Block 33 H&S

Question 1

How many elements are there to negligence?

Answer 1

• 3
• individual to be successfully sued, each must be proved.

Question 2

Negligence: duty of?

Answer 2

• A duty of care must be proven between the health authority, individual professional and the patient.

Question 3

Negligence: breach?

Answer 3

• A breach in the duty of care must be proven

Question 4

Negligence: damage?

Answer 4

• There must be evidence of damage caused by the breach

Question 5

When should confidentiality be broken?

Answer 5

1. Protect children
2. Protect public – e.g. from acts of terrorism
3. Required by courts
4. Prevent or detect a crime
5. Provide care in life-threatening circumstances
6. Protect the service provider in life-threatening circumstances

Question 6

Right to life?

Answer 6

• The European court has held that the article requires hospitals to take measures to ensure steps are in place to secure an individual’s right to life = mostly relevant with
  regards to suicide

Question 7

Prohibition of torture (human rights act)

Answer 7

• Have to justify medical treatment (as side effects / process e.g. ECT) could be classified as torture
• Relevant to MHA as could give patient cheaper drug with worse side effects (can’t do this), or give drug instead of psychological thera

Question 8

right to liberty and security?

Answer 8

cannot take away right to freedom without good reason

Question 9

right to a fair trial?

Answer 9

:
* Everyone sectioned has the right to a mental health review tribunal hear

Question 10

independent MH advocate =

Answer 10

Allocated worker to support pt, allow them to express their views and concerns and to defend their rights

Question 11

independent mental capacity advocate =

Answer 11

Support people who lack capacity to make certain decisions are provided under the MCA 2005

Question 12

discrediting stigma =

Answer 12

keeping stigmatising conditions hidden except from close family and friends

Question 13

Discreditin stigma =

Answer 13

keeping stigmatising conditions hidden except from close family and
friends

Question 14

felt stigma =

Answer 14

sense of fear due to ones conditions

Question 15

enacted stigma =

Answer 15

physical act of displaying stigma

Question 16

Courtesy stigma =

Answer 16

Stigma felt by someone who is with a person open to stigma e.g. parent
of a child w/ autism

Question 17

Equality act 2010?

Answer 17

makes it illegal to discriminate directly or indirectly against people with
mental health problems in public services and functions, access to premises, work,
education and transport`

Question 18

Crisis team?

Answer 18

• Support mental health crises in the community e.g. suicidal thoughts, self-harm, experiencing psychosis, severe panic attacks, putting others at risk
• Offer short term support to prevent hospital admission or can arrange for pt to go to hospital if pt is very unwell
• May offer medication, arrange regular visits, make sure pt is in touch with other services to get long term support

Question 19

Early intervention in psychosis team?

Answer 19

Can support a pt 14-35 years old if they experience psychosis for the first time or are at risk of experiencing psychosis (primary or from drug use)
- Pts can be supported by the team for up to 3 years

Question 20

what can the early intervention in psychosis teams do?

Answer 20

Provide self-management skills, housing and debt management, employment support, relapse prevention work, psychological and pharmacological
interventions, carer’s assessments, crisis plan, regular checks and monitoring

Question 21

OAT?

Answer 21

• Give intensive support because of complex mental health needs who aren’t engaging effectively with mental health services
• Aim to reduce hospital admission
• Help with daily living, taking medication, psychological therapy, social support, physical health, finding suitable accommodation, access crisis support
  quickly, care plan for family and carers

Question 22

peak onset of depression?

Answer 22

• 50% of cases occur under 40
• peak onset 25-40

Question 23

peak onset for depresion w psychotic features?

Answer 23

• 50-70

Question 24

which ethnic gr has a 4x higher rate of psychosis?

Answer 24

afro-carribean

Question 25

Carers act?

Answer 25

- carers act 1995 - carers have right to assessment of own needs even if the person they care for refuses

Question 26

help for carers - carers assessment?

Answer 26

- Carers assessment - receive a community care assessment to establish how much support from social services they are entitled to - Could mean carer is entitled to personal care assistance - e.g. having someone help pt to wash, adaptations being made to home, respite care

Question 27

Carers UK?

Answer 27

- Provide support for carers especially those having difficulty adjusting/ coping with changes in their life

Question 28

carers online support?

Answer 28

- online forums - carers support groups - carer's direct helpline

Question 29

Bed wetting?

Answer 29

- Normal for children <6 even if “toilet-trained” - Exclude a physical problem - Educate parent about appropriate toilet training methods

Question 30

Temper tantrums?

Answer 30

- normal as a toddler school refusal could be due to anxiety

Question 31

origins of addiction - predisposing and precipitating factors?

Answer 31

- genetics - learned acceptable behaviours - occupation - high in unskilled labourers - stressful life events - males > females

Question 32

maintenance - perpetuating factors in mental illness?

Answer 32

- negative reinforcement - taking drug removes negative side effects of withdrawal - psychological - tolerance develops

Question 33

Addiction =

Answer 33

continued repitition of a behaviour, despite adverse consequences

Question 34

What is dependence?

Answer 34

take a substance, and your body becomes dependent

Question 35

what are the symptoms of dependence syndrome?

Answer 35

- salience - compulsion - tolerance - withdrawal upon absitnence - resinstatement upon abstinence

Question 36

Salience =

Answer 36

substance takes priority over other behaviours

Question 37

MI 4 principles?

Answer 37

- express empathy by using reflective listening - develop discepancy between pt's values and current behaiours - sidestep resistance with empathy and understanding - support self effiacy by building pt's confidence

Question 38

Non NHS agencies in MH?

Answer 38

- MIND - samaritans - childline

Question 39

reasons why people self harm?

Answer 39

- Cry for help - Escape from intolerable situation - Relief from state of mind - Attempt to influence others - Testing the benevolence of fate

Question 40

higher suicide rates?

Answer 40

- unemployed - uni students - doctors - lawyers - farmers - politicians

Question 41

List the members of the community MH team?

Answer 41

- Psychiatrists - Psychologists - Social workers - Occupation therapists - Community psychiatric nurses - Peer support workers

Question 42

Roles of the community MH team?

Answer 42

- Psychiatrists - Assessment and diagnosis of mental health conditions - Prescribing meds - Treatment planning

Question 43

Psychologists?

Answer 43

- CBT and other psychological interventions - Psychological assessments and evaluations

Question 44

role of community psychiatric nurses?

Answer 44

- Ongoing support and care to indiv in the community - Monitor symptoms and medication adherence - Education and guidance

Question 45

role of social workers?

Answer 45

- Assessing social and envir factors impacting MH - Providing support with housing, finances and benefits - Facilitate access to community resources and services

Question 46

role of occupational therapists?

Answer 46

- Assess indiv functional ability and daily living skills - Provide interventions to improve independence

Question 47

what does the mental health act allow for?

Answer 47

- The mental health act (2007) allows for the compulsory detention of those who are mentally ill

Question 48

section 2 of the mental health act lasts for...

Answer 48

- Lasts 28 days max, not renewable

Question 49

section 2 allows for?

Answer 49

- Admission for assessment - Treatment can be given against patient’s wishes

Question 50

who applies for a section 2?

Answer 50

- AMHP makes the application based on the recommendations of 2 doctors - One of the doctors should be approved under section 12(2) – usually consultant psychiatrist

Question 51

what is a section 3?

