adults with incapacity/ethics bits

Question 1

incapacity defined

Answer 1

inability to make, understand, communicate, remember, act upon decisions

Question 2

what does section 47 certification authorise?

Answer 2

non-emergency medical treatment for someone who lacks capacity

Question 3

which detention certificate allos detention in hospital for 72hrs, whats the criteria?

Answer 3

emergency detention certification

criteria
- likely mental disorder
- impaired deciion making ability
- risk to themselves/others
- short term detention would take too long

can be done by any registered medical profession + no appeal process

Question 4

who can intiated each dentention certificate?

Answer 4

emergency - any registered medical professiona;

short term - psychiatrist application + MHO approval

compulsory treatment - MHO application to mental health tribunal

Question 5

how long does each dentention certificate last?

Answer 5

emergency - 72hrs

short term - 28days

compulsory treatment order - 6months in hospital or community

Question 6

criteria for short term detention certificate

Answer 6

(in hospital for 28days to administer psychiatric treatment)

• likely mental disorder
• impaired decision making ability
• risk to themselves/others if not treated
• detainment needed for treatment
• cannot be treated voluntarily

Question 7

compulsory treatment order criteria

Answer 7

(psychiatric treatment for 6 months in hospital or in community)

• DIAGNOSED mental disorder
• impaired decision making ability
• risk to themselves/others if not treated
• treatment available
• cannot be treated voluntarily

Question 8

which detention certificates can you appeal?

Answer 8

emergency detention certificate - no appeal

short term + compulsory treatment order = appeal process though mental health tribunal

Question 9

severity of learning disabilities based on IQ

Answer 9

borderline >70
mild 50-70
moderate 35-50
severe 20-35
profound <20

Question 10

features of ASD

Answer 10

negative impact on social, education, family
onset early in development

behavioural features - ritualised play (lining up blocks in a certain way), obsession with rules in games, repetitive body movements, obsessive special interests

Question 11

ADHD diagnostic features

Answer 11

inattention, hyperactivity, impulsivity
lasting 6 months

dont need to have all 3 for diagnosis
usually presents early childhood

Question 12

management of ADHD

Answer 12

cahms referral
drugs = last resort
- methylphenidate
– not given to kids <5

ADHD meds are cardiotoxic so baseline ECGs

Question 13

physiological abnormalities in anorexia

Answer 13

hypokalaemia
low FSH/LF, oestrogens + testosterone

raised cortisol + growth hormone
impaired glucose tolerance

hypercholesterolaemia
low T3

Question 14

refeeding syndrome + its metabolic abnormalities

Answer 14

occurs due to prolonged catabolic state ending abruptly - may lead to organ failure

hypophosphataemia
hypomagnesaemia
hypokalaemia

if a patient hasn’t eaten for >5days aim to refeed no more than 50% of their recommended requirements

Question 15

difference between baby blues + post natal depression

Answer 15

post natal depression lasts > 2weeks + women are affected around 3months post birth

Question 16

management of baby blues

Answer 16

(typically first 7 days after birth)

none
symptoms should be mild + only last a few days
-> should resolve within 14days

Question 17

management of postnatal depression

Answer 17

mild - CBT
moderate - CBT + SSRI (sertraline/paroxetine)

severe - CBT + SSRI + specialist perinatal psychiatry team

Question 18

screening tool for postnatal depression

Answer 18

edinburgh postnatal depression scale

Question 19

time scale of puerperal psychosis

Answer 19

2-3weeks after delivery
sudden onset with rapid deterioration

differential DDx - puerperal infection causing delirium

Question 20

which psychiatric medication must be avoided in pregnancy + what do they cause?

Answer 20

lithium - ebsteins anomaly

sodium val - neural tube defects (folic acid)

carbamezepine may b used if benefits outweigh risk of a seizure in pregnancy will be very harmful - congenital malformations

Question 21

SSRIs in pregnancy

Answer 21

regularly used - need to weigh up risks of pregnant mother with worsening depression

babies can be born with neonatal abstinence syndrome
- poor feeding + irrtability
- supportive therapy

paroxetine increases risk of congenital malformations - esp in 1st tri

Question 22

which antidepressants are excreted in breast milk?

Answer 22

all of them
SSRI + tricyclics show lower levels
- *except fluoxetine

can still give them whilst breast feeding just need to monitor baby for side effects

Question 23

ebsteins anomaly

Answer 23

rare congenital heart defect in which tricuspid valve is incorrectly formed + lower than usual in heart

half of patients also have an atrial septal defect