Psychosis and schizophrenia

Question 1

1) What happens in psychosis?
2) Define hallucination.
3) Define delusion.
4) What is the lifetime risk of developing schizophrenia?
5) When is the usual onset of schizophrenia?

Answer 1

1) People lose touch with reality, experiencing hallucinations and delusions.
2) A perception in the absence of a stimulus.
3) A fixed, false belief held despite rational argument or evidence to the contrary. It cannot be explained by the patient’s cultural, religious or educational background.
4) About 1%.
5) Onset is typical from 15 to 45 years.

Question 2

1) Who is affected more by schizophrenia?
2) When schizophrenia presents in childhood, what is it often associated with?
3) Describe the aetiology of schizophrenia.
4) What is the lifetime risk of schizophrenia for first degree relatives of people with schizophrenia.
5) What is the lifetime risk of schizophrenia for a child whose parents are both affected by schizophrenia?

Answer 2

1) Overall men and women are affected equally, but men tend to be affected earlier and more severely than women.
2) When it presents in childhood, it is often associated with developmental delay.
3) There is a complex, multifactorial aetiology.
4) Lifetime risk increases from 1-10% for 1st degree relatives of people with schizophrenia
5) 48%.

Question 3

Name 6 potential aetiologies for schizophrenia or psychosis.

Answer 3

1) Genetics
2) Obstetric complications
3) Substance misuse
4) Social disadvantage
5) Urban life and birth
6) Migration and ethnicity
7) Expressed emotion
8) Premorbid personality
9) Adverse life experience

Question 4

1) What is the monozygotic twin concordance rate for schizophrenia?
2) What is the dizygotic twin concordance rate for schizophrenia?
3) What do adoption studies show for aetiology of schizophrenia?
4) Briefly describe the proposed genetic basis behind the development of schizophrenia.
5) What is it thought that genes code for in schizophrenia?
6) Name 3 symptom clusters.

Answer 4

1) 40-50%
2) 10-20%
3) They show that children of people with schizophrenia, raised in families without schizophrenia, remain at high risk of the disorder.
4) It is thought that multiple susceptibility genes probably interact, each making someone slightly more likely to develop schizophrenia.
5) It is thought that genes code for symptom clusters, creating an overlap between genes that contribute to a spectrum os psychotic disorders (schizophrenia, schizoaffective psychosis and affective psychosis).
6) Psychotic, depressive and manic symptoms.

Question 5

1) What 5 obstetric complications could contribute towards an increased risk of developing schizophrenia?
2) With regards to obstetrics, when are rates of schizophrenia found to be higher?
3) What underlying abnormalities might be reflected by obstetric complications which can lead to schizophrenia?
4) Name 4 substances which can cause psychotic symptoms.
5) Describe how cannabis can relate to the development of schizophrenia.

Answer 5

1) Prenatal malnutrition, viral infections, pre-eclampsia, low birth weight and emergency Caesarean section.
2) Rates of schizophrenia are higher in people born in the winter (Jan-Mar in the Northern hemisphere), when viral infections are rife.
3) Underlying genetic abnormalities or hypoxic brain damage.
4) Cananbis, amphetamines, cocaine and LSD.
5) Cannabis does not cause schizophrenia in itself, but it increases the overall risk, contributing to the development of the disorder in susceptible people.

Question 6

1) Name the enzyme which breaks down Dopamine.
2) Name the 2 alleles which code for the enzyme that breaks down dopamine.
3) Describe the relationships between these alleles and the risk of schizophrenia.
4) Which type of cannabis is particularly dangerous for those vulnerable to schizophrenia?
5) Why is this type of cannabis particularly dangerous?

Answer 6

1) Catechol-O-methyl transferase (COMT) breaks down Dopamine.
2) Val and Met code for COMT.
3) The val allele increases the risk of schizophrenia in cannabis users. People who are val-val have the highest risk.
4) Skunk.
5) Because it has higher concentrations of tetrahydrocannabinol, which is the chemical in cannabis most associated with psychosis.

Question 7

1) Why are adolescents very vulnerable to developing psychosis after smoking cannabis?
2) Which social class is schizophrenia more prevalent in?
3) Describe the downward drift of social class with regards to schizophrenia.
4) Why might schizophrenia be twice as prevalent in urban than rural areas?
5) With regards to migration and ethnicity, who has a higher risk of developing schizophrenia?