Answer 51

- Admission for treatment - Up to 6 months but can be renewed - Tx can be given against ppt’s wishes

Question 52

who applies for a section 3?

Answer 52

- AMHP along with 2 doctors

Question 53

section 4 is a ?

Answer 53

- 72 hour assessment order - Used as an emergency when a section 2 would involve an unacceptable delayw

Question 54

who applies for a section 4?

Answer 54

- GP and an AHMP

Question 55

what is section 4 often changed to?

Answer 55

- Often changed to a section 2 on arrival at hosp

Question 56

section 5(2)?

Answer 56

* a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours

Question 57

section 5(4)?

Answer 57

* similar to section 5(2), allows a nurse to detain a patient who is voluntarily in hospital for 6 hours Sec

Question 58

section 17a?

Answer 58

* Supervised Community Treatment (Community Treatment Order) * can be used to recall a patient to hospital for treatment if they do not comply with conditions of the order in the community, such as complying with medication Sec

Question 59

section 135?

Answer 59

* a court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety Sec

Question 60

section 136?

Answer 60

* someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety * can only be used for up to 24 hours, whilst a Mental Health Act assessment is arranged

Question 61

under which sections can people not be treated?

Answer 61

- section 135 - section 136

Question 62

common law?

Answer 62

used to treat patients in emergency scenarios

Question 63

MCA?

Answer 63

- used in patients who require treatment for physical disorders that affect brain function. - Remember this may be delirium secondary to sepsis or a primary brain disorder such as dementia

Question 64

MHA?

Answer 64

- used in patients who require treatment for mental disorders. - For patients already admitted to hospital, a section 5(2) is used if there is not the time for a more formal section 2 or 3.

Question 65

AMHPs?

Answer 65

- usually social workers - can also be nurses, OTs, psychologists, doctors, psychiatrists

Question 66

Diagnostic criteria for depression?

Answer 66

Key symptoms: * persistent sadness or low mood; and/or * loss of interests or pleasure * fatigue or low energy * at least one of these, most days, most of the time for at least 2 weeks * if any of above present, ask about associated symptoms: o disturbed sleep o poor concentration or indecisiveness o low self-confidence o poor or increased appetite o suicidal thoughts or acts o agitation or slowing of movements o guilt or self-blame

Question 67

Not depressed =

Answer 67

<4 symptoms

Question 68

mild depression?

Answer 68

4 symptoms

Question 69

moderate depression =

Answer 69

5 -6 symptoms

Question 70

severe depression?

Answer 70

- seven+ symptoms - with ot without psychotic symptoms

Question 71

depression symptoms should be present for?

Answer 71

symptoms should be present for a month or more and every symptom should be present for most of every day

Question 72

GAD diagnostic criteria?

Answer 72

1. Excessive anxiety and worry, occurring more days than not for at least six months, about a number of events or activities. 2. The individual finds it difficult to control the worry. 3. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past six months): * Restlessness or feeling keyed up or on edge. * Being easily fatigued. * Difficulty concentrating or mind going blank. * Irritability. * Muscle tension. * Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep). 4. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 5. The disturbance is not exclusively due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a mood disorder, psychotic disorder, or pervasive developmental disorder.

Question 73

panic disorder diagnostic criteria?

Answer 73

- Recurrent panic attacks which are characterised by a discrete period of intense fear or discomfort, typically reaching a peak within minutes and during which time 4+ of the following symptoms occur: - Palpitations, pounding heart, or accelerated heart rate. - Sweating. - Trembling or shaking. - Sensations of shortness of breath or smothering. - Feelings of choking. - Chest pain or discomfort. - Nausea or abdominal distress. - Feeling dizzy, unsteady, lightheaded, or faint. - Chills or heat sensations. - Paresthesias (numbness or tingling sensations). - Derealization (feelings of unreality) or depersonalization (being detached from oneself). - Fear of losing control or going crazy. - Fear of dying.

Question 74

panic disorder At least one of the attacks has been followed by one month or more of one or both of the following?

Answer 74

- Persistent concern or worry about individual panic attacks or their consequences - Significant maladaptive change in behaviour related to the attacks e.g. avoidance of situations

Question 75

Schizophrenia - characteristic symptoms?

Answer 75

- At least one of the following - Must be present for at least a month: - Delusions - Hallucinations - Disorganised speech - Grossly disorganised or catatonic behaviour - Negative symptoms such as avolition – lack of motivation

Question 76

what to exclude w schizophrenia?

Answer 76

- Schizoaffective disorder and mood disorder with psychotic features have been ruled out - Exclusion of organic causes - One of more major areas of functioning such as work, interpersonal realtions or self care are markedly reduced

Question 77

management of a violent patient - immediate safety measures?

Answer 77

- Ensure safety of patient and staff - removal of weapons

Question 78

management of a violent ppt - assessment and risk management?

Answer 78

- conduct thorough mental state assessment - assess risk level - create risk management plan tailored to the patient’s indivdual needs

Question 79

management of a violent patient - de-escalation?

Answer 79

- verbal techniques to reduce agitation - Calm and non confrontational demeanour

Question 80

Medications for violent behaviour?

Answer 80

- IM lorazapam - Haloperidol and other Aps

Question 81

psych therapy for violent patient?

Answer 81

- Conselling and other therapy aimed at improving social skills and anger management

Question 82

Prevalence of anxiety?

Answer 82

- Prevalence: Adult Psychiatric Morbidity survey – 19% of adults - Gender differences: women > men Worlwide: 4%

Question 84

prev of depression?

Answer 84

- Prev: 19% - Gender: women> men - Worldwide: 5% - 280 million people worldwide

Question 85

prevalence =

Answer 85

- Proportion of people in a population who have a disease at a specific time period or over a specified period - Measure of the total burden of disease in the population

Question 86

what does prevalence include?

Answer 86

- Includes new and existing cases

Question 87

what is prevalence influenced by?

Answer 87

- Influenced by duration of disease, incidence, rate of recovery or mortality

Question 88

incidence =

Answer 88

- Rate at which new cases occur in the population - Measures risk of developing the disease within a certain time frame

Question 89

incidence is the ? per ?

Answer 89

- New cases per unit of population at risk

Question 90

what is incidence used to study?

Answer 90

- Used to study risk factors of a disease

Question 91

role of mental health teams in management od depression?

Answer 91

- Assessment and diagnosis: psychiatrists, psychologists, nurses - Treatment planning: development of treatment plans tailored to needs and preferences - Medication management: psychiatrists monitor medications and adjust treatment regiments - Psychotherapy – psychologists - CBT

Question 92

Relationship between cultural factors and symptoms and experience of depression?

Answer 92

- Cultural norms and values – in some cultures mental health problems may be stigmatized or misunderstood -> symptom concealment or symptom delay - rCultural attititudes e.g. towards emotional expression can influence how depression is experienced

Question 93

relationship between SES and depression?

Answer 93

- SES – income, education, housing - Can influence prevalence, severity, and course of depression - Lower SES -> inc stress, financial strain

Question 94

relationship between ethnicity and depression?

Answer 94

- Discrimination and marginalisation based on race, gender, sexual orientation or immigration status -> stress, psychological distress and increasing risk of depression - Discrimination can impact access to healthcare and treatment -> making mental health disparities worse

Question 95

cultural beliefs influence a person's....

Answer 95

-Cultural beliefs – influence an individual’s understanding of depression and their help seeking behaviours

Question 96

cultural factors and seeking treatment for depression?

