Psychosis: Management Flashcards
what kinds of psychiatric patients with a history of what are the most worrying?
severe mental illness
substance abuse
violence
how does aggression differ from violence
doesnt usually involve physical injury
how can you prevent a violent occurrence from happening?
room layout
have someone there
minimise objects
how should you intervene with a violent patient?
restraint
sedation
rapid tranquillisation
immediate management of an aggressive patient?
manage substance withdrawal
manage behaviour eg by inc observations
what is an advance statement?
a document under the MHA that a patient can write when they are well about their own preferences for their health and treatment
what is a mental disorder?
any mental illness, personality disorder or learning disability; can be primary or secondary to something else
substance abuse is a mental disorder T or F
F
what part of the MHA do the police have a role in?
police
what is nurses holding power?
a section of the MHA that allows a mental health nurse 2 hours for a doctor/other colleague to come and assist
you should look for consent from an MHO if you are preparing an emergency detention T or F
T
who is a mental health officer?
a trained social worker
how long do you have to get the patient into the hospital if you have them under emergency detention?
72hrs
what is a named person?
someone who the patient identifies as having a special role in their care
application for a compulsory treatment order is made by….
what do they need?
an MHO
2 medical reports from 2 different medical practitioners eg GP and psychiatrist
what approach should you try first before tranquilising the patient?
distract them
seclusion
try talking to them
what would make a patient a risky candidate for tranquilisation?
unknown history
known cardiac disease
no history of antipsychotic use
current substance abuse
first line Tx for tranquilisation (include dose)?
lorazepam 1-2mg (add haloperidol 5mg if safe/known drug history)
when should you commence then next line in treatment for tranquillisation?
if oral therapy doesnt work within 30 mins
2nd line Tx for tranquillisation?
lorazepam 1-2mg IM
add haloperidol 5mg IM if severe
how long should you wait before a second injection?
30 mins
are benzos or antipsychotics better for sedation?
benzos
atypical/typical antipsychotics are first line
atypical
1st line Tx for a schizophrenic patient with T2D?
risperidone
how long should paranoid delusions be to be diagnosed as schizphrenia
6 months
why do patients on anti-psychotics get extrapyramidal side effects?
by blocking dopamine the anti-psychotics cause ACh to increases which is responsible for these side effects
if a patient on an antipsychotic gets strong extrapyramidal symptoms what can you give to prevent this?
give an anticholinergic along with their antipsychotic to calm down the ACh overreaction
what system in the brain are you trying to act on with antipsychotics?
mesocortical system
side effects of atypical antipsychotics?
Weight gain, insulin resistance, metabolic syndrome, agranulocytosis (clozapine), prolonged QT syndrome, sedation, galactorrhoea, osteopenia/osteoporosis, sexual dysfunctions, hyperprolactinaemia (gynaecomastia etc)
side effects of typical antipsychotics?
– extrapyramidal side effects: bradykinesia, restless legs, shuffling gait, masked face, akathisia
atypical antipsychotics act on what receptors?
dopamine
histamine
serotonin
typical antipsychotics act on what receptors?
dopamine
give an example of atypical antipsychotics
olanzapine risperidone quetiapine aripiprazole clozapine
best tolerated atypical antipsychotics?
olanzapine
aripiprazole
quetiapine
risperidon
what are the problems with risperidone?
akathisia
prolactinaemia
what comorbidities can quetiapine help with?
anxiety
depression
atypical antipsychotics do not cause extrapyramidal side effects T or F
F, they can but it’s rare
why do you get hyperprolactinaemia as a side effect of atypical antipsychotics?
they are blocking dopamine which is a prolactin antagonist so by doing that you will increase prolactin
