General Adult Flashcards
Schizophrenia Management
Explanation
- Schizophrenia is a mental health condition that affects how you think, feel and behave.
- Symptoms are described as ‘positive’ or ‘negative’.
Epidemiology
- 1 in every 100 people
- M=F
- Usually between 15-35 yrs
Diagnostic Criteria
- One month
- 2 of the following (1 has to be 1-4)
(1) Delusions
(2) Hallucinations
(3) Disorganised thinking
(4) Experience of influence, passivity or control
(5) Negative Symptoms: affective flattening, alogia or paucity of speech, avolition, asociality and anhedonia
(6) Grossly disorganized behaviour that impedes goal-directed activity
(7) Psychomotor disturbances: catatonic restlessness or agitation, posturing, waxy flexibility, negativism, mutism, or stupor
Causes
- Genes, FHx, brain damage, drugs, ETOH, cannabis, stress, family problems, difficult childhood
Management
- Biological: Baseline bloods, ECG, Antipsychotic medication, Co-morbid MH Rx. Drug use. Meds monitoring
- Psychological: Individual CBT, Family intervention for household (10 planned sessions over 3 months to 1 year). Art therapy (-ve Sx)
- Social: Finance, occupation, housing, local support groups, carer groups
- CMHT: CPA, care co-ordinator, crisis plan, hospital if severe relapse
Prognosis
- 5 people with SZ
– 1 full recovery 5yrs post 1st Sx
– 3 have repeated episodes
– 1 long term symptoms
Schizoaffective Disorder Management
Description
- Mental health condition that affects your thoughts and emotions, and may affect your actions
- Combinations of both ‘psychotic’ symptoms and ‘bipolar disorder’ symptoms
- Three types: manic, depressive, mixed
Epidemiology
- W>M
- Older people = depressive
- Younger = Bipolar
Diagnostic Criteria
- At least a month
- Schizophrenia + a Moderate or Severe Depressive / Manic / Mixed Episode
- Onset of psychotic and mood symptoms is simultaneous / within a few days
Causes
- Genes, stress
Best Practice Management Plan
- Biological: R/o organic causes, bloods, ECG
– Manic = mood stabiliser + antipsychotic
– Depressive = Mood stabiliser + antidepressant
- Psychological: CBT, counselling, CMHT
- Social: Finance, occupation, housing, local support groups, carer group, crisis plan, family meetings, art therapy, self-help group
Prognosis
- 5 people with SZ
– 1 full recovery 5yrs post 1st Sx
– 3 have repeated episodes
– 1 long term symptoms
Acute & transient psychotic disorder Management
Description
- Psychosis is an umbrella term for and experience that affects how someone thinks, feels and behaves.
- In psychosis people often struggle to figure out what’s real and what isn’t
Epidemiology
- Rare - 1 in 2000
Diagnostic Criteria
- Maximum 3 months
- Acute onset of psychotic symptoms: delusions, hallucinations, disorganized thinking, or experiences of influence, passivity or control
- No prodrome, maximum severity in two weeks
- Catatonia may be present
- Rapid change in symptoms
- No negative symptoms
Causes
- Traumatic event, post-partum
Best Practice Management Plan
- Biological: Physical health, r/o organic causes, bloods, ECG, medication, monitoring
- Psychological: Education, therapy, CMHT
- Social: Finance, occupation, housing, local support groups, carer group, crisis plan
Prognosis
Extra Info
Delusional Disorder Management
Catatonia Management
Bipolar Affective Disorder Management
Depression Management
Generalised Anxiety Disorder Management
Panic Disorder Management
Agoraphobia Management
Specific Phobia Management
Social Anxiety Management
Hypochondriasis Management
Obsessive Compulsive Disorder Management
Body Dysmorphic Disorder History
Presenting Complaint (ODPI)
- Onset, Duration, Progression, Impact
- Core Features: intrusive thoughts of perceived physical defects, which cause a degree of distress and psychosocial impairment (evidenced by lack of employment and relationships). Responded to by repetitive behaviours, such as checking, concealing, and repetitive use of make-up/camouflage.
- Parts
Past Psychiatric History
Past Medical History
Drug History
- Allergies, Regular medication
Family History
Biological:
- Appetite, sleep, energy
Psychological / MSE / Differentials
- Mood, Psychosis
- Check delusional intensity
- Anxiety / OCD (checking behaviours)
- Anorexia - restricted eating, low body image, fear of fatness
Social History
- Living situation, Occupation, Relationships, Alcohol & substance use
Risk Assessment
- Self: SH, suicide, self- neglect, risky surgery
- Others: Violence, neglect, safeguarding, children
https://www.rcpsych.ac.uk/docs/default-source/training/examinations/exams-casc-history-marksheet.pdf?sfvrsn=799913fa_2
