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64 Cards in this Set
- Front
- Back
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Past Psych Hx Components |
Prev psych contact Depression + mania/hypomania Hx of self harm |
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MSE components |
Appearance & Behaviour. Speech. Mood & affect. Thought content & form. Perception. Cognition. Insight. Risk assessment |
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What are the diagnostic criteria for schizophrenia? |
1 symptoms of Schneider’s FRS OR 2 symptoms of non-FRS but suggestive |
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Hyperactivity |
Increased motor activity that is goal directed |
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Agitation |
Motor restlessness |
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Psychomotor retardation |
Reduced, slow body movements. associated with depression |
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Stupor |
Loss of activity with no response to external stimuli |
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Echopraxia |
Imitation by pt of interviewer’s movements |
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Stereotypies |
Repetitive voluntary non-goal directed movements that are purposeless e.g foot tapping, body rocking, grunting (associated with schizophrenia, hyperkinetic disorder & autism) |
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Akathisia |
Unpleasant motor restlessness, worse in the lower limbs, leading to constant shifting of posture. Associated with antipsychotic treatment |
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Neologisms |
Creation of new words or phrases which only have meaning to the patient. Associated with schizophrenia & autism |
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Pressure of speech |
Increased rate of speech. Associated with hypomania & mania |
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Poverty of speech |
Decreased rate of speech. Associated with depression |
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Word salad (schizophasia) |
A jumble of word that are no apparently linked and ma be difficult to understand |
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Subjective Mood MSE |
Description of overall mood based on patient’s own words |
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Objective Mood MSE |
Clinical description of overall mood e.g. Euthymic/depressed/elated/labile/anxious/irritable/perplexed |
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Affect MSE |
Patient’s emotional response to stimulus e.g. reactive/flat/blunted |
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Thought content MSE |
Harming self/others Obsession Overvalued idea Delusion Passivity phenomenon |
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Obsession definition |
Involuntary, intrusive, unwanted thoughts despite person’s recognition (of senselessness & as own) and resistance |
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Overvalued idea |
Unreasonable and sustained belief that is maintained with less intensity (able to acknowledge may not be true) |
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Delusion |
Fixed, false, unshakeable belief held despite contrasting evidence & out of keeping with individual’s background |
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What are the main symptoms of schizophrenia? |
1) Thought alienation (insertion, withdrawal, broadcasting) 2) Delusions of control/passivity 3) Hallucinatory voices 4) Persistent delusions which are culturally inappropriate & impossible |
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How does an acute & transient psychotic disorder differ from schizophrenia? |
Acute onset (within 2 weeks or less) Typical schizophrenic sx are rapidly changing There is a precipitating stressor Complete recovery within months or days |
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What are the diagnostic criteria for schizoaffective disorder? |
Both affective & schizophrenic sx are prominent within the same episode (spontaneous/ across few days) Episode does not meet criteria for either schizophrenia or any mood disorders |
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What is the first line medication used in schizophrenia? |
A second gen antipsychotic (olanzapine/quetiapine) |
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What psychotherapies are recommended for schizophrenia? |
CBT (behavioral control) Family intervention (⬇️ high expressed emotions) psychoeducation art therapies supportive counseling cognitive remediation |
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What are Schneider’s second rank symptoms? |
2nd person auditory hallucination Secondary delusion following a premorbid experience Hallucinations in other modalities apart from auditory Perplexity. Emotional blunting. |
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What are Schneider’s FRS? |
1) Auditory hallucinations 2) Delusions of passivity 3) Delusional perception |
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What are negative symptoms? |
Affective blunting. Alogia (⬇️ speech). Avolition (⬇️ motivation). Apathy (indifference). Anhedonia (⬇️ pleasure). Asociality (⬇️ interest in social contact). Attention disturbance |
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What are the predisposing factors for schizophrenia? |
Bio: Genetic, Developmental abnormalities, Early onset substance abuse Psycho: Childhood trauma, Premorbid personality Social: Unemployment, Lower socioeconomic group, Urban birth, 1st & 2nd gen immigrants |
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How does delusional disorder differ from schizophrenia? |
Delusions are the only clinical feature with no FRS Present for at least 3 months and can be life long No evidence of brain disease, no/occasional perceptual disturbance & can have fairly normal life Very difficult to treat |
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How does an acute & transient psychotic disorder differ from schizophrenia? |
Acute onset (crescendo within 2 weeks or less) Typical schizophrenic sx are rapidly changing There may or may not be a precipitating stressor & non-organic Complete recovery within months or days |
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What are negative symptoms? |
Affective blunting Alogia (⬇️ speech) Avolition (⬇️ motivation) Apathy (indifference) Anhedonia (⬇️ pleasure) Asociality (⬇️ interest in social contact) Attention disturbance |
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What are the predisposing factors for schizophrenia? |
Genetic Developmental abnormalities Early onset substance abuse Childhood trauma Unemployment Lower socioeconomic group Urban birth Premorbid personality 1st & 2nd gen immigrants |
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What psychotherapies are recommended for schizophrenia? |
CBT (behavioral control) Family intervention (⬇️ high expressed emotions) PE, art therapies, supportive counseling, cognitive remediation, compliance therapy |
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What are the pillars of medical ethics? |
Autonomy Benevolence Non-maleficence Justice |
