Psychosis History and Management - Psych Flashcards
Key questions
-presentation of psychosis
Auditory hallucinations
- voice detail - male/female, always the same
- real/pseudo - in head or same room
- 1st, 2nd (depression), 3rd person (schizophrenia)
- content - commands, running commentary, grandiose, persecutory
Passivity experiences
-made feelings, actions, thoughts - Do you feel that your feelings, actions and thoughts are controlled by someone else?
Thought manipulation
-insertion, broadcast, removal, block
Delusions - do you have any beliefs that others around you don’t seem to share?
-why do you believe this?
Insight testing
What do you think the problem is
Do you believe that you are unwell
You are here on a mental health ward, do you believe that you need to be here?
Do you believe you need treatment?
Schizophrenia
- risk factors
- core features
- management
Risk factors
- FHx
- pregnancy, birth complications
- life stress
- cannabis
Core features
3rd person AH running commentary
Delusions of thought, control, perception
-persecutory, grandiose, erotomanic
Negative symptoms
-apathy, anhedonia, asociality, amotivation
Management
Acute - hospital admission voluntary/sectioned + antipsychotics (reduce anxiety+aggression within hours, hallucinations+delusions within days-weeks)
Maintenance - min 1-2years after 1st episode to prevent further episodes
Delusional disorder
- risk factors
- core features
- management
Risk factors
- FHx
- life stress
- alcohol, drug use
Core features
Delusions causing disruption to life
Management
- CBT
- antipsychotics
Bipolar disorder
- risk factors
- core features
- management
Risk factors
- FHx, psych Hx
- alcohol, substance misuse
Depression
CORE - anergia, anhedonia, low mood
BIOLOGICAL - weight/libido changes, poor sleep, early waking,
PSYCH - poor conc, mood congruent delusions (guilt, hopeless)
Mania
CORE - high energy, high pleasure/risky activities, high mood/irritability
BIOLOGICAL - decreased need for sleep, rapid speech/mv
PSYCH - mood congruent delusions (power, wealth, success)
Pattern - normal mood between periods of depression and mania
Management
Acute - antipsychotic
Maintenance - mood stabiliser (lithium or valproate)
Schizoaffective disorder
- risk factors
- core features
- management
Features of schizophrenia + mood disorders within same episode
Risk factors
- FHx
- cannabis use
Core features
3rd person AH running commentary
Delusions of thought, control, perception
-persecutory, grandiose, erotomanic
Negative symptoms
-apathy, anhedonia, asociality, amotivation
Depression
CORE - anergia, anhedonia, low mood
BIOLOGICAL - weight/libido changes, poor sleep, early waking,
PSYCH - poor conc, mood congruent delusions (guilt, hopeless)
Mania
CORE - high energy, high pleasure/risky activities, high mood/irritability
BIOLOGICAL - decreased need for sleep, rapid speech/mv
PSYCH - mood congruent delusions (power, wealth, success)
Management
Acute - antipsychotics
Maintenance - mood stabilisers/antidepressants
Psychotic depression
- core features
- risk factors
- management
Risk factors
- FHx
- isolation
- biopsychosocial life stresses
Depression
CORE - anergia, anhedonia, low mood
BIOLOGICAL - weight/libido changes, poor sleep, early waking,
PSYCH - poor conc, mood congruent delusions (guilt, hopeless), hallucinations (worthless, nihilistic, 2nd person
Management
-SSRIs + antipsychotics + CBT
Puerperal psychosis
- core features
- risk factors
- management
Risk factors
- FHx
- recent life stressors
- Hx of low mood, anxiety
- poor social support
Core features within 2 weeks of birth
Depression or manic or both
Psychosis - hallucinations, delusions
Management
Acute - antipsychotics
Maintenance - mood stabilisers/antidepressants + CBT
Delirium
- core features
- risk factors
- management
Risk factors
- age
- dementia, cognitive impairment, frailty
- visual, hearing impairment
- dehydration, poor sleep
- polypharmacy, comorbidities
- acute infection
- Hx
Core features Acute change that fluctuates Alert - agitation, drowsy Awareness - poor PADY Attention - poor, highly distractable, delusions, hallucinations
Management
-find cause
Dementia with Lewy bodies
- core features
- risk factors
- management
Risk factors
- older male
- FHx
Core features
Cognitive fluctuations
Visual hallucinations - small people, animals
Parkinsonism + RBD
Management
- cholinesterase inh
- antipsychotics with caution
Systems review
-
Psych
- mood
- 1st rank
Systemic
-fever, night sweats, fatigue, weight loss
Neuro
- memory, behaviour, headache, vision, hearing, balance, swallow
- sensation, movement, bowels and bladder
Organic differentials
Drugs - cannabis, CS, opioids, cocaine, amphetamines
Alcohol
Cerebrovascular
- strokes, TIA
- epilepsy
- dementia
- PD
- traumatic brain injury
Infection/inflammation
- HIV, meningitis, enceophalitis, syphylis
- SLE
Past medical history
Drug history
Family history
Past medical history
- physical health conditions and management
- mental health conditions and management
- past surgeries, hospital visits
Drug history
- prescription, OTC, herbal, recreational
- alcohol, smoking (cannabis, cocaine)
Allergies
Family history
-physical/mental health conditions
Social history
Living
- where
- who with? carers? dependents?
- social network
Occupation
- work? finances?
- hobbies
Medication counselling - atypical antipsychotics
ATHLETICS
Brief history of symptoms
Understanding of their condition
Action
- Schizophrenia is a condition where there is an imbalance of a brain chemical called dopamine. This imbalance results in the symptoms that you are experiencing
- antipsychotics work by reducing the action of dopamine in your brain
Timing - tablet OD or depot 2/52 - 4/52
How - slowly build up dose over a week and adjust based on response
Length of treatment - long term to prevent worsening
Effects - days-weeks
Tests - weight, BP, FBCs, BM, PRL, ECG, lipid, liver, renal,
Important SE
- Movement - akithisia, tardive dyskinesia, dystonia, parkinsonism
- Metabolic - weight gain, T2DM, sedation, lactation
Complications -NMS - high fever, rigidity, confusion, autonomic instability => stop antipsychotic, supportive care -agranulocytosis - fever, sore throat => rapid infection -withdrawal Contraindications and cautions -severe kidney, liver impairment -long QT -PD, seizures Supplementary advice - Mind