Answer 7

1) Because their brains are still developing.
2) Higher prevalence of schizophrenia amongst adults of lower SES.
3) People who have schizophrenia with a lower SES did not necessarily start with a lower SES. Therefore, the downward drift is thought to be due to the illness, and the lower SES results from social isolation and unemployment.
4) Due to downward drift or due to stress that is specific to the urban environment.
5) First and second generation immigrants have an average 3 fold increase in risk of schizophrenia. Black Caribbean and black African populations have a 4-6 fold increase in risk of schizophrenia compared to white British populations.

Question 8

1) What can double the risk of relapse in patients with schizophrenia in the 9-18 months following discharge from hospital.
2) What type of premorbid personality precedes schizophrenia in up to a quarter of cases?
3) Name the disorder which is more commonly associated with schizophrenia and state why.
4) What adverse life experiences increase the risk of schizophrenia?

Answer 8

1) Close contact with highly critical or over involved relatives doubles the rate fo relapse in the 9-18 months following discharge from hospital.
2) Schizoid personality precedes schizophrenia in up to a quarter of cases.
3) Schizotypal disorder is commonly associated, possibly due to a shared genetic basis.
4) Sexual or physical abuse in childhood or adulthood increase the risk of schizophrenia.

Question 9

1) Name the 3 main theories of development of schizophrenia.
2) State the 2 macroscopic changes to the brain which have been identified in patients with schizophrenia.
3) What part of the neurodevelopmental theory suggests that changes in the brain that can lead to schizophrenia occur before adulthood?
4) Which 4 psychological factors might cause brain changes which can lead to contribute to the development of schizophrenia.
5) Describe how initial brain abnormalities may progress to evolve to cause overt schizophrenic symptoms.

Answer 9

1) Neurodevelopmental theories, neurotransmitter theories and psychological theories.
2) Enlarged ventricles and overall smaller and lighter brains.
3) There is no gliosis at post mortem.
4) Lower pre-morbid IQ, deficits in learning, memory and executive function.
5) These abnormalities progress as the brain matures through ongoing myelination and synaptic pruning. Maturation with other risk factors such as cannabis may allow functional and connectivity abnormalities to evolve until overt schizophrenic symptoms emerge.

Question 10

Describe the 2 psychological theories behind the development of schizophrenia.

Answer 10

1) Cognitive models propose subtle defects of thinking such as tendency to jump to conclusions without adequately examining contraindicatory evidence, leading to delusions.
2) Fear of madness may prompt the defences of denial and rationalisation, resulting in a delusional system to explain persecutory voices.

Question 11

1) What does the Dopamine hypothesis state?
2) What are positive symptoms thought to result from?
3) What are negative symptoms thought to arise from?
4) Why is it thought that Dopamine is not the only causative neurotransmitter?
5) What other 2 neurotransmitters might be implicated in the aetiology of schizophrenia?

Answer 11

1) That schizophrenia is a result of dopamine overactivity in certain areas of the brain.
2) Excess dopamine in the mesolimbic tracts.
3) Dopamine underactivity in the mesocortical tracts.
4) Because antipsychotics which target dopamine do not cure all psychoses.
5) Serotonin overactivity and Glutamate dysregulation.

Question 12

1) Give the 3 clinical stages that schizophrenia can be divided into.
2) Why is the term prodrome losing popularity?
3) What is the typical picture of someone at the ‘at risk mental state’ stage.
4) What does a patient in the ‘at risk mental state’ seem like?
5) What 3 other conditions can the ‘at risk mental state’ be hard to distinguish from?

Answer 12

1) At risk mental state (prodrome), acute phase, chronic phase.
2) Because it wrongly suggests that psychosis is inevitable.
3) Someone in their late teens or early twenties who has dropped out of college or work after a period of increasing absences.
4) They often seem ‘distant’, giving no reason for self-isolation.
5) depression, substance misuse and normal teenage behaviour.

Question 13

State 5 of the low grade symptoms associated with the ‘at risk mental state’.

Answer 13

1) Social withdrawal
2) Loss of interest in:
a) work
b) study
c) relationships
3) No psychotic symptoms

Question 14

1) What does the acute phase of psychosis have?
2) What does disturbed thinking in the acute phase of psychosis cause?
3) What 3 negative symptoms can also be present in the acute phase?
4) What type of delusions are most often present in schizophrenia/ psychosis?

Answer 14

1) The most striking and florid psychotic features (hallucinations and delusions) - consists of positive symptoms.
2) Muddled speech and withdrawn, overactive or bizarre behaviour.
3) Marked decrease in self care, social withdrawal and anhedonia can also present in the acute phase.
4) Persecutory.

