Psychosis

Question 1

4 language features of psychosis?

Answer 1

Word salad
Derailment - Knights move
Neologism
Alogia - lack of speech

Question 2

Difference between a belief and delusion?

Answer 2

Belief is when someone believes something with absolute certainty with or without evidence
Delusion is when someone believes something with aboslute certainty despite contradictory evidence

Question 3

Anhedonia?

Answer 3

Lack of enjoyment

Question 4

Avolition?

Answer 4

diminished motivation

Question 5

Environmental factors that could contribute to development of schizophrenia?

Answer 5

Birth trauma, urban living, trauma, moves in childhood, famine, urban living, cannabis

Question 6

How do structural brain alterations occur in schizophrenia?

Answer 6

Abberant DNA methylation
HPA axis dysregulation
Pro inflammatory state
brain alterations

Question 7

Mechanism of chlorpromazine?

Answer 7

Binds to postsynaptic dopamine receptors, feedback to presynaptic, more dopamine released, more metabolites in synapse

Question 8

3 phases of schizophrenia management?

Answer 8

Acute phase, stabilization phase, stable phase

Question 9

Drug treatment choice of schizophrenia?

Answer 9

Chlorpromazine

Question 10

What is used in treatment resistant schizophrenia?

Answer 10

Clozapine

Question 11

First generation antipsychotics?

Answer 11

“azines”
chlorpromazine

Haloperidol

Question 12

6 second generation anti-psychotics?

Answer 12

Quitiapine
Clozapine
Respiridone 
Olanzapine
Aripiprazole
Ziprazidone

Question 13

First generation antipsychotics tend to have what 4 side effects?

Answer 13

tardive dyskinesia
increased prolactin
Weight gain
Sedation

Question 14

What specific side effects do first generation antipsychotic Thiorazine come with?

Answer 14

usual:
Tardive dyskinesia
Prolactin increase
Weight gain
Sedation

Specific:
Qtc prolongation
Hypotension
Anticholinergic

Question 15

Main 6 side effects of clozapine?

Answer 15

Weight gain
Glucose abnormalities
Lipid abnormalities

Hypotension
Sedation
Anticholinergic SE

Question 16

Which class of antipsychotic should be used when someone has sensitivity to extrapyramidal SE?

Answer 16

second gen

Not high risperidone

Question 17

Which class of antipsychotic should be used when someone has sensitivity to prolactin increase?

Answer 17

Second gen

Not risperidone

Question 18

Which class of antipsychotic should be used when someone has sensitivity to weight gain and hyperglycaemia?

Answer 18

Aripiprazole

Ziprasidone

Question 19

Blood tests for schizophrenia/ psychosis?

Answer 19

FBC
U&E
B12
Folate
TFTs
Glucose/HbA1c
Serum calcium
Cholesterol
LFTs

Question 20

Investigations into psychosis

Answer 20

ECG - antipsychotic prolonged qtc
ct brain - organic cause
EEG - temporal lobe epilepsy
Urine drug test - temporal lobe epilepsy

Question 21

What antipsychotics are used first line in schizophrenia?

Answer 21

atypical - olanzapine, risperidone

Question 22

When is ECT used in schizophrenia?

Answer 22

Catatonic or treatment resistant

Question 23

Schizophrenia support groups?

Answer 23

SANE

Rethink

Question 24

Causes of challenging behaviour developing?

Answer 24

Drugs - not managing pain, SE, withdrawal
Psychotic illness
Learning disability 
Hypoxia
Infection
Personality disorder
Substance abuse or withdrawal
Head injury

Question 25

What do you need to know in order to manage someones acutely disturbed behaviour?

Answer 25

``` When did it start? Has it happened before? How was it managed? Any precipitants? Any changes to medication? Why were they admitted? ```

Question 26

How do you approach an acutely disturbed patient?

Answer 26

Calmly, eye level, know your exits, safe environment, not alone, clear communication

Question 27

What training do staff need in order to provide physical intervention for acutely disturbed patients?

Answer 27

MAPA

Question 28

What is the stepwise management plan of managing an acutely disturbed patient?

Answer 28

De-escalate verbally MAPA trained staff provide physical restraint Pharmacological intervention

Question 29

What benzodiazepine is chosen to be administered to patients experiencing an acute psychotic episode? adverse effects of drug on patients who are suffering what?

Answer 29

Flumazenil - adverse effects on those with anxiety or panic

Question 30

When should antipsychotics not be given to a patient suffering an acute psychotic episode?

Answer 30

When the cause if delirium tremens as it lowers the seizure threshold

Question 31

After IM sedatives are given to treat an acutely disturbed patient, how often do obs need to be recorded?

Answer 31

5-10 minutes for first hour | Every half hour till they are ambulatory again

Question 32

What is oral medication and doses given to an acutely disturbed patient?

Answer 32

Lorazepam 250-500mcg PO up to 2mg daily Risperidone 250mcg to 500mcg PO up to 2mg daily (Can give Haloperidol or Olanzapine 2.5-5mg PO daily up to 5mg)

Question 33

If oral medication is refused in an acutely unwell patient, what IM medications can be administered?

Answer 33

IM Lorazepam 0.5-1mg IM up to 2mg a day IM Haloperidol 0.5mg IM up to 2mg a day (Can give olanzapine 2.5-5mg IM up to 5mg a day)

Question 34

What is a form 5?

Answer 34

Document that doctors fill out in order to ensure patient stays in hospital to be assessed properly