1.5 Mental and Behavioural Disturbances

Question 1

What forms of restraint can be used?

Answer 1

1. Physical restraint
   
   • 5-point restraint
2. Chemical restraint/ sedation
   
   • NSW:
     
     • Droperidol 5-10mg IM, repeated up to 20mg IM
     • Midazolam 5-10mg IM, more ideally titrated in 2.5mg boluses
   • QLD:
     
     • Lorazepam (weight based)
     • Olanzapine (weight based)

Question 2

What does ‘medical clearance’ actually mean?

What is its purpose?

Answer 2

It means answering 2 questions:

1. Does the patient have a significant acute medical illness which requires acute care, or a significant exacerbation of a chronic illness which requires acute management?
2. Does the patient have an underlying physical or medical illness causing their psychological disturbance?

It does not mean the patient is cleared from any medical conditions. It is to determine if the patient has any condition that may make their admission to a psychiatric illness unsafe or inappropriate, even if their primary presentation is due to a psychiatric disturbance?

Question 3

Describe a patient with a psychiatric complaint who is low medical risk.

Answer 3

• Aged 15-55 y.o.
• No acute medical complaints
• No new physical or psychiatric symptoms
• No evidence or pattern of substance abuse

Question 4

Describe the clinical approach to assessing a mental health patient for ‘medical clearance’.

Answer 4

1. CABCDE
2. History
3. Examination (Minimum Examination)
   
   • Vital signs
   • Blood sugar
   • Gait, strength, speech
   • Memory, concentration
   • Clear vs. clouded sensorium
4. Investigations
   
   • Only if required for acute care of patient

Question 5

Explain the GFCMA approach to the mental state examination.

Answer 5

• G - general appearance
• F - form of thought
• C - content of thought
• M - mood and affect
• A - attitude