Psychosis: Management

Question 1

what kinds of psychiatric patients with a history of what are the most worrying?

Answer 1

severe mental illness
substance abuse
violence

Question 2

how does aggression differ from violence

Answer 2

doesnt usually involve physical injury

Question 3

how can you prevent a violent occurrence from happening?

Answer 3

room layout
have someone there
minimise objects

Question 4

how should you intervene with a violent patient?

Answer 4

restraint
sedation
rapid tranquillisation

Question 5

immediate management of an aggressive patient?

Answer 5

manage substance withdrawal

manage behaviour eg by inc observations

Question 6

what is an advance statement?

Answer 6

a document under the MHA that a patient can write when they are well about their own preferences for their health and treatment

Question 7

what is a mental disorder?

Answer 7

any mental illness, personality disorder or learning disability; can be primary or secondary to something else

Question 8

substance abuse is a mental disorder T or F

Answer 8

F

Question 9

what part of the MHA do the police have a role in?

Answer 9

police

Question 10

what is nurses holding power?

Answer 10

a section of the MHA that allows a mental health nurse 2 hours for a doctor/other colleague to come and assist

Question 11

you should look for consent from an MHO if you are preparing an emergency detention T or F

Answer 11

T

Question 12

who is a mental health officer?

Answer 12

a trained social worker

Question 13

how long do you have to get the patient into the hospital if you have them under emergency detention?

Answer 13

72hrs

Question 14

what is a named person?

Answer 14

someone who the patient identifies as having a special role in their care

Question 15

application for a compulsory treatment order is made by….

what do they need?

Answer 15

an MHO

2 medical reports from 2 different medical practitioners eg GP and psychiatrist

Question 16

what approach should you try first before tranquilising the patient?

Answer 16

distract them
seclusion
try talking to them

Question 17

what would make a patient a risky candidate for tranquilisation?

Answer 17

unknown history
known cardiac disease
no history of antipsychotic use
current substance abuse

Question 18

first line Tx for tranquilisation (include dose)?

Answer 18

lorazepam 1-2mg (add haloperidol 5mg if safe/known drug history)

Question 19

when should you commence then next line in treatment for tranquillisation?

Answer 19

if oral therapy doesnt work within 30 mins

Question 20

2nd line Tx for tranquillisation?

Answer 20

lorazepam 1-2mg IM

add haloperidol 5mg IM if severe

Question 21

how long should you wait before a second injection?

Answer 21

30 mins

Question 22

are benzos or antipsychotics better for sedation?

Answer 22

benzos

Question 23

atypical/typical antipsychotics are first line

Answer 23

atypical

Question 24

1st line Tx for a schizophrenic patient with T2D?

Answer 24

risperidone

Question 25

how long should paranoid delusions be to be diagnosed as schizphrenia

Answer 25

6 months

Question 26

why do patients on anti-psychotics get extrapyramidal side effects?

Answer 26

by blocking dopamine the anti-psychotics cause ACh to increases which is responsible for these side effects

Question 27

if a patient on an antipsychotic gets strong extrapyramidal symptoms what can you give to prevent this?

Answer 27

give an anticholinergic along with their antipsychotic to calm down the ACh overreaction

Question 28

what system in the brain are you trying to act on with antipsychotics?

Answer 28

mesocortical system

Question 29

side effects of atypical antipsychotics?

Answer 29

Weight gain, insulin resistance, metabolic syndrome, agranulocytosis (clozapine), prolonged QT syndrome, sedation, galactorrhoea, osteopenia/osteoporosis, sexual dysfunctions, hyperprolactinaemia (gynaecomastia etc)

Question 30

side effects of typical antipsychotics?

Answer 30

– extrapyramidal side effects: bradykinesia, restless legs, shuffling gait, masked face, akathisia

Question 31

atypical antipsychotics act on what receptors?

Answer 31

dopamine histamine serotonin

Question 32

typical antipsychotics act on what receptors?

Answer 32

dopamine

Question 33

give an example of atypical antipsychotics

Answer 33

``` olanzapine risperidone quetiapine aripiprazole clozapine ```

Question 34

best tolerated atypical antipsychotics?

Answer 34

olanzapine aripiprazole quetiapine risperidon

Question 35

what are the problems with risperidone?

Answer 35

akathisia | prolactinaemia

Question 36

what comorbidities can quetiapine help with?

Answer 36

anxiety | depression

Question 37

atypical antipsychotics do not cause extrapyramidal side effects T or F

Answer 37

F, they can but it's rare

Question 38

why do you get hyperprolactinaemia as a side effect of atypical antipsychotics?

Answer 38

they are blocking dopamine which is a prolactin antagonist so by doing that you will increase prolactin