Answer 96

- Cultural beliefs can lead to stigma which can deter a person from seeking support due to fear of social rejection or discrimination - Cultural acceptance and understanding can facilitate help seeking and treatment adherence

Question 97

support for treatment for depression?

Answer 97

- Social support networks – family networks and cultural norms influence availability and effectiveness of social support networks for ppl w depression - Strong support systems -> coping w symptoms and accessing treatment

Question 98

what limits people accessing support for MH?

Answer 98

- Accessing help – SES, cultural beliefs, and systemic barriers can affect access to HC and treatment services for depression - Limits ability to seek and receive mental health care

Question 99

MH problems in PC?

Answer 99

- 1 in 3 patients presenting to PC have a MHC - Increased demand – patients with mental health problems often have physical symptoms -> freq consultations -> inc demand - Complexity of care – due to multifaceted nature of mental health conditions and co-morbities

Question 100

MH problems present a ? challenge in primary care

Answer 100

- Diagnostic challenges due to overlap of physical and psychological symptoms

Question 101

? of ppl w a MHP are cared for entirely witjin primary care?

Answer 101

- 90% of people with mental health problems are cared for entirely within primary care - PC uses less than 10% of the total expenditure on MH

Question 102

epidemiology of self harm?

Answer 102

- 13% - Higher rates in females

Question 103

in which age gr are self harming rates higher?

Answer 103

- Women: 15-24 - Men: 25-34

Question 104

epidemiology of suicide?

Answer 104

- Higher rates in men - Highest amongst middle aged adults, paticularly males - Females are more likely to attempt suicide but men are more likely to die by suicide

Question 105

in which age group do suicide rates peak?

Answer 105

-45-49 age gr is the peak

Question 106

assessment of self harm?

Answer 106

- Assessment of self harm behaviour – including frequency, methods, triggers - Develop a safety plan with the individual – e.g. identifying warnings signs, coping strategies, emergency contacts Psycho

Question 107

psychoeducation for self harm?

Answer 107

- Provide info and psychoeducation about self harm including common triggers, and potential consequences - Alternate coping strategies such as relaxation techniques, mindfulness and problem solving skills

Question 108

CBT for self harm?

Answer 108

- CBT or DBT for self harm - CBT focuses on identifying and challenging negative thought patterns, learning adaptive coping skills, and developing alternative ways of responding to emotional distress.

Question 109

referral for self harm?

Answer 109

- Includes PC, CMHTs, specialist services for self harm and suicide prevention - Collaborate with MHPs to develop comprehensive care plans

Question 110

referral to non NHS agencies for self harm?

Answer 110

- That offer specialized support and interventions for self harm such as counselling, peer support grs, crisis helplines Discus

Question 111

impact of ethnicity on diagnosis of psychosis - diagnostic bias?

Answer 111

- Diagnostic bias – ppl from ethnic minorities such as Black and Hispanic populations are more likely to be diagnosed with psychosis comp to white people - This may be influenced by diagnostic bias, where cultural differences in expression of distress and symptoms are misinterpreted as signs of psychosis.

Question 112

impact of ethnicity on diagnosis of psychosis - access to care?

Answer 112

- Access to care – racial and ethnic disparities in access to MH services may result in delayed or inadequate Tx for psychosis

Question 113

impact of ethnicity on diagnosis of psychosis - language barriers?

Answer 113

-Language barriers contribute to disparities in diagnosis and Tx

Question 114

culture and the diagnosis of psychosis?

Answer 114

- Cultural interpretation of symptoms – differences in interpretation of psychotic symptoms can influence how families and indiv perceive and attribute distressing experiences - Cultural expression of distress – cultural norms and values influence how psychotic symptoms are expressed within different cultures

Question 115

Age & diagnosis of psychosis?

Answer 115

- Childhood onset psychosis may present with atypical symptoms and developmental delays - Age related RF - such as cognitive decline, medical comorbidities, and substance use, can complicate the diagnosis and management of psychosis in older adults - Co-morbidities can mask psychotic symptoms

Question 116

Give examples of the impact on carers where a person has complex mental health needs - emotional ?

Answer 116

- Emotional strain – feelings of stress, anxiety, sadness, frustration - Witnessing struggle of loved ine

Question 117

Give examples of the impact on carers where a person has complex mental health needs - physical?

Answer 117

demands of caregiving as they may neglect their own health

Question 118

Give examples of the impact on carers where a person has complex mental health needs - social and financial?

Answer 118

- Social isolation – many carers find it difficult to maintain social activities and connections outside of caring. Can worsen feelings of loneliness - Financial strain – reducing hours/ leaving job to care

Question 119

Give examples of the impact on carers where a person has complex mental health needs - psych impact?

Answer 119

- Psychological impact – psych distress, depression, burnout – unpredictability and severity of loved one’s mental health symptoms

Question 120

Give examples of the problems that people with sensory impairments may have accessing mental health services ?

Answer 120

- Communication barriers – struggling with telephone systems, GP touchscreens, lack of sign language - Lack of accessibility – digital resources and informational materials may not be accessible - Stigma and discrimination – deter them from accessing help - Transportation challenges

Question 121

impact of addiction on society?

Answer 121

- Economic burden – healthcare costs, lost productivity, social welfare costs - Crime and violence – ASB, drug related offenses, domestic violence - Public health crisis – HIV. AIDs, Hepatitis

Question 122

Impact of addiction on family?

Answer 122

- Strains relationships - Emotion distress of family members – shame, guilt, depression, low self eseteem - Financial instability – debt, economic hardship for families

Question 123

impact on indiv of addiction?

Answer 123

- Physical health consquences – infectious, resp, cardiovascular problems - MH – addiction often co-occurs with MH disorders - Social isolation – due to strained relationships and alientation

Question 124

RF for drug taking?

Answer 124

* early aggressive factors * lack of parental supervision * academic problem * peer substance use * drug availability * child abuse/ neglect * poverty

Question 125

individual risk factors for drug taking?

Answer 125

* genetic disposition * prenatal alcohol exposure * difficult temperament * poor impulse control * low harm avoidance * lack of self regulation * ADHD/ anxiety/ depression/ antisocial behaviour * rebelliousness

Question 126

personality traits increasing risk of drug taking?

Answer 126

Personality traits: including disinhibition, poor impulse control, novelty or sensation seeking may increase the risk of substance misuse.

Question 127

co-morbidities increasing risk of drug taking?

Answer 127

Psychiatric co-morbidities (depression, anxiety, PTSD, psychosis): illicit drugs may be used in an attempt to self-medicate.

Question 128

societal factors increasing risk of drug taking?

Answer 128

* peer pressure * lack of family involvement * attitudes towards drugs/ alcohol * Social and environmental factors: * poor school achievement, unemployment, social deprivation, history of criminal activity, peer influence, and normalisation of substance misuse in the individual’s culture or peer group.

Question 129

Health promotion for reducing alcohol - education and awareness?

Answer 129

- Increasing public awareness - By providing accurate information abt health consequences. Social impacts and legal ramifications of substance use ppl can make informed decisions abt drug and alcohol use

Question 130

Health promotion for reducing alcohol - risk reduction strategies?

Answer 130

- Promotion of harm reduction strategies to minimise negative consequences - E.g. resp drinking behaviours such as moderate alcohol consumption, avoiding binge drinking

Question 131

Harm reduction strategies?

