Tiêu đề PSYCHOTIC DISORDER ✅

PSYCHOTIC DISORDER 1. HISTORY TAKING (of latest admission because history usually too long) 4C a. Complain i. Hearing voices/ Talking to himself 1. 2nd/ 3rd person 2. Male/female 3. Recognize or not 4. Commanding/ talking bad/ want to harm 5. Able to control/ not able, if able, how? 6. Related to sleep or not (hypnopompic/hypnagogic) 7. No insight 8. Clear 9. Within objective space(outside head) ii. Disorganized/ aggressive behavior 1. Due to commanding voices 2. Due to persecutory delusion 3. Due to catatonia iii. Additional points 1. Show how it affect patient’s function 2. Suicidal thought/ ideation/ attempt 3. Manic symptoms - talkative, reduced need for sleep, increased energy 4. Depressive symptoms - low mood, loss of interest, increased sleep time 5. Anxiety symptoms - excessive worrying, fear of something awful will happen, fear of losing control 6. Schneider first rank symptoms (ABCD) a. Auditory hallucinations b. Broadcasting, insertion, withdrawal c. delusion of Control d. Delusional perception b. Course i. Usually start with stressor → hallucination/delusion for some times → only kept to patient, symptoms not shown → start showing obvious symptoms by disorganized speech or behavior → noticed by family or partner/ brought by police ii. Current treatment
1. Name of current medication with dose 2. Compliant or not 3. Complications of treatment 4. Follow up, attend all follow up or not (re-confirm the treatment compliant, if follow up not attend, how to continue medication?) c. Cause i. New stressor/ precipitating factor: 1. Events; conflict with people/ relationship problem/ deaths/ 2. substance; a. Stimulants - amphetamine, ketamine b. Depressants - alcohol 3. drugs; steroids 4. medical conditions; encephalitis, stroke, hypothyroidism, lupus, temporal lobe epilepsy d. Complications i. Of Treatment 1. EPS ( mainly in 1st gen anti-psychotics; haloperidol, chlorpromazine ) 2. Metabolic syndrome; Weight gain, latest blood glucose 3. Sedation ii. Of Disease 1. Functioning ; occupation, family, financial 2. Support; family, partner 2. Past Psychiatric history a. Diagnosed with psychotic illness b. When, where c. What complaint, associated symptoms; manic, depressive, anxiety d. What medications and doses, compliance, follow up e. Change of medications or its doses, due to side effects/ not effective?
f. How many previous admission 3. Past Medical history a. Possible medical causes: stroke, hypothyroidism, epilepsy b. Other chronic illness i. Complaint ii. Current control or status iii. Complication of disease and treatment iv. Compliance 4. Drug history a. Steroids, substance 5. Family history a. Of Psychotic disease b. Of Medical illness 6. Social history a. Smoker/ alcohol b. Stay with who c. Occupation/ income/ still functioning or not d. Who take care family 7. Personal History a. Antenatal: i. term/preterm ii. maternal infection iii. birth trauma, prolonged jaundice, seizure b. Early childhood: i. Developmental milestone ii. Family death/ sexual abuse/ physical abuse c. Middle childhood: i. Family death/ sexual abuse/ physical abuse/ relationship problem d. Late childhood: i. Friend peer, drugs substance e. Adulthood i. Legal history = arrested for any rimes 2. PHYSICAL EXAMINATION Neck swelling, scar on forearm
3. MENTAL STATE EXAMINATION A. General appearance and behavior a. any catatonia noted b. eye contact poor c. agitated or not B. Speech a. Poverty of speech (asociality) C. Perceptual disturbance a. Hallucination b. Delusion c. Derealisation d. Depersonalization D. Thinking disturbance a. Circumstantiality b. Tangentiality E. Cognitive function a. - F. Judgement a. - G. Insight a. Know he/she is sick b. Know the symptoms is due to illness c. Willing to get treatment 4. GENERAL INVESTIGATION CHRONOLOGICALLY (FROM GP/KK TO GENERAL HOSPITAL) 1. Investigation to prove provisional diagnosis a. Positive and negative symptoms scale of schizophrenia (PANSS) 2. Investigation to rule out differential a. Biological i. Urine toxicology ii. FBC to rule out infection iii. Thyroid function test to rule out hypothyroidism iv. BUSEC to rule out uremic encephalopathy b. Psychosocial i. Interview family member ii. Trace back old records 3. Investigation to monitor progress (baseline) a. Biological i. Random blood glucose - risk of metabolic syndrome