Psychosis

Question 1

What is psychosis?

Answer 1

• Any disorder so severe that the victim loses contact with reality.
• Examples:
  
  • Schizophrenia
  • Bipolar disorder (previously known as manic-depressive illness).
  • Schizoaffective disorders.
  • Persistent delusional disorders.
  • Schizophreniform psychosis (significant symptoms present for majority of 1 month but not 6 months yet).

Question 2

What is the most common age of diagnosis of schzophrenia?

Answer 2

• Men - early 20s
• Women - late 20s

Question 3

What is the impact of schizophrenia?

Answer 3

• 20% who have a first episode recover.
• 80% will suffer either another acute episodes or a more chronic condition.
• 10% successfully commit suicide.
• 19% are employed.

Question 4

Describe the symptoms of schizophrenia.

Answer 4

• Episodic
• Lack of insight
• Symptoms (positive and negative):
  
  • Pervasive thought disturbance
  • Difficulty in ignoring irrelevant stimuli (internal or external)
  • Cognitive deficits
  • Withdrawl from personal contact
  • Delusions
  • Hallucinations
  • Emotional disorder
  • Behavioural disruption

Question 5

Describe the diagnostic criteria for schizophrenia.

Answer 5

Question 6

What are the cognitive defecits of executive function associated with schizophrenia?

Answer 6

• Sustained attention
• Planning
• Verbal and visuo-spatial working memory
• Language skills
• Explicit learning and memory
• Perceptual / motor processing

Question 7

What symptoms result from schizophrenia?

Answer 7

• Few early friends
• Little opportunity for social reality testing
• Cannot distinguish between reality and fantasy
• Delusions
• Hallucinations
• Emotional reactivity
• Lack of emotions / inappropriate affect
• Behavioural disruption
  
  • Catatonic
  • Disorganised

Question 8

What are the risk factors for schizophrenia?

Answer 8

• Deficits in the ability to keep thoughts and actions on track.
• Can be affected by:
  
  • Genetics
  • Physiological
  • Anatomical
  • Psychosocial

Question 9

Describe the physiology of schizophrenia,

Answer 9

• Dopamine hypothesis
  
  • Classical antipsychotics
  • Overstimulation
• Dopamine-serotonin interaction hypothesis
  
  • Atypical antipsychotics
• Other possibilities:
  
  • ACh
  • Glutamate
  • GABA

Question 10

What are the psychosocial risk factors for schizophrenia?

Answer 10

• Higher prevalence in lower social class
• Associated with being in a minority position
• Associated with growing up in an urban environment
• Family environment - high levels of expressed emotion found in families of people with a diagnosis of schizophrenia
• Cannabis use

Question 11

What are the treatment options for a patient with schizophrenia?

Answer 11

• Early intervention tends to result in better long-term outcomes.
• Drug therapies:
  
  • Classical antipsychotics
  • Atypical antipsychotics
• Think about side effects
• Psychological interventions (alongside drug treatment):
  
  • Family intervention
  • Cognitive behaviour therapy
  • Social-skills training

Question 12

What is the NICE reccommendation for treatment of a first episode of schizophrenia?

Answer 12

• Oral antipsychotic medication in conjunction with psychological intervention.
• In Ewan’s case this was Aripiprazole (atypical antipsychotic) and Behavioural Family Therapy (skills based therapy focused on positive communication, problem solving skills and stress mangement).

Question 13

What is the NICE reccommendation for treatment of a continuing schizophrenia?

Answer 13

• Continuing treatment and care (psychosis services or specialist community-based team):
  
  • Offer CBT to assist in promoting recovery (particularly if persistent symptoms or in remission).
  • Offer family intervention.
  • Consider offering depot or long-acting antipsychotic medication if the patient would prefer it after an acute episode or to avoid covert non-adherence as a clinical priority.
  • Monitor physical health regularly, particularly in relation to potential side effects of medication, but also overall physical health.

Question 14

What are the outcomes of schizophrenia for patients in terms of how they can exist on their own?

Answer 14

• Inependent (30%)
• Relatively dependent (50%)
• Highly dependent (20%)

Question 15

What are the different types of detention under the mental health act?

Answer 15

• Emergency detention order = 72 hours.
• Short term detention certificate which has to be done by a psychiatrist and a mental health officer (MHO) who is a social worker (there is always one on call) lasts for 28 days.
• Compulsory treatment order lasts for 6 months and can be renewed.