Answer 131

- Harm reduction strategies – needle exchange programmes, overdose prevention training, access to naloxone

Question 132

Policy in reducing alcohol?

Answer 132

- EB policies and regulations to reduce misuse and harm at the population level - E.g. restrictions on alcohol advertising and marketing, increasing taxes on alcohol and tobacco products, enforcing age restrictions for alcohol and tobacco sales

Question 133

cycle of change model stages?

Answer 133

- precontemplation - contemplation - prep - action - maintenance - termination

Question 134

precontemplation?

Answer 134

not yet considering changing their behaviour

Question 135

contemplation?

Answer 135

aware of the need to change and are considering taking action

Question 136

preparation stage?

Answer 136

person has made a commitment to change and is preparing to take action

Question 137

action?

Answer 137

ppl modify their behaviour to achieve theit goals

Question 138

maintenance stage?

Answer 138

- ppl work to sustain the changes they have made over the long term. - May develop strategies for managing cravings, coping and triggers and preventing relapse

Question 139

termination stage?

Answer 139

In this stage, individuals have successfully integrated the new behavior into their lifestyle, and the risk of relapse is minimal

Question 140

MI is a...

Answer 140

- Goal oriented approach to facilitating behaviour change by helping individuals explore and resolve ambivalence

Question 141

what are the steps of MI?

Answer 141

- Empathetic approach – active listening - Develop discrepancy - Practitioners help clients explore the discrepancy between their current behavior and their goals, values, or aspiration - Avoid argumentation – practioners take a non-confrontational stance - Support self-efficacy – improve confidence of the ppt in making positive changes

Question 142

Outline how effective co-working with other NHS specialties and non-NHS agencies maintains high quality patient care?

Answer 142

- Co-working allows development of holistic treatment plans - Collaborating with specialists allows HC teams to draw on diverse perspectives and knowledge - Continuity of care – as ppts move between different HC settings and services - Shared care planning and monitorig between different agencies

Question 143

Attachment in the development of personality?

Answer 143

- Attachment – e.g. with primary caregivers - Secure attachment: responsive and nurturing caregiving, fosters trust and good emotional regulation - Insecure attachment: inconsistent or neglectful parenting -> insecurity and difficulties in forming close relationships

Question 144

personality - authoritative parenting ->

Answer 144

warmth and support -> positive outcomes such as self confidence

Question 145

authoritarian parenting- >

Answer 145

high control and low warmth -> anxiety, low self esteem and rebellious behaviour

Question 146

how does culture shape personality?

Answer 146

- Cultural and environmental factors, such as cultural norms, values, and societal expectations, shape personality development by influencing the socialization process and providing context for individuals' experience

Question 147

What are personality disorders?

Answer 147

Personality disorders are characterized by enduring patterns of thoughts, feelings, and behaviors that deviate from cultural expectations and cause significant impairment in social, occupational, or other areas of functionin

Question 148

Arguments for personality disorders?

Answer 148

- Clinical utility – provides a framework for understanding and diagnosing indiv with persistent maladaptive heaviours - Helps to identify people who may benefit from interventions - Treatment planning – allows us to addess the underlying patterns of dysfunction - Research benefits – allows study of etiology, course and treatment outcomes of different PDs

Question 149

Arguments against the concept of PD?

Answer 149

- Stigmatisation and labelling - Diagnostic overshadowing - Dimensional nature of personality – oversimplification of the complexity of personality functioning - Limited treatment efficacy

Question 150

Duty of care?

Answer 150

- HCPs have a duty to assess and manage the risk of violence to others

Question 151

informed consent?

Answer 151

- Informed consent required before using interventions aimed at managing the risk of violence - May be lack of insight

Question 152

confidentiality?

Answer 152

- Legal exception where there is a serious risk of harm to others - Balance of duty to maintain confidentiality with the duty to warn others Least r

Question 153

least restrictive measures?

Answer 153

- Least restrictive measures should be used to the level of risk – not restrict their right to liberty unnecessarily

Question 154

effectcts of normal aging on health?

Answer 154

- Cognitive changes – concerns over memory loss -> anx and stress - Emotional regulation – more susceptibility to depression, anx, loneliness - Physical health conditions such as chronic pain and arthritis -> distress, functional impairment, reduced QoL

Question 155

effects of physical illness on MH - distress?

Answer 155

Diagnosis of a physical illness, particularly chronic or life-threatening conditions, can lead to psychological distress, including anxiety, depression, and adjustment disorders

Question 156

effects of physical illness on MH - uncertainty?

Answer 156

- Uncertainty about prognosis, treatment options, and future health outcomes can contribute to emotional distress and existential concerns.

Question 157

other effects of physical illness on MH?

Answer 157

- Pain and insomnia -> distress, disruption of daily activities - Medication side effects e.g. sexual dysfunction, CI, mood changes Social

Question 158

Social and family consequences of physical illness?

Answer 158

- Caregiver stress - Financial strain - Changes in family dynamic

Question 159

effects of dementia on carers ?

Answer 159

- Emotional strain – witnessing cognitive decline - Caregiver burden – exhaustion, burnout - Social isolation - Financial - Role strain – balancing multiple roles and resp such as caregiver, spouse etc - Loss of personal identity

Question 160

Support for dementia carers?

Answer 160

- Dementia advisors and support workers – personalised support, info and guidance to carers and families - Practical support with navigating the care system and accessing local support

Question 161

carer support group?

Answer 161

- bring together individuals who are caring for someone with dementia to share experiences, advice, and practical tips for coping with caregiving challenges.

Question 162

respite care services for dementia?

Answer 162

- temp relief for carers by providing short term care and support for the person w dementia - allowing carers to take a break

Question 163

how can respite care services be provided?

Answer 163

- Respite care services may be provided in various settings, including day centers, residential respite care facilities, or through home-based respite care services.

Question 164

community support for patients with psychiatric disorders in old age?

Answer 164

- CMHTs - day centers - home care centers

Question 165

CHMTs for older adults w psychiatric conditions?

Answer 165

- CHMTs provide MDT support and treatment for older adults w psychiatric disorders in the community - Includes assessment, psych therapies, social support

Question 166

day centers for older adults with psych condt?

Answer 166

- provide structured daytime programs - provide social activities. cognitive stimulation, practical support

Question 167

home care services for older ppl w psychiatric conditions?

Answer 167

- for people living in their own homes - includes personal care, medication Mx, meal prepping, transportation and companionship

Question 168

assisted living facilities offer...

Answer 168

- Assisted living facilities offer residential accommodation and support services for older adults with psychiatric disorders who require assistance with activities of daily living but do not require 24-hour nursing care.

Question 169

what are the types of assisted living facilities?

Answer 169

- residential care homes - gr homes

Question 170

residential care homes?

Answer 170

Residential care homes provide 24-hour supervised care and support for older adults with psychiatric disorders who require more intensive assistance with personal care, mobility, and supervision

Question 171

group homes?

Answer 171

- a.k.a as residential homes and supported housing - offer shared accom for older ppl w psych disorders - Residents live together in a supportive community setting and receive assistance with daily living activities, medication management, and social support. Nursin

Question 172

nursing homes for older adults w psych conditions?

Answer 172

- provide 24-hour nursing care and support for older adults with psychiatric disorders who have complex medical needs, functional impairments, or behavioral challenges that require skilled nursing care - some have specialised dementia care units

Question 173

features of health adjustment responses to physical illness?

