2: Management of psychosis Flashcards
Patients with psychosis have the potential to behave ___ towards you or others.
violently
Over the last 20 years, the rate of crime has (increased / decreased) overall.
decreased
What three factors increase the chances that someone will commit an act of violence?
Substance misuse
Mental illness
History of violence
What is the difference between violence and aggression?
Violence is a physical act
Aggression esp. in hospital is an attempt to gain an advantage over someone which MAY take the form of violence
How might you predict that a patient will become aggressive?
Body language
How is the risk of aggression against hospital staff reduced?
De-escalation of the situation - talking down, isolation or tranquilisation
Observers
Room layout i.e make sure there’s a quick exit, don’t stand between the patient and the door
What are some interventions to prevent an aggressive patient from doing harm?
Restraint
Isolation
Tranquilisation
If you think a patient is at risk of self harm or becoming aggressive, how can their observation be stepped up?
Change from routine observation to 1-1 or 2-1 observation
What is an advance statement?
Instructions given by a patient before they are unwell
So they can be treated properly if they lose capacity to decide for themselves
Which acts give you the power to
a) treat patients with mental disorders
b) treat physical disorders in patients with mental disorders?
a) Mental Health Act
b) Adults with Incapacity Act
Who does the Mental Health Act apply to?
Patients with mental disorders
Which diseases are included under the umbrella of “mental disorder”?
Mental illness
Personality disorder
Learning disability
WHATEVER THE CAUSE
Is intoxication with drugs or alcohol a valid reason to detain someone using the MHA?
No
but if they develop a mental disorder e.g psychosis as a result, you can
What are the three types of detention order you need to know about?
Emergency detention order
Short term detention order
Compulsory treatment order
Who can fill out an emergency detention order?
FY2+
with the consent of a Mental Health Officer
Why would you file an emergency detention order?
Patient requires a full mental state examination
AND you think they are a risk to themselves or others
Who needs to give their permission before an FY2+ doctor can file an emergency detention order?
Mental health officer
How long does an emergency detention order last?
Can it be appealed?
72h
No
Who can approve a short term detention order?
How long does it last?
ST4+ psychiatrist
28 days
Apart from doctors, who else can use the MHA?
Nurses
Police
Judges
In general, emergency detention orders are filled out for patients with mental disorders who lack ___.
lack capacity
Does the MHA authorise treatment?
Emergency treatment only
Where do patients need to be taken once an emergency detention certificate has been filled out?
Hospital
Psychiatric unit
Under which act can you give a patient emergency treatment while they are under an emergency detention order?
Adults with Incapacity Act
Which detention order allows you to detain a patient for 28 days?
Is treatment allowed under this act?
Short term detention order
Yes
Can patients appeal against
a) emergency detention
b) short term detention?
a) No
b) Yes
In general, short term detention orders are for patients who cannot make ____ for themselves.
decisions
i.e they don’t have capacity due to their mental disorder
AND they pose a risk to themselves or others
What is meant by significant risk to a patient or others?
Obviously homicide and suicide
but also loss of possessions, disruption to family life, finances…
Which detention order allows a patient to be treated in hospital or in the community long-term?
Compulsory treatment order
How long does a compulsory treatment order last?
6 months
Who is responsible for filing a compulsory treatment order?
Mental health officer
with support from senior doctor and/or GP
A ___ must hear a patient’s case before a compulsory treatment order can be filed.
tribunal
What is a last ditch method of calming an aggressive patient who poses a risk to themselves or others?
Rapid tranquilisation using drugs
Which oral drug is used first line to rapidly tranquilise a patient?
Lorazepam
If oral tranquilisation isn’t effective, how can drugs be administered to calm an aggressive patient?
IM
Which oral drugs are used to rapidly tranquilise patients if they have a psychiatric history?
Lorazepam
AND/OR
Haloperidol
If a patient does not respond to rapid tranquilisation, what would you do?
Wait 30 mins and try again
If still no response, get help
Which class of antipsychotic is usually first-line for treating psychosis?
Atypical / 2nd generation
except clozapine
Which antipsychotic drug is used third-line for treatment resistant illness?
Clozapine
Due to risk of agranulocytosis
What is a depot?
Formulation injected into arm / buttock which releases drug slowly over weeks - months
What does formal admission mean in the context of psychiatric illness?
Admission under detention
What are the three risk factors you need to know to assess a patient’s risk of becoming aggressive?
Mental illness
Alcohol / substance abuse
History of violent behaviour
Which class of drug can cause psychotic symptoms as a side effect?
Steroids
