3.2 Psychosis management, MHA, and aggression Flashcards
What is violence?
The intentional use of physical force or power, threatened or actual
against oneself, other person, group/community
which results in or has a high likelihood of resulting injury, death, psychological harm, maldevelopment, or deprivation
-WHO
What medications can be used to treat violence?
Haloperidol 0.5-5mg PO then IM, max 10mg in 24H
If Parkinsons, Lewy body dementia, or hypsensitivity to neuroleptics:
Lorazepam 0.5-2mg (? confirm)
What mental health legislation exists to help manage violence?
Scottish Mental Health Act
What is aggression?
Used more in hospital vs violence
“intentionally hurting or gaining advantage over another person without necessarily involving physical injury)
How do you manage aggressive behaviour?
- Predict
- Prevent- de-escalation, observations, room layout etc.
- Intervention- restraint, seclusion, rapid tranquillisation
What are the principles of the Scottish Mental Health Act?
Participation- using pt's advance statements respect for carers informal care benefit non-discrimination respect for diversity least restrictive reciprocity child welfare equality
Who does the Scottish Mental Health Act apply to?
Patient: Person who has or appears to have a mental disorder
Not necessarily someone who is detained
Mental disorder: any mental illness, personality disorder, learning disability, however caused or manifested
Who can use which parts of the Scottish Mental Health Act?
- Emergency detention- any medical practitioner
- Short term detention or Compulsory Treatment Order- Approved Medical Practitioner
- Place of Safety order- Police
Patients, nurses, mental health tribunal for scotland, and courts may also use the Scottish Mental Health Act (for various reasons)
How do you use an Emergency Detention Certificate?
Use: where necessary in urgency to detain pt in hospital for full assessment of person’s mental state, AND where non-detention would be a significant risk to themselves or others
Any registered medical practitioner - GP, A/E doctor, Acute care etc.
USUALLY with consent of the Mental Health Officer, but may proceed without if urgent, state why
- The Pt is not already detained
- If pt not in hosp- you have 72H to get them into hosp
- no pt right of appeal
- DOES NOT AUTHORISE TREATMENT EXCEPT EMERGENCY TREATMENT - any tx must report to MWC on T4 form
- Must reviewed by AMP asap
What does an Emergency Detention Certificate do?
Detains a patient in hospital for maximum of 72 hours
They must be likely to have a mental disorder
Their decision making ability for medical tx for mental disorder must be significantly impaired
No alt to urgent tx in hospital
To be used where short term detention is impractical
What is a Short Term Detention (Certificate)?
Authorises treatment for max 28 days
It’s a “gateway” order
Patients get more rights and there is a named person
Pts have right to appeal to Tribunal and Mental Welfare Commission
The Approved Medical Practitioner must consider what in issuing a Short Term Detention Certificate?
- Pt has mental disorder
- Pt has significantly impaired decision making ability
- It is necessary to detain pt in hospital to decide what tx should be given, or to give pt tx.
- There would be a sig risk to health/safety/welfare of pt or to safety of another person if not detained
- STD certificate granting was necessary
What is a Compulsory Treatment Order?
It’s an order that must be applied for that authorises treatment by a tribunal hearing. It can last up to 6 months and makes treatment compulsory either in community ro hospital.
Application made by MHO supported by 2 medical reports
-1 MUST be AMP
-1 usually from GP
Pt has right of appeal, +/- legal rep
What pharmacological tx is used in the Tayside rapid tranquilisation policy for patients with:
- Hx of cardiac disease
- no hx of typical antipsychotic use
- current illicit drug use
Lorazepam 1-2mg PO or IM
Repeated once if necessary
If more than 2 injections considered, seed advice from senior experienced doctor.
What pharmacological tx is used in the Tayside rapid tranquilisation policy for patients with:
-Confirmed significant hx of typical antipsychotic use (not just stat/prn)
PO Lorazepam 1-2mg +/- Haloperidol 5mg OR IM Lorazepam 1-2mg +/- Haloperidol 5mg Repeated once (total 2 doses) if necessary. If more than 2 injections considered, seed advice from senior experienced doctor.
