W02 - PSYCH: Schizo & Psychotic Disorders; Legal Aspects; COVID Psych. Flashcards
Describe the symptoms and defiinition of schizophrenia
positive and negative symptoms affecting:
*thinking = delusions disordered lack
* emotion = apathy
* behaviour = lack of interest
- negative symptoms = poorer prognosis
- more than aa month in the absence of organic or affective disorder: (one of)
- alienation of thought
- delusional perception
- hallucinatory
- persistently impossible delusions
AND/OR
- persistent hallucination for at least a month
- neologisms, breaks, or interpolations in the train of thought
- catatonic behaviour
- negative symptoms: apathy, pausity of speech, blunting/incongruity
To have a knowledge of the phenomenology associated with symptoms of schizophrenia
most common cause of psychosis
M=F
*15-35 years earlier in men than women; mean of 28yrs
*different subtypes of schizophrenia and temporal classification
- excess in migraant populations: alteration in framework of self in time, morality, and cultural symbols
=> migration induces changes at all these levels
=> significant alterations correlates with vulnerability to severe mental illness - social isolation
- precipitating life events
-highly expressed emotions in family environment. = relapse in schiz.
Identify the relevant factors in the history of someone presenting with schizophrenia
biopsychosocial &
predisposing factors
precipitating factors
perpetuating factors
- genetic concordance
- neuregulin
- dysbindin
- di george syndrome
- dopamine hypothesis
- and other neurochemistry and NT
- neurological physical abn.
other RF:
+ obstetric complications @ birth
+ maternal influenza
+ manutrtion and famine
+ winter birth
+substance misuse
To list the differential diagnosis for schizophrenia and describe appropriate investigations to confirm the diagnosis
- delirium/ organic brain syndrome comprising of:
- prominent visual disturbance
- affect or terror
- fluctuation
nb: if more than 4w
- affective disorder
Have a basic knowledge of the different types of schizophrenia
- schizoaffective disorder
Be aware of the natural history of schizophrenia
symptoms may still persist but can still “recover” from initial dysfunctional state
-small group with chronic symptoms and little. recovery
good prognostic and poor prognostic factors
To describe the pharmacological treatment of schizophrenia
> antipsychotics for 2w
* nil response 4w = change
> antipsychotics for acute or recurrence
* review aat 4w
maintenance tx for prophylaxis
>
*
cognitive dysfunction
> Acetyl cholinesteraase inhibitors
tx-resistaance
> clozapine
+ lamotragine
+
To have an awareness of the role of other treatment modalities in schizophrenia
> CBT for psychosis
cognitive remediation: persisting cognitive difficulties in schizophrenia
family intervention
social skills training
To describe treatment methods for patients with treatment resistant illness
> clozipine
augmented with lamotrigine or
Clinical presentation of psychosis
-Hallucinations
* full force and clarity of true perceptions
* not willed or controlled
- 5 special senses
Types of delusion
grandiose
paranoid (correctly persecutory)
hypochondriacal
self referential
What is catatonic state
excitement
posturing or waxy flexibility
negativism
mutism
stupor
Describe protocols of detainment?
18+ can be detained
<18yo:
- require child/adol. specialist
- specialist resorces used
emergency detention = up to 72hrs
short term = 28d
compulsory treatment order (CTO) = up to six mos (2 practiioners required)
nurses holding power = up to three hours
- considers safety of patient and others
- impaired decision making ability
+ named person for witness
+ access to advocacy for every person w/ mental disorder
Be familiar with the main provisions of the Mental Health (Care and Treatment) (Scotland) Act 2003 and the Criminal Procedure (Scotland) Act
Criminal Procedure Act
* Part VI of the Criminal Procedure (Scotland) Act 1995 (CPSA) includes a complex series of options for courts who are dealing with accused or convicted persons who have a significant mental illness or learning disability.
Adults with Incapacity Act (2000)
- intervention beneficial and least restricitive to the freedom of the adult
- account of past and present wishes taken
- accounts of views of relatives and carers taken and relevant others
- capacity is decision specific