Answer 173

- active coping - engaging in problem solving strategies - seeking social support - using coping strategies

Question 174

features of unhealthy adjustments to physical symptoms?

Answer 174

- avoiding or denying physical symptoms - minimising significance - refusing to acknowledge need for medical care - delay seeking treatment, ignore warning signs - maladaptive coping – substance abuse, self medication to provide temp relief but can exacerbate health problems

Question 175

personal factors which can influence adjustment to physical symptoms?

Answer 175

- Individual differences in personality, coping styles, resilience, and psychological resources can influence adjustment to physical symptoms. - Factors such as self-efficacy, optimism, and perceived control over health outcomes can promote healthy adjustment, - while factors such as low self-esteem, learned helplessness, and negative beliefs about illness may contribute to maladaptive adjustment. Family

Question 176

family factors influencing adjustment to physical symptoms?

Answer 176

- Positive family support, open communication, and shared coping strategies can facilitate healthy adjustment, - while family conflict, dysfunction, or lack of support may hinder adaptation and exacerbate distress

Question 177

cultural factors affecting a person's adjustment to physical symptoms?

Answer 177

- Cultural factors shape individuals' attitudes toward seeking medical care, expressing emotions, and relying on social support. - Cultural stigma, discrimination, and beliefs about fate, destiny, or spiritual explanations for illness may impact adjustment and help-seeking behaviors

Question 178

primary HP strategies for promotion of mental wellbeing?

Answer 178

- Public awareness campaigns - Public awareness campaigns aim to raise awareness about mental health issues, reduce stigma, and promote positive attitudes toward mental well-being - Education and training programs - Education and training programs provide individuals with knowledge, skills, and resources to promote mental well-being and resilience. - Promotion of healthy lifestyle behaviours – such as regular physical activity, balanced nutrition and adequate sleep

Question 179

importance of prevention in child MH ?

Answer 179

- Early intervention and risk reduction - Prevention efforts aim to identify and address risk factors for mental health problems in children before they escalate into more severe issues. - By intervening early, prevention programs can reduce the likelihood of children developing chronic mental health conditions and experiencing long-term negative outcomes.

Question 180

normalisation of mental health concerns in children?

Answer 180

Normalizing mental health concerns, such as anxiety, bedwetting, school refusal, or tantrums, helps reduce stigma and increase awareness of common childhood challenges.

Question 181

early intervention and prevention can reduce the?

Answer 181

long term impact of mental health problems on a child’s overall QoL and school functioning

Question 182

role of the school in managing child MH?

Answer 182

- Identification of early signs of MH concerns – teachers and staff - Preventative interventions - may include social-emotional learning (SEL) programs, bullying prevention initiatives, stress reduction activities, - Supportive environment for students by providing access to school counselors, school psychologists

Question 183

Health visitors in the management of child MH?

Answer 183

- Identification of RF and screening for parental MH problems - provide information, guidance, and referrals to appropriate services. - Offer home visits, developmental assessments and parenting support - Health visitors promote positive parent-child bonding and attachment by providing guidance on responsive caregiving, communication strategies, and stress management techniques

Question 184

Role of social services in management of child MHP?

Answer 184

- develop support plans and interventions to address concerns such as parental mental illness, substance abuse - child protection and safeguarding - identifying and responding to concerns of abuse, neglect, or exploitation.

Question 185

educational psychologists in managing child MH?

Answer 185

- assessment and intervention - assess children's cognitive, emotional, and behavioral functioning to identify factors that may impact their learning and well-being. - Support for special education needs

Question 186

Physiological theories of EDs - genetic factors?

Answer 186

higher concordance rate for eating disorders among identical twins compared to fraternal twins

Question 187

Physiological theories of EDs - neurobiological?

Answer 187

dysregulation of neurotransmitters such as serotonin, dopamine, and norepinephrine, may contribute to the development of eating disorders

Question 188

Physiological theories of EDs - endocrine?

Answer 188

hormonal imbalances such as disruptions in HPA axis and abn in secretion of hormones like cortisol, insulin and leptin

Question 189

sociological factors in development of ED?

Answer 189

- Social pressures – medial portrayals of thinness and pressure to attain ideal body images - Exposure to media images, peer pressure and societal emphasis on appearance - Family – parental modelling of dieting behaviours, perfectionism

Question 190

Cultural factors in development of ED?

Answer 190

- Cultural – societies that prioritise thinness may stigmatise certain body types and may contribute to internalisation of thin-ideal standards

Question 191

Developmental theories in the development of EDs - early life?

Answer 191

- Developmental transitions, such as puberty, adolescence, and young adulthood, are critical periods for the onset of eating disorders - Life events such as trauma or absuse

Question 192

development theories in the development of EDs- insecure attachment?

Answer 192

- Insecure attachment styles, characterized by ambivalence, avoidance, or disorganization, may predispose individuals to develop maladaptive coping mechanisms, including disordered eating behaviors, as a way to regulate emotions and seek validation.

Question 193

developmental theories of ED - personality traits?

Answer 193

- Individuals with perfectionistic tendencies, low self-esteem, identity confusion, or difficulties in emotion regulation may be more vulnerable to developing eating disorders

Question 194

Role of the mental health act in management of an eating disorder?

Answer 194

- If a person with an eating disorder is deemed to be at risk of serious harm to themselves or others due to their condition, they may be detained under the MHA for assessment and treatment. - Compulsory treatment – sectioning or use of CTOs

Question 195

the MHA requires that indiv w EDs, are?

Answer 195

assessed for their capacity to make decisions about their treatment. If a person lacks the capacity to make informed decisions due to the severity of their eating disorder or associated mental health issues, their treatment decisions may be made by healthcare professionals

Question 196

RCT is an?

Answer 196

- Effectiveness study. Experimental

Question 197

cohort studies look at?

Answer 197

risk or prognosis. Can be retro or prospective

Question 198

CCS look at?

Answer 198

risk or prognosis. Always retrospective.

Question 199

issues w methodology?

Answer 199

- Blinding, allocation concealment? - Administering the intervention - Differences in population - Biases introduced - How was the data measured and analysed?

Question 200

problems that can arise w cohort/ CCS?

Answer 200

- Long enough follow up? - Biases - Recruitment - Measurement and analysis? - Differences in population

Question 201

Child protection act?

Answer 201

- set of laws aimed at safeguarding children from harm and ensuring their welfare

Question 202

what does the child protection act cover?

Answer 202

- mandatory reporting of abuse - child welfare assessments - provisions of children in need of protection or care

Question 203

when was the child protection act made?

Answer 203

1998

Question 204

mandatory reporting?

Answer 204

- all cases of FGM under 18s - child sexual abuse

Question 206

children act was made in?

Answer 206

2004

Question 207

Principles of the children act 2004?

Answer 207

- Allow children to be healthy - Help children to be happy and enjoy life - Allowing children to remain safe in their environments - Help children to succeed - Help achieve economic stability for the future - of children - Help make a positive contribution to children's lives

Question 208

what did the children act 2004 outline?

Answer 208

- children's comissioner for england - safeguarding boards - co-ordinate efforts between organisations like social, healthcare and the police - imp of info sharing

Question 209

the children act 2004 introduced the ? framework?

Answer 209

The act introduced the Common Assessment Framework to provide a standardized approach for assessing the needs of children and identifying appropriate services to support them.

Question 210

psychological consequences of substance misuse?

