Week 2 - Psychosis

Question 1

What is the treatment of first time psychosis?

Answer 1

Oral antipsychotic medication
+
Psychological interventions
(eg. family interventions / individual CBT)
- 1 / 2 sessions to help them understand the illness and coping mechanisms

Question 2

What are common side effects of antipsychotic medications?

Answer 2

• Raised prolactin
• Diabetes
• Sedation

Question 3

What investigations should be done before initiating antipsychotics?

Answer 3

Weight 
Waist circumference 
Pulse 
BP 
Fasting BM 
HbA1c 
Blood lipid profile 
Prolactin leves 
Assessment of any movement disorders 
Assessment of nutritional status, diet and level of physical activity
ECG (under specific circumstances - eg. when starting quetiapine)

Question 4

What is involved in a section 2?

Answer 4

Detainment for assessment of a mental health disorder

Question 5

What is involved in a section 3?

Answer 5

Detainment for treatment of a mental health disorder

Question 6

How long can you be held under a section 2?

Answer 6

Up to 28 days

Question 7

What conditions are antipsychotics used in?

Answer 7

• Schizophrenia
• Schizoaffective disorder
• Bipolar disorder
• Severe depression with psychosis
• Augmenting agent in treatment resistant depression and anxiety disorders
• Behavioural and psychological symptoms of dementia (BPSD)

Question 8

What are the two groups of antipsychotics?

Answer 8

• Typicals

- Atypicals

Question 9

How do antipsychotics work?

Answer 9

The target the dopamine pathways in the brain

Question 10

What are the two types of typical antipsychotics?

Answer 10

High potency (eg. haloperidol)

Low potency (eg. chlorpromazine)

Question 11

When are typical antipsychotics used?

Answer 11

In long and short acting depots

When patients are unable to tolerate atypical antipsychotics

Question 12

What are common side effects of typical antipsychotics?

Answer 12

Sedation

Hypotension

Question 13

What is a side effect of amisulpiride?

Answer 13

Hyperprolactinaemia

Question 14

How do atypical antipsychotics work?

Answer 14

Serotonin-dopamine 2 antagonists (SDAs)

Question 15

What type of medication is risperidone?

Answer 15

Atypical antipsychotic

Question 16

What are the side effects of risperidone?

Answer 16

Extrapyramidal side effects at high doses

Hyperprolactinaemia

Weight gain and sedation at high doses

Question 17

What type of medication is olanzapine?

Answer 17

An atypical antipsychotic

Question 18

How is olanzapine given?

Answer 18

Short acting IM injection

/

Regular / immediate release tablets

Question 19

What are the side effect of olanzapine?

Answer 19

Marked weight gain

Sedation

Hyper

Question 20

What investigations should you do before starting olanzapine?

Answer 20

Fasting glucose

Fasting lipids

(these should be monitored during use)

Question 21

What type of medication is quetiapine?

Answer 21

Atypical antipsychotic

Question 22

What is low-dose quetiapine used for?

Answer 22

Augment antidepressants in unipolar depression

Question 23

What is mid-dose quetiapine used for (eg. 100-300mg)?

Answer 23

Mood stabilising

Question 24

What is high dose quetiapine used for?

Answer 24

As an antipsychotic

Question 25

What is a common side effect quetiapine?

Answer 25

Orthostatic hypotension Prolonged QTC interval Some weight gain Som hypertriglyceridemia, hypercholesterolemia and hyperglycaemia

Question 26

What investigations should you do before starting quetiapine?

Answer 26

Baseline ECG

Question 27

What type of medication is aripiprazole?

Answer 27

Atypical antipsychotic

Question 28

What forms is aripirazole available in?

Answer 28

long-acting IM depot Tablets

Question 29

What side effects can aripiprazole cause?

Answer 29

Agitation

Question 30

What type of medication is clozapine?

Answer 30

Atypical antipsychotic

Question 31

What forms is clozapine available in?

Answer 31

Tablet form

Question 32

When is clozapine used?

Answer 32

Treatment resistant psychosis

Question 33

What are the side effects of clozapine?

Answer 33

Agranulocytosis and neutropenia (FBC must be monitored regularly when taking) Increased risk of seizures (may require a co-prescribed anticonvulsant) Sedation Weight gain Deranged LFTs Increased risk of hypertriglyceridaemia, hypercholesterolaemia and hyperglycaemia

Question 34

What are the symptoms of neuroleptic malignant syndrome?

Answer 34

- Autonomic dysfunction - Severe muscle rigidity - High fever - Confusion - Raised WBCs and LFTs

Question 35

What symptoms of autonomic dysfunction do you get in neuroleptic malignant syndrome?

Answer 35

- Hyperthermia - Hypertension - Hyperreflexia - Tachycardia - Tremor - Agitation - Irritability - Sweating

Question 36

What are the severe complications of neuroleptic malignant syndrome?

Answer 36

- Rhabdomylosis (from muscle breakdown) - Hyperkalaemia - Kidney failure - Seizures

Question 37

Is neuroleptic malignant syndrome fatal?

Answer 37

Yes Mortality rate around 10%

Question 38

What is the treatment of neuroleptic malignant syndrome?

Answer 38

- Discontinue medication - ICU (circulatory / ventilator support) - Active cooling (hyperthermia) - Dantrolene / Bromocriptine / Amantadine (Ridgidity) - Benzodiazepines (agitation) - Aggressive IV hydration with diuresis

Question 39

What is a section 135?

Answer 39

A warrant to gain access to premises to remove patient to a place of safety

Question 40

Who can section under 135?

Answer 40

One doctor, AMHP and police

Question 41

What is a section 136?

Answer 41

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

Question 42

Who can section under 136?

Answer 42

Police

Question 43

How long does a section 3 last?

Answer 43

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

Question 44

What is a section 4?

Answer 44

Emergency admission for assessment

Question 45

How long does a section 4 last?

Answer 45

72 hours

Question 46

What is a section 5(2&4)?

Answer 46

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

Question 47

What is the difference between a section 5(2) and 5(4)

Answer 47

5(2): lasts 72 hours, applied for by a doctor 5(3): 6 hours, applied for by a nurse

Question 48

What causes positive symptoms of psychosis?

Answer 48

Overactivity of dopamine in the mesolimbic pathway of the brain