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Psychiatry Week 3 2018/19 > 2: Management of psychosis > Flashcards

2: Management of psychosis Flashcards

1
Q

Patients with psychosis have the potential to behave ___ towards you or others.

A

violently

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2
Q

Over the last 20 years, the rate of crime has (increased / decreased) overall.

A

decreased

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3
Q

What three factors increase the chances that someone will commit an act of violence?

A

Substance misuse

Mental illness

History of violence

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4
Q

What is the difference between violence and aggression?

A

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

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5
Q

How might you predict that a patient will become aggressive?

A

Body language

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6
Q

How is the risk of aggression against hospital staff reduced?

A

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

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7
Q

What are some interventions to prevent an aggressive patient from doing harm?

A

Restraint

Isolation

Tranquilisation

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8
Q

If you think a patient is at risk of self harm or becoming aggressive, how can their observation be stepped up?

A

Change from routine observation to 1-1 or 2-1 observation

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9
Q

What is an advance statement?

A

Instructions given by a patient before they are unwell

So they can be treated properly if they lose capacity to decide for themselves

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10
Q

Which acts give you the power to

a) treat patients with mental disorders
b) treat physical disorders in patients with mental disorders?

A

a) Mental Health Act

b) Adults with Incapacity Act

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11
Q

Who does the Mental Health Act apply to?

A

Patients with mental disorders

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12
Q

Which diseases are included under the umbrella of “mental disorder”?

A

Mental illness

Personality disorder

Learning disability

WHATEVER THE CAUSE

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13
Q

Is intoxication with drugs or alcohol a valid reason to detain someone using the MHA?

A

No

but if they develop a mental disorder e.g psychosis as a result, you can

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14
Q

What are the three types of detention order you need to know about?

A

Emergency detention order

Short term detention order

Compulsory treatment order

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15
Q

Who can fill out an emergency detention order?

A

FY2+

with the consent of a Mental Health Officer

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16
Q

Why would you file an emergency detention order?

A

Patient requires a full mental state examination

AND you think they are a risk to themselves or others

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17
Q

Who needs to give their permission before an FY2+ doctor can file an emergency detention order?

A

Mental health officer

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18
Q

How long does an emergency detention order last?

Can it be appealed?

A

72h

No

19
Q

Who can approve a short term detention order?

How long does it last?

A

ST4+ psychiatrist

28 days

20
Q

Apart from doctors, who else can use the MHA?

A

Nurses

Police

Judges

21
Q

In general, emergency detention orders are filled out for patients with mental disorders who lack ___.

A

lack capacity

22
Q

Does the MHA authorise treatment?

A

Emergency treatment only

23
Q

Where do patients need to be taken once an emergency detention certificate has been filled out?

A

Hospital

Psychiatric unit

24
Q

Under which act can you give a patient emergency treatment while they are under an emergency detention order?

A

Adults with Incapacity Act

25
Q

Which detention order allows you to detain a patient for 28 days?

Is treatment allowed under this act?

A

Short term detention order

Yes

26
Q

Can patients appeal against

a) emergency detention
b) short term detention?

A

a) No

b) Yes

27
Q

In general, short term detention orders are for patients who cannot make ____ for themselves.

A

decisions

i.e they don’t have capacity due to their mental disorder

AND they pose a risk to themselves or others

28
Q

What is meant by significant risk to a patient or others?

A

Obviously homicide and suicide

but also loss of possessions, disruption to family life, finances…

29
Q

Which detention order allows a patient to be treated in hospital or in the community long-term?

A

Compulsory treatment order

30
Q

How long does a compulsory treatment order last?

A

6 months

31
Q

Who is responsible for filing a compulsory treatment order?

A

Mental health officer

with support from senior doctor and/or GP

32
Q

A ___ must hear a patient’s case before a compulsory treatment order can be filed.

A

tribunal

33
Q

What is a last ditch method of calming an aggressive patient who poses a risk to themselves or others?

A

Rapid tranquilisation using drugs

34
Q

Which oral drug is used first line to rapidly tranquilise a patient?

A

Lorazepam

35
Q

If oral tranquilisation isn’t effective, how can drugs be administered to calm an aggressive patient?

A

IM

36
Q

Which oral drugs are used to rapidly tranquilise patients if they have a psychiatric history?

A

Lorazepam

AND/OR

Haloperidol

37
Q

If a patient does not respond to rapid tranquilisation, what would you do?

A

Wait 30 mins and try again

If still no response, get help

38
Q

Which class of antipsychotic is usually first-line for treating psychosis?

A

Atypical / 2nd generation

except clozapine

39
Q

Which antipsychotic drug is used third-line for treatment resistant illness?

A

Clozapine

Due to risk of agranulocytosis

40
Q

What is a depot?

A

Formulation injected into arm / buttock which releases drug slowly over weeks - months

41
Q

What does formal admission mean in the context of psychiatric illness?

A

Admission under detention

42
Q

What are the three risk factors you need to know to assess a patient’s risk of becoming aggressive?

A

Mental illness

Alcohol / substance abuse

History of violent behaviour

43
Q

Which class of drug can cause psychotic symptoms as a side effect?

A

Steroids

Psychiatry Week 3 2018/19 (9 decks)

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