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Y4 Psych > Week 2 - psychosis/schizophrenia > Flashcards

Week 2 - psychosis/schizophrenia Flashcards

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1
Q

What are some physical health conditions that should be considered in a new presentation of psychosis with paranoia and auditory hallucinations?

A
  • high dose steroids (cushings)
  • thyroid disease
  • encephalitis
  • brain tumour/injury
  • temporal lobe epilepsy
  • huntingtons
  • dementia
  • acute confusion
  • lupus
  • vit B12 deficiency

although these would usually be accompanied by disorientation, memory problems and other neuro features

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2
Q

List some mental health conditions that can cause psychotic symptoms such as hallucinations and delusions?

A
  • schizophrenia
  • manic phase of bipolar
  • severe depression
  • dementia
  • drug induced psychosis
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3
Q

What are the treatment options for patients presenting with their first episode of psychosis ?

A
  • CBT and family intervention
  • antipsychotics
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4
Q

What are some common side effects of antipsychotics?

A
  • sedation
  • movement disorders
  • raised prolactin
  • hypotension
  • diabetes
  • weight gain
  • prolonged QT interval
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5
Q

What observations/investigations must you do before commencing a patient on antipsychotics ?

A
  • weight
  • waist circumference
  • pulse and BP
  • full set of bloods
  • fasting glucose, HbA1c
  • blood lipid profile
  • serum prolactin
  • assessment for movement disorders
  • nutritional status, exercise and diet
  • ECG (if have cardio risk)
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6
Q

What is ‘family intervention’ ?

A

a meeting with the family of a person with schizophrenia to help them understand the condition and respond to symptoms in the most supportive way

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7
Q

Summarise the key points of a Section 135 under the MHA …

A
  • made by police
  • patient taken from home setting
  • does not allow for treatment
  • can be used once

requires:
- police
- 1 doctor
- 1 AMHP (approved mental health professional)

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8
Q

Summarise the key points of a Section 136 under the MHA …

A
  • made by police
  • patient taken from public place
  • does not allow for treatment
  • can be used once

requires:
- police stay in attendance until further assessment is arranged

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9
Q

Summarise the key points of a Section 2 under the MHA …

A
  • lasts up to 28days
  • made by AMHP or nearest relative
  • admission for mental status assessment
  • treatment can be given for mental disorder or direct results of disorder
  • application usually made for a section 3 as well if detained treatment extends beyond 28days
  • patient can appeal to a tribunal

requires
- 2 doctor
- at least one is an AMHP (approved mental health professional)

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10
Q

Summarise the key points of a Section 3 under the MHA …

A
  • lasts up to 6months
  • made by AMHP or nearest relative
  • admission for treatment (“treatment order”)
  • treatment can be given for first 3 months, then consent or second opinion is required
  • patient can appeal to a tribunal

requires
- 2 doctor
- at least one is an AMHP (approved mental health professional)

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11
Q

Summarise the key points of a Section 5(2) under the MHA …

A
  • already an inpatient ”emergency holding order”
  • lasts up to 72hrs
  • made by doctor or AMHP caring for patient
  • treatment can be given only under common law
  • patient cannot appeal

requires
- 2 doctor
- at least one is an AMHP (approved mental health professional)

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12
Q

What % of patients will relapse within a year of their first psychotic episode ?

A

30%

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13
Q

What % of patients will relapse within 5 years of their first psychotic episode ?

A

80%

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14
Q

What are the positive symptoms of schizophrenia ?

A
  • hallucinations (auditory or visual)
  • delusions
  • thought control (withdrawal, insertion, broadcasting)
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15
Q

Give an example of third person auditory hallucinations…

A

(referring to/talking about the patient)

“he’s a bad person”

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16
Q

What are the main types of auditory hallucinations in schizophrenia ?

A
  • third person (talking about patient)
  • running commentary (commenting on what the patient is doing)
  • command (telling patient what to do)
17
Q

Give an example of running commentary auditory hallucinations…

A

(talking about what the patient is doing)

“now he is going up stairs…”

18
Q

Give an example of command auditory hallucinations…

A

(telling patient what to do)

“you should hit him now…”

19
Q

What types of delusions do people with schizophrenia experience ?

A
  • delusions of grandeur (belief they are particularly important)
  • delusions of paranoia (belief someone is trying to harm them)
  • delusions of reference (belief they are being targeted/referred to on TV or radio)
  • delusions of passivity (belief they’re being controlled by external forces)
  • bizarre delusions (beliefs that make no sense/are very strange)
20
Q

What does ‘delusions of grandeur’ mean ?

A

patient believes they are particularly important/have done amazing things

e.g part of royal family, won all gold at olympics etc

21
Q

What does ‘delusions of paranoia’ mean ?

A

patient believes someone is trying to harm them

22
Q

What does ‘delusions of reference’ mean ?

A

patient belief they are being targeted/contacted/referred to on/by the TV or radio or adverts on buses etc

23
Q

What does ‘delusions of passivity’ mean ?

A

patient believes they’re being controlled by external forces

24
Q

What are the 3 main types of thought control that people with schizophrenia can experience ?

A
  • thought withdrawal (external force removing thoughts from their head)
  • thought insertion (external force putting thoughts into their head)
  • thought broadcasting (others can see or hear their thoughts out loud)
25
Q

What is the most common type of hallucinations in schizophrenia ?

A

auditory hallucinations

(third person, running commentary, command hallucinations)

26
Q

What are the negative symptoms of schizophrenia ?

A

effectively the ICD-10 criteria for depression

  • anhedonia
  • lack of motivation
  • poor self care/neglect
  • reduced energy
27
Q

Which are usually more prominent in the early phase of schizophrenia…
a) negative symptoms ?
b) positive symptoms ?

A

positive symptoms

28
Q

Which are usually more responsive to treatment for schizophrenia…
a) negative symptoms ?
b) positive symptoms ?

A

positive symptoms

29
Q

Who is most likely to get schizophrenia ?

A
  • more common in men
  • users of cannabis in teen years
  • associated with deprivation and urban environments
  • more common in populations migrating to a new country

mean age of onset:
- 22yrs for men
- 26yrs for women

30
Q

Roughly, what % of people will completely recover after their first episode of psychosis and never relapse ?

A

~ 20%

31
Q

When is a diagnosis of schizophrenia considered ?

A
  • after repeated episodes of psychosis
  • patient symptoms don’t respond well to treatment for initial psychotic episode
  • persistent negative symptoms
32
Q

What % of people with schizophrenia die by suicide ?

A

5% of patients with schizophrenia (especially young men)

33
Q

What are the risk factors for schizophrenia ?

A
  • family Hx of schizophrenia
  • cannabis use in teenage years
  • African-Caribbean and south asian heritage
  • complications during patients gestation/birth
  • head/brain injury
  • encephalitis
  • developmental delays
34
Q

What is the % risk of developing schizophrenia for
a) general population ?
b) someone with a first degree relative effected by schizophrenia ?

A

general population: 1% risk
first degree relative: 15% risk

35
Q

What are some causes of an episode of psychosis ?

A
  • major life changes
  • separation and/or new independence
  • relationship issues
  • drug use around time of onset (amphetamines and cannabis)
  • social instability
  • poor compliance with treatment
36
Q

What happens when a patient is discharged after treatment for psychosis ?

A

patient is assigned a care coordinator (social worker or community nurse) who organises follow up care including family support and how to get help in a crisis

Y4 Psych (9 decks)

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