Psychosis

Question 1

List 4 (out of 11) organic causes of psychosis

Answer 1

1. Acute confusion
2. Dementia
3. Temporal lobe epilepsy
4. Infections of the nervous system eg AIDs, neurosyphilis, encephalitis
5. Brain injury
6. Brain tumours
7. Huntington’s disease
8. Metabolic disorders eg Vit B12 deficiency, porphyria
9. Endocrine disorders eg Cushing’s syndrome, thyroid disease
10. Medication effects eg high dose steroids
11. Autoimmune disorders eg lupus, thyroid disease

Question 2

What is the Oxford English Dictionary definition of ‘Psychosis’?

Answer 2

“a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality”

Question 3

What treatments are first line for treatment of first presentation psychosis?

Answer 3

• Antipsychotics

- CBT

Question 4

What are 3 (out of 5) common side effects of antipsychotics?

Answer 4

1. Metabolic - weight gain, diabetes, hyperlipidaemia
2. Sedation
3. Extrapyramidal
4. CVS (prolonged QTc)
5. Hormonal (Hyperprolactinaemia)

Question 5

What NICE guidance is available about the monitoring requirements needed when patients are on antipsychotics?

Answer 5

• Weight
• Waist circumference
• Pulse and BP
• Fasting blood glucose and HbA1c
• Blood lipids
• Prolactin levels
• Movement disorder assessments
• Assessment of nutritional status
• ECG

Question 6

What is the duration of the following MHA section; 135?

Answer 6

Can be used once

Question 7

What is the duration of the following MHA section; 136?

Answer 7

Can be used once

Question 8

What is the duration of the following MHA section; 2?

Answer 8

Up to 28 days

Question 9

What is the duration of the following MHA section; 3?

Answer 9

6 months

Question 10

What is the duration of the following MHA section; 4?

Answer 10

72 hours

Question 11

What is the duration of the following MHA section; 5(2)?

Answer 11

72 hours

Question 12

What is the duration of the following MHA section; 5(4)?

Answer 12

6 hours

Question 13

Give a description of the following MHA section; 135

Answer 13

Warrant to gain access to premises to remove the patient to a place of safety

Question 14

Give a description of the following MHA section; 136

Answer 14

Allows police to remove a person from a public place to a place of safety

Question 15

Give a description of the following MHA section; 2

Answer 15

Admission for assessment

Question 16

Give a description of the following MHA section; 3

Answer 16

Admission for treatment

Question 17

Give a description of the following MHA section; 4

Answer 17

Emergency admission for assessment

Question 18

Give a description of the following MHA section; 5(2)

Answer 18

Emergency holding order (patient already admitted to hospital on an informal basis)

Question 19

Give a description of the following MHA section; 5(4)

Answer 19

Emergency holding order (patient already admitted to hospital on an informal basis)

Question 20

What treatment is required when someone is placed under the MHA section 135?

Answer 20

Does not allow for treatment

Question 21

What treatment is required when someone is placed under the MHA section 136?

Answer 21

Does not allow treatment

Question 22

What treatment is required when someone is placed under the MHA section 2?

Answer 22

Treatment can be given for the mental disorder itself or conditions directly resulting from the disorder

Question 23

What treatment is required when someone is placed under the MHA section 3?

Answer 23

Treatment can be given for the first 3 months, then consent is required or a second opinion

Question 24

What treatment is required when someone is placed under the MHA section 4?

Answer 24

Treatment can only be given under common law

Question 25

What treatment is required when someone is placed under the MHA section 5(2)?

Answer 25

Treatment can only be given under common law

Question 26

What treatment is required when someone is placed under the MHA section 5(4)?

Answer 26

Treatment can only be given under common law

Question 27

Who must apply/recommend the use of MHA section 135?

Answer 27

- 1 Doctor - 1 AMHP - Police

Question 28

Who must apply/recommend the use of MHA section 136?

Answer 28

Police power, police will remain in attendance until further assessment is arranged

Question 29

Who must apply/recommend the use of MHA section 2?

Answer 29

- AMHP or nearest relative | - Recommendation by 2 doctors (at least 1 must be section 12 approved)

Question 30

Who must apply/recommend the use of MHA section 3?

Answer 30

- AMHP or nearest relative | - Recommendation by 2 doctors (at least 1 must be section 12 approved)

Question 31

Who must apply/recommend the use of MHA section 4?

Answer 31

- Application by AMHP or nearest relative | - Recommendation by any doctor

Question 32

Who must apply/recommend the use of MHA section 5(2)?

Answer 32

Recommendation from the doctor or approved clinician in charge of the patients care or their nominated deputy

Question 33

Who must apply/recommend the use of MHA section 5(4)?

Answer 33

Recommendation from registered nurse

Question 34

Who can discharge/renew the MHA section 2?

Answer 34

Patient can appeal to a tribunal, can be discharged by the responsible clinician, hospital manager or nearest relative

Question 35

Which MHA sections do not allow a patient to appeal?

Answer 35

- 4 - 5(2) - 5(4)