Jason Gregory Flashcards
Definition of schizophrenia
mental health condition in which a person’s perception, thoughts, mood, and behaviour are significantly altered. It is characterised by positive and negative symptoms.
RFs for schizophrenia
FHx, increasing paternal age, obstetric complications, cannabis use, low IQ, motor dysfunction, psychological stress, childhood abuse, migration, urban environment, Afro-Caribbean ethnicity.
Ddx for schizophrenia
schizoaffective disorder, substance-induced psychotic disorder, dementia with psychosis, bipolar disorder, sepsis induced psychotic disorder, heavy metal poisoning, hyperthyroidism, hyperparathyroidism, liver disease, ASD
Epidemiology of schizophrenia
median lifetime morbid risk is 7.2 per 1000 people. Male:female 1.4:1. Age of onset is usually <25 for males and <35 for females.
aetiology of schizophrenia
multifactorial illness. Most commonly used model is stress diathesis- a person with a specific vulnerability encounters a series of stressful influences over time which lead to symptoms.
clinical features of schizophrenia
: Positive symptoms: hallucinations, delusions, disrupted speech. Passivity phenomena- controlled by an outside force, negative symptoms e.g. flattened affect, apathy, anergia, social withdrawal, and anhedonia. Agitation or distress, suicidal ideation, altered cognition
pathophysiology of schizophrenia
not completely understood, range of structural and functional brain abnormalities have been found- global reduction in brain volume by 5%-10%, enlarged lateral and third ventricular volume, decreased amygdala and hippocampal volume, slight decrease in volume of prefrontal cortex, reduced subcortical structures e.g. cerebellum, caudate and thalamic structures and reversal or loss of asymmetry between cerebral hemispheres. Functionally people with schizophrenia have reduced activation in prefrontal cortex when performing executive cognitive functioning and decreased delta sleep. It is believed that the abnormalities are caused by an imbalance between neurotransmitters such as dopamine, serotonin and glutamate. Modest evidence for hyperdopaminergic theory- hyperactivity of dopaminergic neurons in mesolimbic tract.
management of schizophrenia
Acute: 1st episode- ensure safety of patient and yourself, consider oral benzos and rapid tranquillisation, refer to specialist to start antipsychotics. Relapse of known: ensure safety, oral benzodiazepine, rapid tranquillisation and refer to specialist for antipsychotic treatment review.
Long term management: 1st line is oral non-clozapine antipsychotic e.g. aripiprazole or haloperidol plus psychological interventions and monitor physical health. 2nd line: switch to alternative non-clozapine antipsychotic plus psychological interventions plus physical health monitoring. 3rd line: clozapine plus psychosocial interventions and monitor physical health.
define psychosis
when people lose contact with reality. May include hallucinations and delusions (believing things that are not actually true). Distortion of perception. Though disorder +/- delusions or abnormal perceptions.
describe the classification of mental illness
- Organic: A term used to refer to any conditions caused due to the gradual decrease in the functioning of the brain- due to illnesses not psychiatric in nature. Causes include: intracerebral haemorrhage, subarachnoid haemorrhage, subdural haematoma, concussion, hypoxia, hypercapnia, stroke, dementia. Not psychiatric in nature.
- Functional: applies to mental disorders other than dementia, and includes severe mental illnesses such as schizophrenia and bipolar mood disorder. No underlying objective pathology, but impairment in function is still apparent.
- Psychotic: e.g. schizophrenia, mental illness with psychosis as a symptom
- Neurosis- have contact with reality but have symptoms such as anxiety, depression.
describe the MSE components
- Appearance: distinguishing features, weight, stigmata of disease e.g. jaundice, personal hygiene, clothing, objects
- Behaviour: engagement and rapport, eye contact, facial expression, body language, psychomotor activity, abnormal movements or postures
- Speech: rate, quantity, tone, volume, fluency and rhythm
- Mood and affect: ask questions such as “how are you feeling?”, “have you been feeling … recently?”, subjective, apparent emotion, range and mobility of affect- fixed, restricted or labile. Intensity of affect, congruency of affect- matches what they are saying.
- Thought: speed of thoughts, flow and coherence, loose associations- moving from topic to topic with no clear link. Circumstantial thoughts- include lots of irrelevant and unnecessary details. Tangential thoughts, flight of ideas- often increase in tempo of speech. Thought blocking- sudden cessation of thought. Perseveration- repetition of particular response. Neologisms- patient has made up words,
- Thought content: delusions, obsessions, compulsions, overvalued ideas, suicidal thoughts, violent thoughts- delusion and hallucinations have to be incompatible with cultural background.
- Thought possession: thought insertion, thought withdrawal, thought broadcasting.
- Perception: hallucinations, pseudo-hallucinations (patient is aware its not real), illusions, depersonalisation (patient feels they are no longer their true self and are someone different or strange), derealisation (world around them is not reality)
- Cognition: orientated in time, place and person, attention span, concentration, short-term memory
- Insight and judgment: “what do you think the cause of the problem is?”, “do you think you have a problem at the minute?”, “do you feel you need help with your problem?”. Judgement- “what would you do if you smelled smoke in your house?”
describe section 2 of the MHA 2007
admission for assessment, lasts for up to 28days, not renewable, appeals must be sent within 14days to the mental health tribunal, application is made based on the recommendation of 2 doctors one of whom is approved under section 12(2), one of whom is a doctor who knows the patient.
describe section 3 of the MHA 2007
admission for treatment, up to 6 months, exact mental disorder must be stated, renewal after 6 months, then annually, 2 doctors must sign the forms and know why they cannot be treated in the community, must have seen the patient within 24h and there may not be more than 5 days clear between when each doctor saw the patient. They must state that treatment is likely to be for the benefit of the patient, or to prevent deterioration, or that it is necessary for the protection of others. The AMHP has 14d after the second doctor has signed the recommendation to make an application to hospital
describe section 4 of the MHA 2007
emergency treatment for up to 72h, can be used if section 2 would cause undesirable delay, usually converted to a section 2 on arrival to hospital.
describe section 5 of the MHA 2007
detention of a patient already in hospital for up to 72hours, cannot be used for patients in A&E as they are not an inpatient, make a plan for where the patient should go after this 72hours is up. Nurse can section under 5.4 while waiting for a doctor.
