Psychosis - BB Flashcards
Symptoms important to assess re psychosis
- Delusions – fixed false beliefs – e.g. Persecutory delusions/paranoia,
- Delusions of control/passivity phenomena (thoughts, actions or sensations).
- Hallucinations – tend to be auditory hallucinations (third person or running commentary) in Paranoid Schizophrenia.
- Thought echo, insertion, withdrawal or broadcast.
- Negative symptoms including apathy, paucity of speech and blunted affect.
- Catatonic symptoms.
- Mood symptoms e.g symptoms of depression or mania.
Differentials of psychotic episode
- Schizophrenia
- Schizoaffective disorder
- Substance abuse induced psychotic episode
- Bipolar disorder
- Delirium
- Space occupying lesion
- Infection etc
Risk factors to consider for psyhotic patients
- FH psychaitric illness
- Recreational drug use
- History of traumatic life events
- Complications pregnancy, birth and neonate
- Neurodevelopmental delay
Which section is appropriate for first presentation of MH disorder?
section 2 - need assessment
3 risks considered when assessing under MH act
- Risk to self - suicide, malnutrition etc
- Risk to others - eg driving, directly harming them
- Risk to further deterioration of MH eg refusing treatment
Signs on exam of NMS
- Lead pipe rigidity
- Hyperthermia
- Tachycardia
- Hypo/hypertension - fluctuates
- Episode incontinence
Blood results of NMS
- CK elevated
- U&E - metabolic disturbance eg AKI
- Hypercalcaemia
- Leucocytosis
- LFT deranged, LDH raised
- ABG - metabolic acidosis
Interventions following discharge to ensure support after psychosis
- CPN referral
- Early intervention psychosis team
- Psychology referral - CBT? Family therapy?
- Occupational groups/local support groups
- Educate re lifestyle eg drug use, smoking, cardiac health (esp if on 2nd gen antipsychotic)
- Support finances - benefits, employment support
- If student - student support services
Which section of MHA is used by police to assess and remove person from home if suspected MH disorder?
Section 135
Section 136 used if person is in public place rather than home
Which section of MHA is used for patients of previous MH diagnosis suffering from acute worsening?
- Section 3
- Diagnosis known, reason for relapse is clear and relapse is in keeping with known diagnosis
- = admission is for treatment, not investigation
What type of drug is Clozapine?
2nd generation antipsychotic
In what circumstances is Clozapine prescribed?
- Resistant schizophrenia
- = Trial of 2 antipsychotics that give inadequate response at adequate dosage (at least one should be non-clozapine 2nd gen)
- Then trial Clozapine
- Oral medication so needs compliance
Blood test prior to starting Clozapine and frequently after initiation - why?
- FBC
- = risk of agranulocytosis so need to ensure leucocyte count is normal
- Repeated weekly for first 18 weeks
- Then every 2 weeks for 1 year
- Then monthly forever
- Thombocytopenia can also occur
If refusing anti-psychotic medication, what is best way forward with regime?
Consider IM depot injecion
Why is Paliperidone good choice of antipsychotic?
- Paliperidone = depot version of Risperidone
- Not oral so good choice if refusing
- Initiated via loading doses (day 1 and day 8), then monthly injections
- If stable for 4 months can be given formulation that administers every 3 months
Legislation useful to ensure patients remain compliant in taking medication when they leave the hospital
- Community treatment order
- Used to specify conditions which patient is subject to on d/c
- Patient can be recalled to hospital if not met conditions
- This means clinicians don’t need to wait for patient to relapse, become risky and re-section (do not need to meet criteria for section)
- = avoid relapse and consequences
Safest antipsychotic in heart disease
- Arepirazole - does not prolong QTc
What is attachment theory?
- Importance of creating healthy, consistent and secure attachments to at least one nurturing individual during early childhood
- particularly for the first two years of life.
- This creates a stable and secure base for the child to grow and develop.
- Reactive attachment disorder is a consequence of a severe absence of healthy attachments. = emotional withdrawal and inhibition, sadness, fearfulness, irritability and impaired cognition.
Key positive symptoms of schizophrenia
- Auditory hallucinations (hearing voices, particularly a voice narrating the patient’s actions)
- Somatic passivity (believing that an external entity is controlling their sensations and actions)
- Thought insertion or thought withdrawal (believing that an external entity is inserting or removing their thoughts)
- Thought broadcasting (believing that others are overhearing their thoughts)
- Persecutory delusions (a false belief that a person or group is going to harm them)
- Ideas of reference (a false belief that unconnected events or details in the world directly relate to them)
- Delusional perceptions - eg normal perception with deluded meaning
Key negative symptoms Schizophrenia
- Affective flattening (minimal emotional reaction to emotive subjects or events)
- Alogia (“poverty of speech” – reduced speech)
- Anhedonia (lack of interest in activities)
- Avolition (lack of motivation in working towards goals or completing tasks)
Key aspects lack of functioning symptoms affect in schizophrenia
Affects:
Social engagement
Productivity and achievement at work or school
Self-care
Core symptoms paranoid schizophrenia ICD-10
- Hallucinations - auditory esp
- Perceptual disturbances
- Paranoid delusions
In what conditions can hallucinations occur?
- Space occupying lesion
- Mental health - Schizophrenia, bipolar, delirium, PTSD, personality disorders, severe depression
- Neuro - Parkinsons, Alzheimers, epilepsy, stroke
- Substance induced - hallucinogenic, stimulants, alcohol use/withdrawal
- Medical - infection/sepsis, hypoxia, hypoglycaemia
- Charles bonnet syndrome
- Wernicke/Korsakoff - thiamine deficient
