10 - Older Person's Mental Health Flashcards

1
Q

What is the difference between implied and expressed consent?

A
  • Expressed is written or oral
  • Implied is ambiguous e.g nodding, turning up for surgery on time, rolling up sleeve for blood test
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2
Q

What is the definition of mental capacity?

A

One’s own ability to make decisions e.g personal welfare, healthcare, financial

It is time specific and decision specific

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3
Q

What are the 5 principles of the MCA 2005?

A
  1. Assume everyone has capacity until proven otherwise
  2. Provide information in all sources to help aid capacity
  3. Unwise decision doesn’t mean somebody lacks capacity
  4. Best interests
  5. Least restrictive
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4
Q

What are some scenarios where someone may lack capacity?

A
  • Stroke or brain injury
  • Mental health problem
  • Dementia
  • Learning disability
  • Confusion, drowsiness or unconsciousness
  • Substance misuse

Always reassess as time and decision specific

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5
Q

What is the two stage capacity test?

A

Stage 1 - Is the person unable to make a particular decision? (Diagnostic)

Stage 2 - Is the inability to make a decision caused by an impairment of, or disturbance in the functioning of, a person’s mind or brain? e.g mental illness, dementia, or learning disability, or more temporary states such as confusion, unconsciousness, or the effects of drugs or alcohol. 4 test!!!!(Functional)

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6
Q

What is the definition of the following:

  • LPA
  • Deputies appointed by the Court of Protection
  • Public Guardian
  • IMCA
A
  • LPA: Person appointed by pt when they have capacity to make decisions for them when they no longer have capacity
  • Deputies appointed by the Court of Protection: Person appointed once the person has already lost capacity so cannot nominate a LPA. Could be friend, family or solicitor. Can have one deputy for finances/property and one about personal welfare. Not able to make healthcare decisions like LPA can
  • Public Guardian: A person who polices LPAs and Deputies to stop them from financially abusing the person who lacks mental capacity
  • IMCA: When somebody lacks capacity so needs a best interest decision but there is no family/friends for doctors to consult with about the best interest
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7
Q

What is a IMHA?

A

Independent Mental Health Advocate

Statutory right for people detained under most sections of the Mental Health Act, subject to Guardianship or on a community treatment order (CTO)

IMHAs help the patient get their opinions heard and help them to know their rights as per the law

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8
Q

What is DoLS being replaced by?

A

Deprivation of Liberty Safeguard is going to be replaced by Liberty Protection Safeguards (LPS) in 2022

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9
Q

What settings can DOLS be used in?

A
  • Hospitals
  • Care homes

Can only use restraints and restrictions when this is in place and should only be used when in somebody’s best interest

Should not place anybody under this if they can be held under the MHA

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10
Q

How is a DoLS applied for?

A

Must request standard authorisation from local authority

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11
Q

What is the definition of a mental disorder?

A

A behavioral or mental pattern that causes significant distress or impairment of personal functioning

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12
Q

What is the purpose of the following sections in the Mental Health Act 1983/2007, who can enforce it and how long does the section last for:

Section 2

A

Purpose: Allow a person to be detained in hospital for assessment, ADMISSION FOR ASSESSMENT, cannot be extended

Who can enforce it: AMHP + 2 Doctors (one of them being section 12 approved)

Duration: 28 days

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13
Q

What is the purpose of the following sections in the Mental Health Act 1983/2007, who can enforce it and how long does the section last for:

Section 3

A

Purpose: Admission for treatment, can be extended

Who can enforce: AHMP + 2 Doctors (one is section 12 approved and has experience with treatment of condition)

Duration: 6 months but can be extended

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14
Q

What is the purpose of the following sections in the Mental Health Act 1983/2007, who can enforce it and how long does the section last for:

CTO

A

Purpose: Supervised treatment in the community following being detained under a section in hospital. Can return you to hospital immediately for treatment if need be

Who can enforce: Responsible Clinician

How long: 6 months, can be extended

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15
Q

What is the purpose of the following sections in the Mental Health Act 1983/2007, who can enforce it and how long does the section last for:

Section 5 (4)

A

Purpose: Nurse’s holding power to hold you there until you can be assessed by a doctor, the doctor can then decide to end your section or start another

Who can enforce: Nurse

How long: 6 hours

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16
Q

What is the purpose of the following sections in the Mental Health Act 1983/2007, who can enforce it and how long does the section last for:

Section 5 (2)

A

Purpose: Doctor’s holding power, gives enough time for 2 doctors to review to be able to place them on a section 2 or 3

Who can enforce: Doctor

How long: 72 hours

17
Q

What is the purpose of the following sections in the Mental Health Act 1983/2007, who can enforce it and how long does the section last for:

Section 136

A

Purpose: Police can detain someone from a public place if they believe them to be mentally disordered and bring them to a place of safety in the hospital. Allows them to be reviewed by 2 doctors to see if they need a section

Who: Police

How long: 24 hours

18
Q

What is the purpose of the following sections in the Mental Health Act 1983/2007, who can enforce it and how long does the section last for:

Section 135

A

Purpose: Police can go into your home/private place and bring you to a place of safety e.g in the hospital/police station if they believe you to be mentally unwell

Who can enforce: Police or Other healthcare professionals

How long: 36 hours

19
Q

What is the purpose of the following sections in the Mental Health Act 1983/2007, who can enforce it and how long does the section last for:

Section 117

A

Purpose: Aftercare provided to a patient after they leave hospital and have been on certain sections e.g Section 3. May get a CPA and specialist housing, help to meet other people, help with work or education, or free prescriptions for mental health medication

Who can enforce: Anyone on certain sections

How long: when patient no longer needs it and is well

20
Q

What is the difference between a DNACPR and an Advance Decision to Refuse Treatment?

A

Advanced decision to refuse treatment could relate to numerous things e.g no pain relief, no ventilation but DNACPR is just refusing CPR

Both decisions can only be made by patient themselves if they have capacity

21
Q

What are ReSPECT forms for?

A

Recommended Summary Plan for Emergency Care and Treatment

Promotes advanced care planning, good communication, shared decision making and DNACPR

22
Q

How can you distinguish between dementia and delirium:

  • Sleep-wake cycle
  • Attention
  • Arousal
  • Autonomic Features
  • Duration
  • Delusions
A

Collateral history is key!!

23
Q

What is Wilkinson’s theory?

A

It is not individual income that is a main determining factor of health but rather the degree of income inequality within a society

Income distribution determines health

24
Q

What drug can be given to help soothe the hallucinations in Lewy Body dementia?

A

Cholinesterase inhibitors e.g Donepezil, Rivastigmine

25
Q

What is this lady’s clinical frailty score:

86 year old lady with Alzheimer’s who is dependent on family for personal care and feeding.

A

8

26
Q

What is the most likely answer?

A

Cortical Spreading Depression

wave of sustained depolarizationmoving through intact brain tissue and associated with brain ischemia, migraine aura, and seizures.

27
Q

What is the most common ECG abnormality with Donepezil?

A
  • Decreased heart rate
  • Increased PR interval