Question 15

State the 5 first rank symptoms of schizophrenia.

Answer 15

1) Delusional perceptions
2) Passivity
3) Delusions of thought interference.
4) Third person auditory hallucinations.
5) Thought echo.

Question 16

1) What is a delusional perception?
2) What is passivity?
3) What is thought interference?
4) What are the 3 types of thought interference?
5) What is formal thought disorder?
6) What are the 2 types of third person auditory hallucinations?

Answer 16

1) A 2 stage process whereby a real perception is interpreted in a delusional way (The traffic light turned to green and I knew I was the Queen of Ireland).
2) The belief that movement, sensation, emotion or impulse are controlled by an outside force.
3) When the patient believes that their thoughts are under the control of something or someone else.
4) Thought withdrawal, thought insertion and thought broadcasting.
5) When thoughts become disconnected (loosening of associations).
6) Running commentary and two voices conversing.

Question 17

Name 5 other symptoms of schizophrenia which are not 1st rank symptoms.

Answer 17

1) World salad
2) Poverty of thought
3) Thought blocking
4) Disjointed speech (circumstantial speech)
5) 1st and 2nd person auditory hallucinations.

Question 18

1) What might happen to some patients’ psychoses after a few years?
2) Rather than becoming well, what might happen to a patient after the acute phase?
3) How long might the chronic phase last?
4) How might negative symptoms of the chronic phase manifest?
5) How might positive symptoms still manifest in the chronic phase?

Answer 18

1) Some patients’ psychoses may become ‘burnt out’ after a few years.
2) They could enter a chronic phase.
3) May last indefinitely and can be immensely disabling.
4) As a lack of attention to personal hygiene and care, a limited repertoire of daily activities and social isolation.
5) There may be residual and less prominent positive symptoms (a person may still have persecutory delusional thoughts, bu seem less distressed and affected by them).

Question 19

Name 5 negative symptoms of the chronic phase.

Answer 19

1) Apathy: opposite of enthusiasm, loss of motivation.
2) Blunted affect: decreased reactivity of mood.
3) Anhedonia: inability to enjoy interests/ activities
4) Social withdrawal
5) Poverty of thought and speech

Question 20

1) What 2 conditions can both resemble the chronic phase?
2) What can schizophrenia presentations be divided into?
3) What are the 5 subtypes of schizophrenia?
4) What is the most common subtype of schizophrenia?
5) What is paranoid schizophrenia exemplified by and what are the main symptoms?

Answer 20

1) Depression and antipsychotic side effects, but they are often much easier to treat.
2) Different subtypes based upon the most prominent symptoms.
3) Paranoid, catatonic, hebephrenic, simple and residual.
4) Paranoid.
5) Exemplified by the acute phase of schizophrenia description and the main symptoms are prominent delusions and hallucinations.

Question 21

1) What is catatonic schizophrenia dominated by?
2) What is stupor?
3) What is excitement?
4) What is posturing?
5) What is rigidity?

Answer 21

1) Psychomotor disturbance.
2) A state of being immobile, mute and unresponsive, despite appearing to be conscious (eyes are open and will follow people around the room).
3) Periods of extreme and apparently purposeless motor hyperactivity.
4) Assuming and maintaining inappropriate or bizarre positions.
5) Holding a rigid posture against efforts to be moved.

Question 22

Name 7 abnormalities found in catatonic schizophrenia.

Answer 22

1) Stupor
2) Excitement
3) Posturing
4) Rigidity
5) Waxy flexibility
6) Automatic obedience (to any instructions)
7) Perseveration

Question 23

1) What is waxy flexibility?
2) What is perseveration?
3) Why is catatonia now rare in developed countries?
4) Why is it important to exclude physical illness in a presentation involving catatonia?
5) When is the onset usually for hebephrenic schizophrenia?

Answer 23

1) When the patient’s limbs offer minimal resistance to being placed in odd positions which are maintained for unusually lengthy periods (cataplexy).
2) Inappropriate repetition of words or movements.
3) Due to the availability of antipsychotics and active rehabilitation programmes.
4) Because catatonia can also be seen in organic conditions such as encephalitis.
5) Between 15 and 25.

Question 24

1) What are the dominant features of hebephrenic schizophrenia?
2) Describe the affect and behaviour of a patient with hebephrenic schizophrenia.
3) What are not prominent features of hebephrenic schizophrenia?
4) Describe simple schizophrenia.
5) What is residual schizophrenia?

