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
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
- domains of: property, welfare, financial
guardianship order covers financial/welfare)
! authority does not authorise placing adult in hospital for tx against their will
Mentally Disordered Offenders. Provisions
- police powers may detain up to 24 hours. in order to assess and arrange for care and tx.
- criminal not responsible if. mental disorder prevents appreciation of nature of wrongfulness of conduct
Vs solely personality disorder of aggression or irresponsibility = will be responsible
Unfitness for trial
- person incapable to participate effectively in trial, must be able to
- understand the nature of charge
- understand require to tender a plea to the charge
- purpose and follow course of trial
- understand evidence that may be given against the person
- instruct and communicate with the person’s legal and representative
Diminished Responsibility
Instead of convicted of murder, instead for culpable homicide on grounds of diminished responsibility
Restricted Patients
satisfy numerous risk criteria
= treatment order
= compulsion order
= restriction order
To discuss the neuropsychiatric possibilities of COVID infection.
- delirium, poor prognosis ITU - common neurpsych. presenting
*impaired memory
* fatigue
* impaired concentration
= highly prevalent post-infection symptoms
+insomnia, anxiety, depressed mood
High rates of anxiety, depression and PTSD in those discharged from hospital
*healthcare workers scored significantly on BDI (Beck’s Depressive Inventory), alongside PTSD
To describe the range of effects of the pandemic on mental health.
- people with LD reported higher mortality and higher under-reporting relative to general population
- greater prescription of medicines for depression
- increased suicide
To discuss describe the effects of the COVID-19 pandemic on mental health services.
MH attendance to ED not significantly higher
potential increase in suicide ideation
nil significant increase in recorded self-harm