Answer 210

- chronic substance misuse -> cognitive impairment and memory problems - withdrawal symptoms -> emotional instability, agitation and cravings

Question 211

social consequences of addiction?

Answer 211

- strain on relationships w family or friends -> social isolation - impair functioning in their job or in education - stigma and discrimination -> alientation

Question 212

economic consequences of substance misuse?

Answer 212

- economic burdens on HCS due to increased healthcare utilisation and productivity losses - financial costs of substance related costs - decreased productivity

Question 213

link between substance misuse and crime?

Answer 213

- Substance misuse is often associated with criminal behavior, including drug trafficking, theft, burglary, and violent crime. - may be to finance the addiction - could be due to the increased impulsive and risky behaviour

Question 214

section 135 vs 136?

Answer 214

- section 135 - at home - section 136 - in a public place

Question 215

Anxiety screening tool?

Answer 215

- GAD-2 * anxiety disorder is likely if a person answers 2 or 3 to one or both Qs (ie anxiety present > 50% time)

Question 216

Clark's CBT model for panic attacks?

Answer 216

* The trigger can be external (eg crowds) or internal (eg heartbeat) – ‘selective attention’/ ‘hypervigilence’ * The person misinterprets normal body sensations as meaning that a physical or mental disaster is imminent –  ‘catastrophic misinterpretation’ * The ‘fight or flight’ survival response produces more symptoms - which fuel the ‘vicious cycle’ of panic * attempts by the person to manage panic bring short term relief but make it worse in the long term (avoidance + safety behaviours)

Question 217

precipitating factors in GAD?

Answer 217

Stressful life events eg relationship problems, physical illness, threatened loss of employment (contrast losses - which tend to provoke depression)

Question 218

Maintaining factors in GAD?

Answer 218

- CBT theory states that in GAD worrying abour worry maintains anxiety and leads to unsuccessful attempts to control it

Question 219

RF for anxiety?

Answer 219

* Female sex * Family history * Childhood abuse and neglect * Environmental stress (e.g. redundancy, divorce) * Emotional trauma * Substance abuse

Question 220

diagnostic criteria for anxiety?

Answer 220

Question 221

resilience factors =

Answer 221

* Resilience factors (RFs) are psychological resources that buffer the potentially negative effects of stress on mental health. 

Question 222

examples of resilience factors?

Answer 222

* the ways in which individuals view and engage with the world * the availability and quality of social resources * specific coping strategies

Question 223

problem solving and anxiety?

Answer 223

* anxiety (especially chronic) can hinder our ability to filter things that we think of as a threat in order for our brains to accurately concentrate on the retrieval of info necessary for problem solving

Question 224

members of community MH teams?

Answer 224

* nurses * occupational therapists * psychologists * MH support workers * consultant psychiatrists

Question 225

Community mental health teams work as part of an MDT to:

Answer 225

* provide medical support * putting patients in touch with other agencies * short term work for a specific mental health diagnosis which requires short term support * physical health monitoring

Question 226

CMHTs work as part of an MDT and can provide support with (3)?

Answer 226

* support w employment support * psychological approaches * support with day to day activities and functioning

Question 227

organisiation of MH services?

Answer 227

* Primary care - GP * community - MH teams * hospitals and in specialist services * this is primary, secondary and tertiary care

Question 228

NHS LTP?

Answer 228

is going to create intergrated community mental health servcies

Question 229

primary MH services?

Answer 229

GP - refer to secondary services but these can also be accessed through the single point of access

Question 230

secondary MH services?

Answer 230

specialised, include teams like community MH teams, crisis resolution and home treatment teams and hospital care

Question 231

voluntary MH services?

Answer 231

- Running alongside primary and secondary services are voluntary services: support provided in the community, usually by charities and other non-profits. - You can often access these services without a referral

Question 232

tertiary MH services?

Answer 232

highly specialised treatment like forensic MH services or specialist psychotherapy services

Question 233

intergrated care systems =

Answer 233

* removing traditional divisions between different tiers of care * so that people get less disjointed care

Question 234

what do ICS aim to do?

Answer 234

* aims to remove divisions such as those between hospials and GPs, physical and mental health and the NHS & local authority

Question 235

ICS are new partnerships between?

Answer 235

between the NHS and other health and care organisations. Such as the local authority, voluntary sector and social enterprise sector

Question 236

depression epidemiology?

Answer 236

* 4th leading casue of disability worldwide * point prevalence 2-5%

Question 237

RF for depression?

Answer 237

- genetics - Gender – twice as common in women - Childhood experience – e.g. loss of parent, lack of parental care, abuse - Personality – especially neuroticism - Social environment – life stresses, lack of social network etc - Physical illness

Question 238

ICD-10 criteria for depression

Answer 238

Question 239

levels of CBT - self help materials?

Answer 239

* Self-help materials – This is not a form of psychotherapy and no CBT skills or training are required by the individual reading the self-help material (e.g. books/ websites).

Question 240

levels of CBT - assisted self help?

Answer 240

* Assisted self-help - computerized CBT, self-help material presented to a support group or individuals by a health worker, such as a graduate mental health worker or assistant psychologist

Question 241

levels of CBT - CBT approaches?

Answer 241

* CBT approaches - Specific CBT interventions for specific problem areas, e.g. anxiety management, coping with voices etc.

Question 242

levels of CBT - formulation driven CBT?

Answer 242

* Formulation driven CBT– This is a form of psychotherapy, the patients are not fully able to help themselves and have sought help from a trained professional.

Question 243

what are the levels of CBT?

Answer 243

1) Self help materials 2) assisted self help 3) CBT approaches 4) formulation driven CBT

Question 244

what do the therapist and patient agree on during CBT?

Answer 244

* Patient and therapist agree problem list and goals. Treatment is a collaborative partnership * Focuses on ‘here and now’

Question 245

Which type of questioning is used in CBT?

Answer 245

* socratic questioning used by the therapist * open therapeutic process * homework used

Question 246

what is the CBT model of depression?

Answer 246

* Underlying beliefs centre around being helpless or unloveable * Trigger events typically involve loss or ‘failure’ * This produces negative cognitions about self/ future/ world which reinforce underlying beliefs, and affect mood and behaviour

Question 247

CBT model of depression - how are negative thoughts maintained?

Answer 247

* These negative thoughts are maintained by distorted information processing (e.g. overgeneralization, personalization, selective abstraction)

Question 248

red flags in depression?

Answer 248

* Risk of suicide * Feeling of hopelessness * Chronic pain * Disabling symptoms * Severe and prolonged symptoms

Question 249

How do young adults tend to present with depression?

Answer 249

* Young adults tend to sleep a lot, overeat, withdraw and show self-neglect.

Question 250

how do older adults tend to present with depression?

Answer 250

* Older adults often present with insomnia, anxiety, anorexia, poor self-care and exacerbation of pre-existing physical conditions like painful arthritis, constipation, head and neck and back pain

Question 251

Diagnostic criteria for depression

Answer 251

Question 252

depression is the ? most common reason for consulting a GP

Answer 252

3RD

Question 253

Normal grief reactions?

Answer 253

* shock, denial, numbness, guilt, sadness, weeping, resolutuon * Emotional and practical support is normally sufficient.

Question 254

abnormal grief reactions?

Answer 254

* if symptoms are more intense e.g. clinical depression or if they're prolonged (beyond 6 months) or if they're delayed in onset * Counselling, “guided mourning” and occasionally medication may be needed.

