Introduction to serious mental illness

Diagnosis Method of serious mental illness

Clinical interview process that involves history taking and Mental State Examination (MSE).

Components of History Taking in mental illness

• presenting complaint

• past psychiatric history

• medical history

• drug history

• family history

• personal history

• forensic history

• social history

• premorbid personality

Mental State Examination (MSE)

Mental observations exam that assses:

• appearance

• behavior

• speech

• mood

• perception

• thought

• cognition

• insight.

Diagnostic Manuals

ICD-11 and DSM V used for diagnosing mental health disorders.

Environmental Risk Factors of psychosis

Examples include maternal malnutrition and infections during pregnancy.

Positive Symptoms of Psychosis

Core symptoms include delusions, disorganized thinking, and hallucinations.

Negative Symptoms of Psychosis

Symptoms such as social withdrawal, flattening of mood, and loss of motivation.

Bio-Psycho-Social Approach

Integrates biological, psychological, and social dimensions in treatment.

Dopaminergic overactivity

Thought to contribute to the development of positive symptoms in psychosis, such as hallucinations and delusions

• Cocaine, amphetamines, levodopa, bromocriptine induce psychosis

• DA metabolite, HVA Homovanillic acid correlates to severity of psychotic symptoms
  

Serotonergic overactivity

Thought to be associated with mood disorders and may contribute to symptoms such as anxiety and depression

• LSD is partial 5HT agonist – sensory distortions and hallucinations
  

Glutaminergic hypoactivity

Thought to be linked to cognitive deficits and negative symptoms in schizophrenia. It may involve reduced NMDA receptor function, contributing to symptoms like apathy and social withdrawal

• Eg social ketamine use

GABA hypoactivity

Thought to be associated with increased anxiety and seizures, reflecting an imbalance in the neurotransmitter system that can contribute to symptoms of various mental disorders.

Disconnection hypothesis

A theory suggesting that disruptions in the brain's connectivity contribute to the symptoms of schizophrenia, leading to impaired cognition and perception.

1. Less grey matter – particularly temporal lobe

2. Less blood flow between frontal and temporal lobes on specific cognitive tasks

3. Less white matter in tracks connecting frontal and temporal lobes
   

SGA

Atypical antipsychotic medications used to treat schizophrenia and other mental disorders, often with a lower risk of extrapyramidal side effects compared to typical antipsychotics.

EPSE

Extrapyramidal side effects, which are drug-induced movement disorders that can occur with antipsychotic treatment.

• Acute dystonia – Abnormal posture oculogyric crisis, torticollis

• Parkinsonism - R B T

• Akathesia – restlessness

• Tardive Dyskinesia – orofacial
  

Anticholinergic SE

Side effects caused by medications that block acetylcholine, often leading to symptoms such as dry mouth, constipation, urinary retention, and blurred vision.

Anti adrenergic SE

Side effects resulting from medications that block adrenergic receptors, potentially causing symptoms like postural hypotension,tachycardia and erectile dysfunction

Section 117 meeting

A meeting held to discuss aftercare needs for individuals with mental health issues who are eligible for support under Section 117 of the Mental Health Act.

Diabetes in schizophrenia

• Typical antipsychotics - i.e. chlorpromazine and haloperidol cause hyperglycaemia

• Atypical antipsychotics: weight gain, and clozapine, olanzapine may cause Diabetic Ketoacidosis in people without any history of diabetes