adults with incapacity/ethics bits Flashcards
incapacity defined
inability to make, understand, communicate, remember, act upon decisions
what does section 47 certification authorise?
non-emergency medical treatment for someone who lacks capacity
which detention certificate allos detention in hospital for 72hrs, whats the criteria?
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
who can intiated each dentention certificate?
emergency - any registered medical professiona;
short term - psychiatrist application + MHO approval
compulsory treatment - MHO application to mental health tribunal
how long does each dentention certificate last?
emergency - 72hrs
short term - 28days
compulsory treatment order - 6months in hospital or community
criteria for short term detention certificate
(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
compulsory treatment order criteria
(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
which detention certificates can you appeal?
emergency detention certificate - no appeal
short term + compulsory treatment order = appeal process though mental health tribunal
severity of learning disabilities based on IQ
borderline >70
mild 50-70
moderate 35-50
severe 20-35
profound <20
features of ASD
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
ADHD diagnostic features
inattention, hyperactivity, impulsivity
lasting 6 months
dont need to have all 3 for diagnosis
usually presents early childhood
management of ADHD
cahms referral
drugs = last resort
- methylphenidate
– not given to kids <5
ADHD meds are cardiotoxic so baseline ECGs
physiological abnormalities in anorexia
hypokalaemia
low FSH/LF, oestrogens + testosterone
raised cortisol + growth hormone
impaired glucose tolerance
hypercholesterolaemia
low T3
refeeding syndrome + its metabolic abnormalities
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
difference between baby blues + post natal depression
post natal depression lasts > 2weeks + women are affected around 3months post birth
management of baby blues
(typically first 7 days after birth)
none
symptoms should be mild + only last a few days
-> should resolve within 14days
management of postnatal depression
mild - CBT
moderate - CBT + SSRI (sertraline/paroxetine)
severe - CBT + SSRI + specialist perinatal psychiatry team
screening tool for postnatal depression
edinburgh postnatal depression scale
time scale of puerperal psychosis
2-3weeks after delivery
sudden onset with rapid deterioration
differential DDx - puerperal infection causing delirium
which psychiatric medication must be avoided in pregnancy + what do they cause?
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
SSRIs in pregnancy
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
which antidepressants are excreted in breast milk?
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
ebsteins anomaly
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