Question 255

socio-cultural aspects of depression - black and asian races present less ofern with?

Answer 255

* Black and Asian races present less often to their GP with “depression” * Some groups are more likely to complain of physical symptoms eg Mediterranean (“nerves, headache”), China & Asia (“weak, tired”),

Question 256

what are risk factors for suicide?

Answer 256

* migration and not speaking the local language are risk factors for suicide * refer to specific services e.g. Refugee council and use a professional translator

Question 257

for depression to be diagnosed there needs to be?

Answer 257

* 4+ symptoms for at least 2 weeks include at least 2 of the first 3 core symptoms

Question 258

ECT monitoring - addenbrooke's cognitive assessment?

Answer 258

* addenbrooke's cognitive assessment mainly used - measures new learning, retrograde amnesia and subjective memory impairment

Question 259

advantages of ECT?

Answer 259

* Effective when other treatments don’t work * Most effective with most severe illness

Question 260

Disadvantages of ECT?

Answer 260

* Multiple brief anaesthetics * Acute confusional states * Memory impairment: anterograde and retrograde

Question 261

Acute impact of ECT on serotonin?

Answer 261

·  increased cerebral serotonin concentration

Question 262

chronic impact of ECT on serotonin?

Answer 262

·  increase in post-synaptic 5-HT2 receptors

Question 263

inform patient started on AD of:

Answer 263

- risks including transient increase in anxiety at the start of treatment) - and of the risk of discontinuation/withdrawal symptoms if the treatment is stopped abruptly or in some instances if a dose is missed or, occasionally, on reducing the dose of the drug.

Question 264

indications of ECT?

Answer 264

* treatment resistant depression * severe major depression * bipolar depressive and mania * schizophrenia

Question 265

side effects of ECT?

Answer 265

* nausea * headache * fatigue * confusion * slight memory loss

Question 266

self help materials in depression?

Answer 266

* royal college of psychiatrists which provides patient information * MIND * Depression UK * mental health foundation

Question 267

depression management: improving wellbeing?

Answer 267

* provide advice on activities to imptove wellbeing such as * physical activity: walking, jogging, swimming, dance * Maintaining a healthy lifestyle through diet, alcohol intake, and sleep.

Question 268

depression management: social support?

Answer 268

* social support for family/ carers supporting the person

Question 269

CMHTs assess patients who are referred and?

Answer 269

patients are then allocated a key worker who co-ordinates their treatments

Question 270

Crisis teams involve?

Answer 270

* psychiatrists * MH nurses * social workers * support workers

Question 271

Roles of crisis teams (4)?

Answer 271

* can visit the patient's home or them in hospital if they're being discharged * assist with self help strategies * administer medications * provide practical help e.g. with money or housing

Question 272

Early intervention teams can?

Answer 272

support you if you experience psychosis for the first time

Question 273

What are EIT?

Answer 273

* they are MDTs set up to identify and reduce treatment delays at the onset of psychosis and promote recovery by reducing the probability of relapse following a first episode of psychosis

Question 274

who are assertive outreach teams for?

Answer 274

* for those with complex mental health needs e.g. for those with severe long term mental illnesses and those who have been in hospital many times * complex needs such as violent behaviour, drug or alcohol use and mental illness, those detained under the mental health act or serious self harming

Question 275

AOTs are also known as?

Answer 275

* also known as the complex care team or programme of assertive community treatment * AOTs review the care plan every 6 months

Question 276

exposure to ? play a role in the onset of depression?

Answer 276

poverty and violence

Question 277

Cultural factors in depression?

Answer 277

* cultures vary in their conceptualisation of mental health * symptoms they recognize as signs of depression, and their openness towards discussing feelings of depression.

Question 278

How may different cultures interpret the symptoms of depression?

Answer 278

* For instance, some cultures might interpret symptoms of depression in a more somatic or physical way, focusing on complaints like fatigue or pain, while others may focus more on the emotional or cognitive symptoms. 

Question 279

fear of ? may stop people from seeking help for depression

Answer 279

stigma

Question 280

cultural factors also influence the types of ?

Answer 280

treatment sought by the patient, wirh some cultures relying more on traditional/ alternative medicines

Question 281

cultural identifity influences the degree to which a person?

Answer 281

* cultural identity influences the degree to which a person shows physical symptoms of depression * in other words, some cultures are more comfortable reporting depressive symptoms that are physical in nature rather than mental. * For example, research shows that many depressed Chinese people complain of bodily discomfort, feelings of inner pressure, and symptoms of pain, dizziness, and fatigue

Question 282

Depression and the western world?

Answer 282

* depressed individuals might not readily seek out psychiatric or mental health care for depressive symptoms. * Because the public discourse regarding depression is more prevalent in Western societies, it is more socially acceptable to have depression, and more people are willing to seek help.

Question 283

stigmatisation of mental illness in other cultures?

Answer 283

- mental illnesses may be denied out of shame of being identified as craxy - Others may find the label "depression" morally unacceptable, shameful, and experientially meaningless

Question 284

? of people w MH problems are cared for within primary care

Answer 284

90

Question 285

PC uses ? of total expenditure on MH

Answer 285

10

Question 286

Which proportion of GP appoinments are mental health related?

Answer 286

40%, has risen since the pandemic started

Question 287

assessments for disturbed, suicidal or agitated people?

Answer 287

* psychosocial needs - social needs like home environment, recent life events, history leading to the thoughts of self harm * psychological and physical needs - MH disorders, miuse of recreational drugs and/or alcohol

Question 288

factors that increase the person's risk of depression/ self harm?

Answer 288

* hopelessness * features of depression * features suggestive of suicidal intent - evidence of planninf, changes to will, precautions taken to prevent rescue

Question 289

Features that make a person higher risk of suicide/ self harm?

Answer 289

* features associated with risk - male sex, physical health problems, low SES, high-risk employment (such as farmers or healthcare professionals)

Question 290

management of a person at risk of suicide/ self harm?

Answer 290

* prevent access to means of self harm * written and verbal info for the person and their family * ensure all members of MDT are kept informed

Question 291

what does counselling involve?

Answer 291

* involves the patient talking about their feelings and emotions with a trained therapist * the therapist can help the patient gain a abetter understanding of their feelings and thought processes

Question 292

counselling is ideal for people who are?

Answer 292

coping with a current crisis such as anger, bereavement, interftility etc

Question 293

what is behavioural activation?

Answer 293

* talking therapy that aims to help people with depression take simple, practical steps towards enjoying life again. * The aim is to give you the motivation to make small, positive changes in your life.

Question 294

BA also involves teaching the person...

Answer 294

problem-solving skills to help them tackle problems that are affecting their mood

Question 295

problem solving therapy is aimed at?

Answer 295

improving an individual's ability to cope with stresful life experiences

Question 296

what is the underlying assumption of problem solving therapy?

Answer 296

* The underlying assumption of this approach is that symptoms of psychopathology can often be understood as the negative consequences of ineffective or maladaptive coping.

Question 297

PST aims to help individuals adopt a ?

Answer 297

realistically optimistic view of coping, understand the role of emotions more effectively, and creatively develop an action plan geared to reduce psychological distress

Question 298

# PROBLEM SOLVING THERAPY interventions in PST?

Answer 298

psychoeducation, interactive problem solving exercises and motivational homework assigments

Question 299

mental illness with the highest mortality rate?

Answer 299

EDs

Question 300

women: men ratio in anorexia?

