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Acute psychosis

Clinical Discipline(s)/Organ System(s)
Psychiatry/Health Psychology
Progress Test Topic(s)
Mental health
Description
An eighteen year old Māori music student presented with her parents to their GP. Her parents had noticed that she had become progressively withdrawn and would sit in her room for several hours; she no longer maintained previous friendships. She had stopped attending her university course two months previously and seldom played the piano. She paced at night and was often heard 'talking to herself'; and possibly 'talking to voices'. She accused the family of plotting against her and said that the CIA was monitoring all her moves. She repeatedly drew the curtains checking that there were no surveillance vehicles outside. When a neighbour's family visited and left the car on the kerb for two days, she was convinced that she was being monitored and she approached the neighbour, threatening to 'teach the CIA a lesson'.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Current biopsychosocial theories of the aetiology of schizophrenia
   - Neuroanatomy of brain regions postulated to be associated with schizophrenia
   - Pathophysiology of the positive and negative symptoms of schizophrenia
   - DSM-IV criteria for psychotic disorders including schizophrenia
   - Pharmacology of phenothiazines, thioxanthenes, haloperidol, clozapine, olanzapine, risperidone and quetiapine
Clinical and Communication Skills 
   - Elicit a history or collateral history from a patient experiencing acute psychosis; or from a friend or relative screen for risk factors for psychosis
   - Perform a mental state examination of a patient with acute psychosis; recognise different types of delusions and hallucinations; identify and describe thought disorder
   - Differential diagnosis of psychosis
   - Role of specific substances in psychosis
   - Perform a risk assessment for harm to self or others; assess suicide and neglect risk
   - Interpret relevant investigations: electrolytes, hormonal screening, toxicology screen, imaging
   - Management of schizophrenia: pharmacological, psychological, psycho-educational and psychosocial
   - Understand and apply recovery principles
   - Prognosis of schizophrenia
   - Role of early intervention services, crisis care services and the community mental health team
Personal and Professional Skills 
   - Best interests principle
   - Non-judgemental approach to mental illness
   - Show empathy
   - Social impact of mental illness
   - Communicating the diagnosis of a mental illness to a patient and their family/whānau
   - Mental Health Act application and criteria for compulsory admission
   - Principles underlying competency and criteria to define someone as 'not competent'
   - Awareness of own level of comfort when talking to someone with psychosis
Hauora Māori 
   - Ensuring a culturally safe environment and interpretation of symptoms in an appropriate cultural context
   - Awareness of differential pattern of interaction with mental health services for Māori (e.g. more likely to enter through justice system)
   - Understanding of inequities in access to mental health services and quality of psychiatric care for Māori, and how this contributes to higher rates of hospitalisation for psychosis for Maori
   - Understanding of the role of kaupapa Māori mental health policies, services and research in reducing inequalities
Population Health 
   - Epidemiology of schizophrenia
   - Epidemiology of substance abuse and awareness of different substance abuse in different populations
   - Awareness of potential co-morbidities such as metabolic syndrome, tobacco consumption and earlier mortality
Conditions to be considered relating to this scenario
Common
schizophrenia, schizoaffective disorder, infection, steroid use, hypoglycaemia, hyperthyroidism, electrolyte imbalance, depression, bipolar affective disorder, substance abuse, alcohol-related psychosis, temporal lobe epilepsy
Less common but 'important not to miss'
head trauma, encephalopathy of any cause, brain abscess, Addison's disease, Huntington's disease, multiple sclerosis, systemic lupus erythematosus (SLE), encephalitis, HIV, syphilis, Wernicke-Korsakoff syndrome
Uncommon
normal pressure hydrocephalus, paraneoplastic syndrome, Churg-Strauss syndrome, Behçet’s disease, porphyria, Wilson's disease
Related Scenarios
[Bipolar affective disorder]