Answer 24

1) Disorganised and chaotic mood, behaviour and speech.
2) Shallow or inappropriate affect and aimless behaviour.
3) Delusions and hallucinations are not prominent in hebephrenic schizophrenia.
4) Negative features only, without ever having had positive psychotic symptoms.
5) Prominent negative symptoms that remain after delusions and hallucinations subside.

Question 25

1) Name 2 other conditions where the first rank symptoms of schizophrenia can occur.
2) How long should first rank symptoms of schizophrenia be present before a diagnosis can be made?
3) What is the difference between schizophrenia and acute and transient psychotic episodes?
4) What should schizophrenia not be diagnosed in the presence of?
5) When can schizoaffective disorder be diagnosed?

Answer 25

1) Mania and delirium.
2) They should be present for a month before a diagnosis can be made.
3) Acute and transient psychotic episodes resolve completely within a few months and can be stress related.
4) Striking mood disturbance unless the schizophrenic symptoms clearly came first as both depression and mania can produce psychotic symptoms.
5) If both schizophrenic and affective symptoms develop together and are roughly evenly balanced, to the extent that one set of symptoms cannot be said to be more important than the other.

Question 26

Name the 6 categories of differential diagnoses for psychosis/ schizophrenia.

Answer 26

1) Organic causes
2) Acute and transient psychotic episode
3) Mood disorder
4) Schizoaffective disorder
5) Persistent delusional disorder
6) Schizotypal disorder

Question 27

1) What should be checked before starting long term antipsychotics?
2) What is the duration of untreated psychosis?
3) What is the relationship between the duration of untreated psychosis and potential recovery?
4) What is the specific aim of early intervention services?
5) What are patients offered with the aim of keeping the duration of untreated psychosis below 3 months.

Answer 27

1) Lipids.

Question 28

1) What should be checked before starting long term antipsychotics?
2) What is the duration of untreated psychosis?
3) What is the relationship between the duration of untreated psychosis and potential recovery?
4) What is the specific aim of early intervention services?
5) What are patients offered with the aim of keeping the duration of untreated psychosis below 3 months.

Answer 28

1) Lipids.
2) The time delay from the first ever clear cut psychotic symptom until the start of the first ever effective treatment.
3) The longer the DUP, the greater the damage to the person’s cognitive abilities, insight and social situation. The sooner effective treatment can be started, the better the prognosis.
4) Engaging patients with very early symptoms.
5) Antipsychotics and psychosocial interventions with the aim of keeping the DUP <3 months.

Question 29

1) What are the 4 stages in management of a patient with psychosis/ schizophrenia?
2) The greater the what, the more effective antipsychotics are at treating positive symptoms.
3) What causes extra pyramidal side effects?
4) When are extra pyramidal side effects inevitable?
5) When is there a reduced risk of extrapyramidal side effects?

Answer 29

1) Antipsychotics, psychological management, social approaches and risk assessment.
2) The greater the affinity, the more effective antipsychotics are in treating positive symptoms which are caused by Dopamine excess.
3) Generalised Dopamine blockade.
4) They are inevitable at higher doses of all antipsychotics.
5) Newer atypical antipsychotics are more selective , reducing the risk of EPSEs at therapeutic doses.

Question 30

1) Why are greater affinity antipsychotics more effective at treating positive symptoms?
2) What are typical antipsychotics?
3) What do typical antipsychotics tend to cause?
4) Why are typical antipsychotics still widely used?
5) What are depots?

Answer 30

1) Because positive symptoms are caused by Dopamine excess.
2) They are older drugs such as Chlorpromazine and haloperidol.
3) Distressing EPSEs at normal treatment doses.
4) Because they are effective, cheap and provide depot options.
5) They are long-acting injections that are useful for patients who have difficulties taking daily tablets.

Question 31

1) What are 2 positives of atypical antipsychotics?
2) What 2 receptors do atypical antipsychotics block?
3) Name 6 atypical antipsychotics.
4) Name an atypical antipsychotic that is available as a depot injection.
5) What process should you use to find the best effective dose of an antipsychotic

4)

Answer 31

1) They cause fewer EPSEs and generally do not increase prolactin levels.
2) They block Dopamine receptors and Serotonin 5-HT2 receptors.
3) Olanzapine, Risperidone, Quetiapine, Aripiprazole, Amisulpride and Clozapine.
4) Risperidone is available as a depot.
5) To reach the lowest dose that controls symptoms, titrate the drug against symptoms and side effects, allowing time at each dose for the drug to reach therapeutic levels.

