Psychosis

Question 1

What are the organic differentials for psychosis?

Answer 1

Neurological
o	Encephalitis
o	Temporal lobe epilepsy
o	Brain tumour
o	Dementia
o	Brain injury
o	Huntington’s disease

Endocrine
o Thyroid disease
o Cushing’s disease

Metabolic
o B12 deficiency
o Porphyria

Autoimmune
o SLE

High-dose steroids

Question 2

What are the 2 features of psychosis?

Answer 2

Hallucinations = Seeing/hearing/feeling things that other people cannot

Delusions = false beliefs that are held true despite very strong evidence to suggest that there are incorrect

Question 3

What medications can cause psychosis?

Answer 3

• Anticonvulsants
• High-dose corticosteroids
• Levodopa
• Dopamine agonists

Question 4

What bloods would you do for psychosis?

Answer 4

• FBC
• LFTs
• TFTs
• PTH
• Ca
• U+Es
• eGFR

Question 5

How do you manage psychosis?

Answer 5

• CBT

- Antipsychotics

Question 6

What are the general side effects of antipsychotics?

Answer 6

• Metabolic - DM, metabolic syndrome, weight gain
• Hormonal - raised prolactin
  • Low libido, sexual dysfunction, menstrual abnormalities, gynaecomastia and galactorrhoea
• Sedation
• Extrapyramidal – movement disorders such as akathisia (restlessness), dyskinesia (abnormal involuntary movements) and dystonia (uncontrolled muscle spasms)
  • Parkinsonian symptoms
• CV – prolonged QT interval, increase rx of stroke and VTE

Question 7

What are 1st generation/typical antipsychotics?

Answer 7

• Levomepromazine
• Periciazine, - - Prochlorperazine
• Haloperidol

Question 8

What are 2nd generation/atypical antipsychotics?

Answer 8

• Clozapine
• olanzapine
• quetiapine
• risperidone
• amisulpride
• aripiprazole

Question 9

When is clozapine used and what are the side effects?

Answer 9

Treatment resistance

- neutropaenia/agranulocytosis

Question 10

What is involved in the follow-up of psychosis?

Answer 10

• Early Intervention in Psychosis team (Allocate a care-coordinator)
• Care programme approach (written care plan)
• When the person is well
• Annual review in primary care
• Talk about alcohol and substance misuse

Question 11

Why is it important to stop smoking?

Answer 11

Smoking enhances the metabolism of olanzopine and clozapine

Question 12

What is involved in a care programme?

Answer 12

• Written care plan – document who will be providing care (psychiatrist, phycologist, social worker)
• How to get help in a crisis
• An advance statement