Psychosis

Question 1

EARLY PSYCHOSIS

i) name four prodromal symptoms that may be seen?
ii) name three psychotic symptoms?
iii) what is the role of the early intervention service? what does it aim to reduce the risk of? (2)
iv) name three things that may be offered by EIS? how many years do they follow up the patient after first episode psychosis?

Answer 1

i) prodromal > not clearly psychotic and usually more like negative symps
- social withdraw, isolation, irritable, anger, sleep disturb, func impair in ADLs

ii) hallucinations, delusions, thought disorder

iii) EIS recog and tx psychosis in early stages
- aims to reduce risk of relapse and hospitalisation

iv) MDT approach > APs, psychotherapy, occupational and social support
- follow up for 3 years

Question 2

DEFINITIONS

i) what is a hallucination? what is a delusion?
ii) what is a second person hallucination? what is a third person hallucination?
iii) how are hallucinations different from illusions?
iv) what are the three key symptoms of psychosis?

Answer 2

i) hallucination is a perception in the absence of a stimulus

delusion is a fixed false belief - despite evidence/logical argument to the contrary

ii) second person > dialogue with you and person may respond
third person > talking about them, commentary

iii) illusions are normal experiences where there is a stimulus but you mis percieve it
iv) delusions, hallucinations, formal thought disorder

Question 3

SCHIZOPHRENIA

i) for how long must symptoms be presence for a diagnsosis? what two things must be absent?
ii) name four symptoms? what is still in tact?
iii) what is the prevalence? when is the most common time of onset in males and females
iv) name four risk factors

Answer 3

i) symptoms for at least one month in absence of organic disorder or mood disorder

ii) thought echo, insertion, withdrawal or broadcasting
- delusional perception and delusions of control; influence or passivity;
- hallucinatory voices commenting or discussing the patient in the third person
- at first cognition and intellectual capacity is maintained

iii) 1% prev
male - teens/20s
female - 30s

iv) RF = social stressors, FH, cannabis use, migration, urban living, early life factors/adversity

Question 4

THE MENTAL HEALTH ACT

i) what is a section 136? how long can you be detained under it?
ii) who needs to be present for a MHA assessment to be done?
iii) what is section 2 and 3 used for? how long does each last/can be extended to

Answer 4

i) police emergency power if they have concern a person has a mental health disorder in a public place and needs to be taken to a place of safety
- can be detained for 24hrs (max 72 hrs)

ii) two doctors and a mental health practitioner

iii) section 2 = 28 days > can be extended to section 3
section 3 = 6 months and can be extended indefinitely

Question 5

CLOZAPINE

i) what type of antipsychotic is it? what is it reserved for?
ii) what needs to be closely monitored?
iii) what needs to be done in dosing? what happens if you miss a dose for more than 48 hours?
iv) what symptom may be experience on treament commencement? what can be given?
v) name three side effects

Answer 5

i) atypical > reserved for treatment resistant conditions
ii) close monitor blood counts (white cells)

iii) titrate up slowly to a therapeutic dose and continue monitoring
- missed doses > need to titrate up from the start again

iv) may get increased pulse > give a beta blocker
v) weight gain, hypersalivation, sexual dysfunction

Question 6

NEGATIVE SYMPTOMS

i) what neurotransmitter is implicated? what is the hypothesis? which brain area is affected?
ii) are they harder or easier to treat than positive symptoms?
iii) what is affect? what affect is seen in schizophrenia?
iv) name a communication, relation/social and cognitive deficit

Answer 6

i) implicates dopamine - loss of function (hypofunctionality)
- hypofunc of D1 receptor NT through prefrontal cortex

ii) harder to treat

iii) affect is emotional reactivity - are they reacting suitably?
- in schz - see flat or blunted affect (decreased expression of emotion)

iv) communication - poverty of speech
social - apathy
cognitive - memory, attention, disorganised thinking

Question 7

PSYCHOTIC AND NON PSYCHOTIC THOUGHTS

i) name three characteristics of psychotic delusions
ii) name three characteristics of obsessions? name three common themes? what condition are these seen in?
iii) what is an overvalued idea?
iv) give three characteristics of delusions in delirium

Answer 7

i) false beliefs that are fixed and dont change with rational argument, not culturally congruent, evidence to the contrary wont change the belief

ii) reccurent intrusive thoughts, assoc with anxiety and distress, recognise as false/illogical when not distressed
- common themes - harm, violence, sex, morality, hygiene, illness
- associated with rituals
- seen in OCD

iii) reasonable or understandable idea that is held to an extreme degree and dominates a persons life > causes distress to self and others

iv) false beliefs, often persecutory, poorly elaborated but not always fixed
- may be difficult to understand and assoc with confused state

Question 8

FIRST EPISODE OF PSYCHOSIS

i) what is it? what % of FEP will not have another episode?
ii) name five organic causes that need to be ruled out

Answer 8

i) used in early intervention in psychosis service
- 20-40% wont have another episode

ii) delirium in older patients
endocrine conditions (thyroid/steroid prod tumours),
AI disease (lupus), metabolic conds (intermittent porphyria)
infection (HIV, neurosyphilis),
brain pathology/injury (space occ lesion), stroke, head trauma
neurological disorders (MND, PD, wilsons, hungtingtons)
nutrition deficiencies (B12)
substance related (prescrobed meds eg steroids, ilicit eg cannabis, toxins, alcohol)

Question 9

DIAGNOSES AFTER FIRST EPISODE OF PSYCHOSIS

i) what two diagnoses do an affective (mood component) point towards - explain each

iI) what two diagnoses do a non affective component point towards - explain each

Answer 9

i) bipolar affective disorder - chronic mood disorder. If psychotic symptoms are present they must come at the same time as an episode of mania or depression
- schizoaffective disorder - chronic illness where psychotic symptoms occur when euthymic as well as when manic or depressed

iI) schizophrenia - chronic disorder charac by continuous or relapsing epiosdes of psychosis as well as significant positive, negative and cognitive symptoms
- persistent delusional disorder - chronic disorder where there are delusions but no other forms of psychosis (usually fixed on one thing)