Question 32

In what 3 situations should you consider starting an atypical antipsychotic?

Answer 32

1) Choosing first-line treatment in newly diagnosed schizophrenia.
2) There are unacceptable side-effects from typical antipsychotics.
3) If relapse occurs when on a typical antipsychotic.

Question 33

1) Why should you avoid using more than one antipsychotic at the same time?
2) Name 4 extrapyramidal side effects.
3) Name 5 anticholinergic side effects.
4) What are 2 signs of dyslipidaemia?
5) Which antipsychotic has the greatest risk of seizures by lowering the seizure threshold?

Answer 33

1) Because multiple drugs increase risk and widen the side-effect profile.
2) Dystonia, Akathisia, Parkinsonism and Tardive dyskinesia.
3) Dry mouth, blurred vision, constipation, urinary retention and tachycardia.
4) Raised triglycerides and raised cholesterol.
5) Clozapine.

Question 34

What 6 things can hyperprolactinaemia cause?

Answer 34

1) galactorrhoea
2) amenorrhoea
3) gynaecomastia
4) hypogonadism
5) sexual dysfunction
6) increased risk if osteoporosis

Question 35

Name 7 potential side effects of antipsychotic drugs.

Answer 35

1) EPSES
2) Hyperprolactinaemia
3) Weight gain
4) Sedation
5) Increased risk of diabetes
6) Dyslipidaemia
7) Anticholinergic side effects
8) Arrhythmias
9) Seizures
10) Neuroleptic malignant syndrome

Question 36

1) What is neuroleptic malignant syndrome thought to be?
2) Give 2 biochemical signs of neuroleptic malignant syndrome.
3) How might death occur from neuroleptic malignant syndrome?
4) What is treatment resistance?
5) What is the first line drug for treatment resistant (or refractory) schizophrenia.

Answer 36

1) An idiosyncratic response to Dopamine antagonism.
2) Raised creatinine kinase and raised white cell count.
3) an example would be acute renal failure secondary to skeletal muscle breakdown (rhabdomyolysis).
4) Failure to respond to 2 or more antipsychotics, at least one of which is an atypical, each given at a therapeutic dose for at least 6 weeks.
5) Clozapine can work when everything else has failed.

Question 37

List 3 symptoms of neuroleptic malignant syndrome.

Answer 37

1) Muscle stiffness and rigidity
2) Altered consciousness
3) Disturbance of autonomic nervous system (fever, tachycardia and labile BP).

Question 38

Give 5 monitoring methods required for monitoring a patient on antipsychotics.

Answer 38

1) BMI and waist circumference.
2) BP
3) Bloods: FBC, LFTs, U&Es, glucose tolerance test (fasting glucose or HbA1c) and lipids.
4) Prolactin levels (if hyperprolactinaemia is suspected).
5) ECGs (important for middle aged to elderly people and in those on high dose antipsychotics or Clozapine to monitor the QTc interval).

Question 39

1) What is the main serious side effect of Clozapine and in what percentage of patients does this occur?
2) Describe the monitoring process for clozapine.
3) In what percentage of patients does neutropenia occur in?
4) What 3 psychological therapies are used for patients with schizophrenia/psychosis?
5) Within CBT, what is particular emphasis placed on?

Answer 39

1) Agranulocytosis occurs in 0.7% of patients.
2) Weekly blood tests to detect early signs of neutropenia, and in the absence of problems, tests are gradually reduced to once a month.
3) Neutropenia occurs in 3% of patients and means that Clozapine must be stopped.
4) CBT, family therapy and concordance therapy.
5) Reality testing.

Question 40

1) In CBT for patients with schizophrenia, what does the therapist aim to do?
2) What 3 positive effects can CBT have on a patient?
3) What can family therapy reduce?
4) What is concordance therapy?
5) What does psychodynamic theory conceptualise?

Answer 40

1) Gently challenge the patient’s beliefs, aiding awareness of illogical thinking.
2) Improves self-esteem, improves problem solving and may help to cope with troublesome hallucinations and delusions.
3) Relapse rates.
4) A collaborative approach where the patient is encouraged to consider pros and cons of the management, improving their understanding of their treatment needs.
5) The patient’s symptoms and behaviour as a conflict between the psychotic and non-psychotic parts of the personality.

Question 41

Through what 4 ways can the effects of high expressed emotions be ameliorated?

Answer 41

1) Communication skills training
2) Education about schizophrenia
3) Problem-solving
4) Helping patients to expand their social network.
5) Taking time out from families.

