Week 2 - Psychosis Flashcards
What is the treatment of first time psychosis?
Oral antipsychotic medication
+
Psychological interventions
(eg. family interventions / individual CBT)
- 1 / 2 sessions to help them understand the illness and coping mechanisms
What are common side effects of antipsychotic medications?
- Raised prolactin
- Diabetes
- Sedation
What investigations should be done before initiating antipsychotics?
Weight Waist circumference Pulse BP Fasting BM HbA1c Blood lipid profile Prolactin leves Assessment of any movement disorders Assessment of nutritional status, diet and level of physical activity ECG (under specific circumstances - eg. when starting quetiapine)
What is involved in a section 2?
Detainment for assessment of a mental health disorder
What is involved in a section 3?
Detainment for treatment of a mental health disorder
How long can you be held under a section 2?
Up to 28 days
What conditions are antipsychotics used in?
- Schizophrenia
- Schizoaffective disorder
- Bipolar disorder
- Severe depression with psychosis
- Augmenting agent in treatment resistant depression and anxiety disorders
- Behavioural and psychological symptoms of dementia (BPSD)
What are the two groups of antipsychotics?
- Typicals
- Atypicals
How do antipsychotics work?
The target the dopamine pathways in the brain
What are the two types of typical antipsychotics?
High potency (eg. haloperidol)
Low potency (eg. chlorpromazine)
When are typical antipsychotics used?
In long and short acting depots
When patients are unable to tolerate atypical antipsychotics
What are common side effects of typical antipsychotics?
Sedation
Hypotension
What is a side effect of amisulpiride?
Hyperprolactinaemia
How do atypical antipsychotics work?
Serotonin-dopamine 2 antagonists (SDAs)
What type of medication is risperidone?
Atypical antipsychotic
What are the side effects of risperidone?
Extrapyramidal side effects at high doses
Hyperprolactinaemia
Weight gain and sedation at high doses
What type of medication is olanzapine?
An atypical antipsychotic
How is olanzapine given?
Short acting IM injection
/
Regular / immediate release tablets
What are the side effect of olanzapine?
Marked weight gain
Sedation
Hyper
What investigations should you do before starting olanzapine?
Fasting glucose
Fasting lipids
(these should be monitored during use)
What type of medication is quetiapine?
Atypical antipsychotic
What is low-dose quetiapine used for?
Augment antidepressants in unipolar depression
What is mid-dose quetiapine used for (eg. 100-300mg)?
Mood stabilising
What is high dose quetiapine used for?
As an antipsychotic
What is a common side effect quetiapine?
Orthostatic hypotension
Prolonged QTC interval
Some weight gain
Som hypertriglyceridemia, hypercholesterolemia and hyperglycaemia
What investigations should you do before starting quetiapine?
Baseline ECG
What type of medication is aripiprazole?
Atypical antipsychotic
What forms is aripirazole available in?
long-acting IM depot
Tablets
What side effects can aripiprazole cause?
Agitation
What type of medication is clozapine?
Atypical antipsychotic
What forms is clozapine available in?
Tablet form
When is clozapine used?
Treatment resistant psychosis
What are the side effects of clozapine?
Agranulocytosis and neutropenia
(FBC must be monitored regularly when taking)
Increased risk of seizures (may require a co-prescribed anticonvulsant)
Sedation
Weight gain
Deranged LFTs
Increased risk of hypertriglyceridaemia, hypercholesterolaemia and hyperglycaemia
What are the symptoms of neuroleptic malignant syndrome?
- Autonomic dysfunction
- Severe muscle rigidity - High fever
- Confusion
- Raised WBCs and LFTs
What symptoms of autonomic dysfunction do you get in neuroleptic malignant syndrome?
- Hyperthermia
- Hypertension
- Hyperreflexia
- Tachycardia
- Tremor
- Agitation
- Irritability
- Sweating
What are the severe complications of neuroleptic malignant syndrome?
- Rhabdomylosis (from muscle breakdown)
- Hyperkalaemia
- Kidney failure
- Seizures
Is neuroleptic malignant syndrome fatal?
Yes
Mortality rate around 10%
What is the treatment of neuroleptic malignant syndrome?
- Discontinue medication
- ICU (circulatory / ventilator support)
- Active cooling (hyperthermia)
- Dantrolene / Bromocriptine / Amantadine (Ridgidity)
- Benzodiazepines (agitation)
- Aggressive IV hydration with diuresis
What is a section 135?
A warrant to gain access to premises to remove patient to a place of safety
Who can section under 135?
One doctor, AMHP and police
What is a section 136?
Allows police to remove person from public place to place of safety
Who can section under 136?
Police
How long does a section 3 last?
6 months
treatment can be given for the first 3 months, then consent is required or a second opinion
What is a section 4?
Emergency admission for assessment
How long does a section 4 last?
72 hours
What is a section 5(2&4)?
Emergency holding order (patient already admitted to hospital on an informal basis)
What is the difference between a section 5(2) and 5(4)
5(2): lasts 72 hours, applied for by a doctor
5(3): 6 hours, applied for by a nurse
What causes positive symptoms of psychosis?
Overactivity of dopamine in the mesolimbic pathway of the brain
