Psychosis Flashcards
4 language features of psychosis?
Word salad
Derailment - Knights move
Neologism
Alogia - lack of speech
Difference between a belief and delusion?
Belief is when someone believes something with absolute certainty with or without evidence
Delusion is when someone believes something with aboslute certainty despite contradictory evidence
Anhedonia?
Lack of enjoyment
Avolition?
diminished motivation
Environmental factors that could contribute to development of schizophrenia?
Birth trauma, urban living, trauma, moves in childhood, famine, urban living, cannabis
How do structural brain alterations occur in schizophrenia?
Abberant DNA methylation
HPA axis dysregulation
Pro inflammatory state
brain alterations
Mechanism of chlorpromazine?
Binds to postsynaptic dopamine receptors, feedback to presynaptic, more dopamine released, more metabolites in synapse
3 phases of schizophrenia management?
Acute phase, stabilization phase, stable phase
Drug treatment choice of schizophrenia?
Chlorpromazine
What is used in treatment resistant schizophrenia?
Clozapine
First generation antipsychotics?
“azines”
chlorpromazine
Haloperidol
6 second generation anti-psychotics?
Quitiapine Clozapine Respiridone Olanzapine Aripiprazole Ziprazidone
First generation antipsychotics tend to have what 4 side effects?
tardive dyskinesia
increased prolactin
Weight gain
Sedation
What specific side effects do first generation antipsychotic Thiorazine come with?
usual: Tardive dyskinesia Prolactin increase Weight gain Sedation
Specific:
Qtc prolongation
Hypotension
Anticholinergic
Main 6 side effects of clozapine?
Weight gain
Glucose abnormalities
Lipid abnormalities
Hypotension
Sedation
Anticholinergic SE
Which class of antipsychotic should be used when someone has sensitivity to extrapyramidal SE?
second gen
Not high risperidone
Which class of antipsychotic should be used when someone has sensitivity to prolactin increase?
Second gen
Not risperidone
Which class of antipsychotic should be used when someone has sensitivity to weight gain and hyperglycaemia?
Aripiprazole
Ziprasidone
Blood tests for schizophrenia/ psychosis?
FBC U&E B12 Folate TFTs Glucose/HbA1c Serum calcium Cholesterol LFTs
Investigations into psychosis
ECG - antipsychotic prolonged qtc
ct brain - organic cause
EEG - temporal lobe epilepsy
Urine drug test - temporal lobe epilepsy
What antipsychotics are used first line in schizophrenia?
atypical - olanzapine, risperidone
When is ECT used in schizophrenia?
Catatonic or treatment resistant
Schizophrenia support groups?
SANE
Rethink
Causes of challenging behaviour developing?
Drugs - not managing pain, SE, withdrawal Psychotic illness Learning disability Hypoxia Infection Personality disorder Substance abuse or withdrawal Head injury
What do you need to know in order to manage someones acutely disturbed behaviour?
When did it start? Has it happened before? How was it managed? Any precipitants? Any changes to medication? Why were they admitted?
How do you approach an acutely disturbed patient?
Calmly, eye level, know your exits, safe environment, not alone, clear communication
What training do staff need in order to provide physical intervention for acutely disturbed patients?
MAPA
What is the stepwise management plan of managing an acutely disturbed patient?
De-escalate verbally
MAPA trained staff provide physical restraint
Pharmacological intervention
What benzodiazepine is chosen to be administered to patients experiencing an acute psychotic episode? adverse effects of drug on patients who are suffering what?
Flumazenil - adverse effects on those with anxiety or panic
When should antipsychotics not be given to a patient suffering an acute psychotic episode?
When the cause if delirium tremens as it lowers the seizure threshold
After IM sedatives are given to treat an acutely disturbed patient, how often do obs need to be recorded?
5-10 minutes for first hour
Every half hour till they are ambulatory again
What is oral medication and doses given to an acutely disturbed patient?
Lorazepam 250-500mcg PO up to 2mg daily
Risperidone 250mcg to 500mcg PO up to 2mg daily
(Can give Haloperidol or Olanzapine 2.5-5mg PO daily up to 5mg)
If oral medication is refused in an acutely unwell patient, what IM medications can be administered?
IM Lorazepam 0.5-1mg IM up to 2mg a day
IM Haloperidol 0.5mg IM up to 2mg a day
(Can give olanzapine 2.5-5mg IM up to 5mg a day)
What is a form 5?
Document that doctors fill out in order to ensure patient stays in hospital to be assessed properly