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What are the 4 criteria to capacity? |
Communicate (any method) Understand Retain Balance (weigh pros & cons) |
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What are the indications for an involuntary admission under the Mental Health Act? |
1) Suffering from a mental illness, dementia or learning disability (but not personality disorder/substance misuse) 2) Serious & imminent risk to self or others 3) Judgment may deteriorate and admission can provide benefit to material extent |
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How long should you prescribe anti-depressants for? |
6m if 1st trial (review in 1m) + 1yr if relapse (1-2 episodes within 6m) Up until 2yr generally, 5yr for BPAD, for life if schizophrenia |
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Who could be eligible for Home Support services? |
People aged > 65 (or younger if deemed necessary) who need help to continue living at home E.g. getting in and out of bed, dressing & undressing, personal care such as showering & shaving |
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What differentiates schizotypal disorder from schizophrenia? |
Inappropriate/constricted affect, odd appearance & behavior, speech, beliefs, suspicious/paranoid ideas (not delusions), unusual perceptual disturbances, transient quasi psychotic episodes. Chronic course & may precipitate schizophrenia |
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What is considered a drug induced psychosis? |
Psychotic sx (AH, delusions +/- confusion) present after substance misuse but not part of withdrawal/intoxication Does not exceed 6 months Includes alcoholic hallucinosis |
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Paranoid personality disorder may present as? |
Excessive sensitivity to setbacks, bears grudges, overly suspicious, increased sense of personal rights, persistent self-referential attitude, preoccupation with conspiracies |
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What is a schizoid personality? |
Few activities provide pleasure, emotional coldness, limited capacity to express feelings, indifference to praise/criticism, solitary lifestyle, no interest in sex, introspective & fantasist, no friends |
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What social interventions are recommended for schizophrenia in the NICE guidelines? |
Pt centered care re their preferences, access to local education & employment GP monitor 1x year minimum + comorbid substance misuse Address housing, eligible benefits, support groups, CPN support |
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What role does a CPN play in patient management |
Provide info, education and support to pt & family, admin of depot if prescribed Monitor for signs of deterioration, compliance w meds Liaise w consultant psychiatrist, GP & other members of MDT |
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What is a depot antipsychotic? |
A long-acting injection into a large muscle (usually gluteus maximus) allowing sustained release over 1-4 weeks |
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What are the main side effects of Clozapine? |
Agranulocytosis (👩🏻>👨🏻, 👵🏻>👱♀️, 🇨🇳>🇪🇺) Sedation, weight gain, constipation, autonomic agitation, seizures OCD symptoms exacerbation |
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What are the plasma level recommendations for Clozapine & how can they be affected? |
350-500ug/L Decreased in males, younger pts & smokers Increased in Asian |
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What investigations would you perform to establish baseline prior to commencing medication?what |
Bloods: FBC, U&E, fasting cholesterol, lipids, glucose levels, TFTs Imaging: ECG, chest x-ray Bedside: Weight |
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What are other indications for Clozapine apart from treatment resistant schizophrenia? |
Tardive dyskinesia, psychosis in Parkinson’s, Huntington’s psychosis, resistant mania |
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Which depot antipsychotics are associated with increased risk of EPSEs? |
Haloperidol deconate (Haldol), Fluphenazine deconate (Modecate), Pipotiazine palmitate (Piportil) |
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Why would family intervention be useful in managing patients with schizophrenia?w |
Addresses high expressed emotions (known perpetuating RF) & may prevent relapse & reduce persisting symptoms |
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What is the MOA of antipsychotics? |
Blocking D2 receptors mainly in the mesolimbic pathway to mediate antipsychotic effects. D2 blocking in nigrostriatal pathway causes EPSEs, mesocortical deteriorates cognitive fx, tuberoinfudibular increases prolactin release |
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Arrange the antipsychotics in descending order with respect to weight gain |
Clozapine>olanzapine>quetiapine>risperidone>amisulpride *Aripiprazole is weight neutral & may be associated with weight loss |
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What services does a social worker provide? |
Address housing, financial support (social welfare payments, medical card etc) |
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How does an OT contribute to MDT management? |
Attends to access to education, employment & training of practical skills i.e. cooking |
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What role does a psychiatrist play in patient management? |
Assess pt (MSE, risk, SEs, progress) Investigate for complications & need for interventions, review hx Record recent life events/current stressors Prescribe appropriate medication, inquire about SEs & attitude to treatment |
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What can a psychologist offer to patient management? |
Family therapy, psychoeducation, CBT, compliance therapy |
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How would you approach initial treatment with antipsychotics? |
Pt/carer choice OR SGA. Starting dose & titrate to minimum effective dose. Adjust to response & tolerability. Assess over 6-8 weeks |
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What would you do if the initial antipsychotic medication proves ineffective? |
Switch to different SGA (different receptor profiles & efficacy). If still unsuccessful combine 2 antipsychotic agents with differing receptor profiles. E.g. Olanzapine (>5HT) + Amisulpride (>DA) |
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Following failed adequate trials of 2 atypical antipsychotics (SGA), what other treatments would you consider & why? |
Clozapine. Effective for treatment resistant schizophrenia. Reduces suicidality, hostility, agression & both +ve and -ve symptoms. Does not increase prolactin release. |
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How can you augment Clozapine to induce a better patient response? |
Add Amisulpride/Aripiprazole/Haloperidol Add Lamotrigine (for -ve symptoms) |
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When would you consider a depot antipsychotic for a patient? |
If there is poor compliance with oral treatment Failure to respond to oral treatment Memory problems/factors interfering with ability to take medications regularly |