Question 42

1) What might social approaches to the management of schizophrenia include?
2) What 4 other areas are social approaches also concerned with?
3) What is social skills training primarily aimed at?
4) What does rehabilitation psychiatry focus on?

Answer 42

1) Admission to hospital for observation, treatment or refuge.
2) Practical needs like benefits, housing, training and education.
3) Improving interpersonal skills.
4) The patient’s quality of life, overcoming disability where possible and accepting limitations where not.

Question 43

What 5 areas does rehabilitation psychiatry focus on?

Answer 43

1) Accessing education, training or employment.
2) Skills (budgeting and cooking)
3) Housing (supported accommodation/ independent flats)
4) Accessing social activities
5) Developing personal skills

Question 44

1) Patients with schizophrenia are at the greatest risk to who?
2) What 4 risks to themselves do patients with schizophrenia pose?
3) What is the lifetime risk of suicide for patients with schizophrenia?
4) Which patients with schizophrenia are especially vulnerable to the possibility of suicide?
5) When is risk of suicide highest in patients with schizophrenia?

Answer 44

1) Themselves.
2) Suicide, self-neglect, social isolation and victimisation.
3) 10% (10 times that of the general population).
4) Intelligent young men with good premorbid functioning.
5) Risk is highest in the early years after diagnosis, following first admission, or where there are depressive symptoms.

Question 45

1) In patients with schizophrenia, violence is usually a direct response to what?
2) Patients are at an increased risk of what from the general population?
3) What proportion of patients with schizophrenia recover and experience no further difficulties after a single episode?
4) After recovery, what proportion of patients with schizophrenia remain liable to relapse or continue to have symptoms?
5) What proportion of patients with schizophrenia will be seriously and continuously disabled?

Answer 45

1) Persecutory delusions or command hallucinations.
2) They are at an increased risk of being victims of crime.
3) A quarter.
4) Two thirds
5) 1 in 10.

Question 46

Name 5 factors that might increase the risk of patients with schizophrenia being violent.

Answer 46

1) Past history of violence
2) Substance misuse
3) Acute psychotic symptoms
4) Non-concordance with treatment
5) Access to weapons
6) Specific threats to a victim
7) Co-morbid personality disorder (dissocial, emocional unstable or paranoid) or psychopathy.

Question 47

Give 5 positive prognostic factors for patients with schizophrenia.

Answer 47

1) Female
2) Later, acute onset
3) < 3 months duration
4) High premorbid IQ
5) Affective prominent symptoms
6) Good social support
7) Concordant with medication
8) No family history
9) Evidence of precipitating factors
10) No substance misuse

Question 48

Give 5 poor prognostic factors for patients with schizophrenia.

Answer 48

1) Male
2) Early, insidious onset
3) > 3 months duration
4) Low premorbid IQ
5) Negative prominent symptoms
6) Poor social support/ social withdrawal
7) Not concordant with medication
8) Positive FHx
9) No precipitating features
10) Evidence of substance misuse, especially cannabis.

Question 49

1) What is the relative mortality of patients with schizophrenia?
2) Among patients with schizophrenia, what group of patients has significantly higher rates of mortality.
3) What main factor contributes to the high mortality rates of patients with schizophrenia?
4) Which antipsychotics are especially associated with weight gain?

Answer 49

1) More than twice that of the general population.
2) Higher rates of mortality among males than females because of their increased rates of accidents and suicides.
3) Poor physical health contributes to the high mortality rates.
4) Olanzapine and Clozapine.

Question 50

Describe section 2 of the MHA.

Answer 50

patient can be held as an inpatient for up to 28 days for assessment.

Question 51

Describe section 3 of the MHA act.

Answer 51

patient can be held as an inpatient for up to 6 months for treatment.

Question 52

1) What does a section 5(2) give the powers to do?

2) What does a section 5(4) give the powers to do?

Answer 52

1) doctors can detain someone in a hospital for up to 72 hours during which time the patient should receive a psychiatric assessment to decide if further detention under the MHA is necessary.
2) gives nurses the ability to detain someone in hospital for up to 6 hours.

Question 53

Describe section 135 of the MHA.

Answer 53

warrant giving police the powers to enter your home, if need be by force, to take a patient to a place of safety for an assessment by an approved mental health professional and a doctor.

Question 54

Describe section 136 of the MHA.

Answer 54

can be used by police in a public place then can take you to a place of safety (hospital or sometimes police station) where you will be assessed by a mental health professional and a doctor. Patient can be kept there until the assessment is completed, for up to 24 hours.