together.
Biological- Needs anti-depressant but this should be started by GP so send letter to GP.
Psychological- Can self refer or get referred by GP for CBT.
Social- Exercise (20 mins hot and sweaty 3-5 times weekly), lifestyle changes, diet, alcohol reduction etc. Encourage husband to take 2wks off work to stay with her at home.
In the community:
1) If really worried then admit patient, may need to section them.
2) Crisis team
3) Follow up with GP. If written to by ED the GP will take a few weeks to response so the patient should go to the GP herself or CMHT.
