Psychosis and schizophrenia
Schizophrenia, first-episode psychosis, drug-induced psychosis and antipsychotic treatment.
High-yield points
Schizophrenia: positive symptoms (delusions, hallucinations, disorganisation) and negative symptoms for at least 6 months (DSM-5).
First-episode psychosis: exclude organic causes and drugs (methamphetamine, cannabis); refer to an early psychosis service.
Second-generation antipsychotics are first line, starting low; long-acting injectables help with adherence.
Metabolic monitoring (weight, waist, glucose, lipids, BP) is essential on antipsychotics.
Clozapine for treatment-resistant schizophrenia (failed 2 adequate antipsychotic trials); weekly FBC for the first 18 weeks for neutropenia, and watch for myocarditis.
Neuroleptic malignant syndrome: rigidity, hyperthermia, autonomic instability, high CK; stop the antipsychotic.
Many patients are treated in the community under community treatment orders.
India vs Australia
Where the answer the AMC marks correct differs from what’s usually taught in Indian MBBS.
| Aspect | India (MBBS)What you learn in MBBS | Australia (AMC)What the exam marks as correct |
|---|---|---|
| Drug-induced psychosis | Cannabis and alcohol. | Methamphetamine ('ice') is a major cause in emergency departments. |
| Physical health | Less emphasis. | Strong focus: regular metabolic monitoring on antipsychotics, because people with severe mental illness die years earlier from CVD. |
| Community care | Family-centred care with hospital follow-up. | Community mental health teams with case managers; early psychosis services for young people. |
| Clozapine | For treatment resistance. | Largely the same: after two failed antipsychotics, with mandated blood monitoring and myocarditis surveillance early on. |
Drug-induced psychosis
India (MBBS)
Cannabis and alcohol.
Australia (AMC): what the exam expects
Methamphetamine ('ice') is a major cause in emergency departments.
Physical health
India (MBBS)
Less emphasis.
Australia (AMC): what the exam expects
Strong focus: regular metabolic monitoring on antipsychotics, because people with severe mental illness die years earlier from CVD.
Community care
India (MBBS)
Family-centred care with hospital follow-up.
Australia (AMC): what the exam expects
Community mental health teams with case managers; early psychosis services for young people.
Clozapine
India (MBBS)
For treatment resistance.
Australia (AMC): what the exam expects
Largely the same: after two failed antipsychotics, with mandated blood monitoring and myocarditis surveillance early on.
The Australian context
Methamphetamine ('ice') is a major cause of acute psychosis presentations in Australian emergency departments. People with severe mental illness die years earlier, largely from cardiovascular disease, so physical health monitoring is a strong theme.