Week 2 - psychosis/schizophrenia Flashcards
What are some physical health conditions that should be considered in a new presentation of psychosis with paranoia and auditory hallucinations?
- 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
List some mental health conditions that can cause psychotic symptoms such as hallucinations and delusions?
- schizophrenia
- manic phase of bipolar
- severe depression
- dementia
- drug induced psychosis
What are the treatment options for patients presenting with their first episode of psychosis ?
- CBT and family intervention
- antipsychotics
What are some common side effects of antipsychotics?
- sedation
- movement disorders
- raised prolactin
- hypotension
- diabetes
- weight gain
- prolonged QT interval
What observations/investigations must you do before commencing a patient on antipsychotics ?
- 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)
What is ‘family intervention’ ?
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
Summarise the key points of a Section 135 under the MHA …
- 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)
Summarise the key points of a Section 136 under the MHA …
- 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
Summarise the key points of a Section 2 under the MHA …
- 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)
Summarise the key points of a Section 3 under the MHA …
- 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)
Summarise the key points of a Section 5(2) under the MHA …
- 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)
What % of patients will relapse within a year of their first psychotic episode ?
30%
What % of patients will relapse within 5 years of their first psychotic episode ?
80%
What are the positive symptoms of schizophrenia ?
- hallucinations (auditory or visual)
- delusions
- thought control (withdrawal, insertion, broadcasting)
Give an example of third person auditory hallucinations…
(referring to/talking about the patient)
“he’s a bad person”
What are the main types of auditory hallucinations in schizophrenia ?
- third person (talking about patient)
- running commentary (commenting on what the patient is doing)
- command (telling patient what to do)
Give an example of running commentary auditory hallucinations…
(talking about what the patient is doing)
“now he is going up stairs…”
Give an example of command auditory hallucinations…
(telling patient what to do)
“you should hit him now…”
What types of delusions do people with schizophrenia experience ?
- 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)
What does ‘delusions of grandeur’ mean ?
patient believes they are particularly important/have done amazing things
e.g part of royal family, won all gold at olympics etc
What does ‘delusions of paranoia’ mean ?
patient believes someone is trying to harm them
What does ‘delusions of reference’ mean ?
patient belief they are being targeted/contacted/referred to on/by the TV or radio or adverts on buses etc
What does ‘delusions of passivity’ mean ?
patient believes they’re being controlled by external forces
What are the 3 main types of thought control that people with schizophrenia can experience ?
- 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)
