Psych Written - Psychotic & Dissociative Disorders Flashcards
Clozapine monitoring
Requires normal FBC before starting Tx
THEN weekly FBC (for 18 weeks)
THEN bi-weekly (for 1 year)
THEN monthly
Standard anti-psychotic monitoring
BMI + waist circumference
BP
Bloods - FBC, LFTs, U&Es, lipids, glucose (+OGTT and HbA1c if abnormal)
+/- prolactin (if Sx or specific med - risperidone)
+/- EEG (older people, high dose med, clozapine)
How long should anti-psychotics generally be continued?
at least 3 years after 1st episode psychosis
longer if recurrent psychotic episodes
Indication for clozapine?
Treatment resistant SCZ
defined as:
- 2 unsuccessful trials of antipsychotic
- at least 1 being atypical
- for minimum 6 weeks
- at therapeutic dose
What is DUP? Why does it matter?
Duration of untreated psychosis = time from first clear psychotic Sx until start of effective Tx
Longer DUP = greater damage to cognitive abilities, insight, social
Aim to keep DUP < 3months
Indications for atypical antipsychotic?
1st line in new psychosis
Unacceptable SE from typical agent
Relapse on typical agent
Psychological Tx in psychotic disorders?
CBT - emphasis on reality testing + helping client to spot illogical thinking
Cognitive remediation therapy (CRT) - useful for negative Sx, improved neurocognitive skills
Family intervention - reduces high expressed emotion (e.g. over involvement, criticism) which can be detrimental
Arts therapy - often as group, can be effective during acute episode or for negative Sx in chronic phase
Lifetime suicide risk in psychotic disorders?
10%
Highest RF for suicide in psychotic disorders?
Intelligent young male with high premorbid IQ
Early after diagnosis
After first admission
Co-existing depression
Pathophysiology of negative Sx in SCZ
Dopamine under activity in mesocortical tracts
Pathophysiology of positive Sx in SCZ
Excess dopamine in mesolimbic tracts
Strongest RF for SCZ?
Family Hx
Other SCZ risk factors
Migration Black Caribbean Urban environment Cannabis (esp skunk) Increased paternal age Winter born Social disadvantage Childhood adversity Obstetric complications
Diagnostic criteria for SCZ
1 of the first rank Sx
OR 2 of:
- persistent hallucination in any modality
- thought disorder
- catatonai
- negative Sx
for at least 1 month
1st rank Psychotic Sx
Thought disorder / alienation
- broudcasting
- withdrawal
- insertion
Passivity phenomena
Auditory hallucinations
- numerous 3rd person discussions ‘he/she is …’
- running comentary
- thought echo (repeats thoughts aloud just after)
Delusional perceptions - ordinary stimulus triggers delusional belief e.g. it was cloudy so I was God