Psychosis (first ep, substance induced)

Question 1

Why is it important to identify early psychosis?

Answer 1

Early phase of psychotic disorder associated with maximum severity and impact giving unique opportunity for preventive intervention

• i. social/occupational: disruption during adolescence, young adulthood impairs life trajectory
• ii. neurobiological

Question 2

Changes observed in pre-psychotic / prodromal phase?

Answer 2

Often non specific:

• cognitive e.g. poor concentration, vague thinking
• depression, anxiety
• suspiciousness and odd preoccupations
• delusional mood (e.g. vague sense something is wrong with self or mood) may be relieved on development of explanation (i.e. transition to overt psychosis)
• social withdrawal, problems with work / study, deterioration in self care, drug taking etc

Question 3

Foci of assessment first ep psychosis?

Answer 3

1. Safety of pt and contacts
2. Hx and MSE to determine whether DIP or organic psychosis likely
3. PEx and routine tests to r/o DDx

Question 4

Medication in first episode psychosis?

Answer 4

Minimised target dose for First Ep patients:
-2mg risperidone
-7.5mg OLZ
(starting dose even lower).
Increase if little response after 3-4/52

Question 5

Why are second gen antipsychotics preferred?

Answer 5

Less side effects, especially minimising the EPS of 1s gen (Parkinsonism, akathesia, acute dystonia, tardive dyskinesia)

Question 6

When should clozapine be used in Mx psychotic disorders?

Answer 6

• Offer early (ideally within 6/12) to 10-15% of patients unresponsive to new antipsychotics or those with severe EPS
• With CBT for those with established SCZ who have not recovered