Answer 300

10:1

Question 301

anorexia - MDT approach when?

Answer 301

there is comorbid physical or mental illness

Question 302

feeding against will?

Answer 302

* last resort * should only be done in the context of the Mental Health Act 1983 or Children Act 1989.

Question 303

lifetime female prev of bulimia?

Answer 303

2%

Question 304

bulimia occurs across all?

Answer 304

socioeconomic groups

Question 305

Female: male ratio in bulimia?

Answer 305

* female:male 10:1 although incidence in men is increasing * common in adolescent and young adulthood

Question 306

RF for bulimia

Answer 306

Question 307

core features of bulimia?

Answer 307

* regular binge eating, loss of control eating during binges * attempts to counteract the binges * BMI > 17.5kg/m2 * Preoccupation with weight, body shape and body image * Preoccupation with food & diet.

Question 308

physical symptoms of bulimia?

Answer 308

* bloating & fullness * lethargy * heartburn & reflux * abdominal pain * sore throat & dental problems

Question 309

what is common with bulimia?

Answer 309

* mood disturbances, anxiety, low self esteem and self harm are common with bulimia * depressive symptoms are more common than anorexia nervosa

Question 310

Bulimia - prognosis?

Answer 310

80% make full recovery without Tx

Question 311

? of bulimia patients go on to develop anorexia

Answer 311

10-15%

Question 312

? has the highest mortality rate - deadliest psychiatric condition

Answer 312

anorexia

Question 313

causes of death with EDs?

Answer 313

* suicide - always screen for mood disturbances and also suicide risk * medical complications - heart failure, fatal arrhythmias, severe dehydration/ malnourishment, multi-organ failure

Question 314

screening questionnaire for EDs?

Answer 314

SCOFF questionnaire

Question 315

SCOFF questionnaire?

Answer 315

* do you make yourself Sick because you feel uncomfortably full? * do you worry that you have lost Control over how much you eat? * have you lost more than One stone in a 3-month period? * Do you believe yourself to be Fat when others say you’re too thin? * Would you say Food dominates your life? (2+ indicate likely case of anorexia or bulimia)

Question 316

Capacity is related to a patient’s ability to:

Answer 316

* understand information relevant to the specific decision; * be able to understand the nature of their illness and understand the implicationsof non-treatment * be able to rationally weigh up the pros and cons of treatment; * thus make an informed decision regarding their management and communicate their decision.

Question 317

new MCA (2005) means

Answer 317

* under the new MCA (2005) people lacking capacity may be treated if it's in their best interest

Question 318

treating people without capacity:

Answer 318

* needs to be the least restrictive option * is not depriving them of their liberty * there is no advanced refusal or objection by a done or court of protection.

Question 319

anorexia and MH act?

Answer 319

* Treatment of people with severe anorexia nervosa who are not consenting to treatment for their mental disorder will in most cases require use of the MHA as it involves deprivation of liberty and compulsory refeeding.

Question 320

for people lacking capacity, emergecy treatment can be performed under ?

Answer 320

* For people lacking capacity, emergency medical treatment can be performed under Common Law. * Non-emergency treatment for a physical condition not related to the eatingdisorder may be performed under the MCA 2005.

Question 321

16-18 year olds who are refusing Tx?

Answer 321

* treatment for 16-18 year olds who are refusing treatment - parental conset cannot be used as authority to treat

Question 322

EDs in males ?

Answer 322

* later age of onset * typically higher rates of obesity pre-onset * Often a fixation on body shape or type rather than weight. e.g. ‘to be muscular’ * More likely to see excessive exercise

Question 323

3 phases of adolescent focused therapy?

Answer 323

* Alliance and mutual understanding of AN * Enhancing independence from parents * Develop strategies to deal with the tasks of adolescence * AFT less effective and takes longer than FBT

Question 324

family based therapy/ maudsley model - 4 phases?

Answer 324

  1 -  Acknowledging state of starvation, focus on refeeding, emphasis on parental control   2 – Continued focus on weight gain, starting to shift   responsibility   3 – Weight maintenance, focus on family relationships,   develop family strengths   4 – Relapse prevention, endings

Question 325

Family therapy?

Answer 325

* views the problems as relational not individual * externalisation of the ED * non-blaming, unifies the family and shares responsibility * family is best positioned to find their own solutions

Question 326

Developmental theories of ED?

Answer 326

* features preceding the onset of EDs which are present in childhood * childhood perfectionism * individuals with both constrained (anorexia) and disinhibited (bulimia) eating share the personality trait of high harm avoidance. * impulsivity & binge eating * compulsivity and anorexia

Question 327

Genetic predisposition in ED?

Answer 327

* genetic predisposition - relatives of those diagnosed with an eating disorder are up to 6x more likely to develop an ED

Question 328

sociocultural theory of ED?

Answer 328

* Eating disorders are overwhelmingly found in Western countries where there is a heavy emphasis on thinness- a core feature of eating disorders. * It is also found in countries where food is in abundance as in places of deprivation, round figures are more desirable 

Question 329

SLT in development of EDs?

Answer 329

* During childhood, children encode the behaviour of their role models (e.g., celebrities or parents), imitating it. * They do not imitate all behaviour, but if it is reinforced or is the generally accepted opinion of society, they are likely to replicate it. * Society and the media perceive 'skinnier' women and 'muscular' men as more attractive.

Question 330

family in ED?

Answer 330

* one of the strongest external contributors to maintaning EDs * often family members are praised for their thiness * maintains maladaptive eating behaviours * Families that emphasize thinness or place a large emphasis on physical appearance are more likely to have a child diagnosed with an eating disordeR

Question 331

personality in ED - perfectionism?

Answer 331

* Perfectionism - especially for anorexia * perfectionism magnifies normal body imperfections, leading an individual to go to excessive (i.e. restrictive) behaviors to remedy the imperfection

Question 332

Personality in ED - self esteem?

Answer 332

Self esteem - Low self-esteem not only contributes to the development of an eating disorder, but is also likely involved in the maintenance of the disorde

Question 333

transdiagnostic model of ED?

Answer 333

suggests that overall low self-esteem increases the risk for over-evaluation of body, which in turn, leads to negative eating behaviors that could lead to an eating disorder

Question 334

Using the MH act and compulsory treatment ?

Answer 334

* If a person's physical health is at serious risk due to their eating disorder, they do not consent to treatment, and they can only be treated safely in an inpatient setting *

Question 335

Child or young person without capacity?

Answer 335

if physical health is at serious risk and they do not consent to treatment, ask their parents or carers to consent on their behalf and if necessary, use an appropriate legal framework for compulsory treatment (such as the Mental Health Act 1983/2007 or the Children Act 1989).

Question 336

Causes of MCI?

Answer 336

* early dementia * physical health problems like COPD * medication side effects e.g. anti cholinergics or meds that cause drowsiness * MH problems

Question 337

Prevalence of MCI?

Answer 337

* between 5% and 25%

Question 338

NICE - at risk groups for delirium?

Answer 338

* 65+ * prev history of cognitive impairment/ suspected cognitive impairment * current hip fracture * severe illness

Question 339

STOPP criteria

Answer 339

* STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) aims to reduce the incidence of medicines-related adverse events from potentially inappropriate prescribing and polypharmacy.

Question 340

START criteria?

Answer 340

* START (Screening Tool to Alert to Right Treatment) can be used to prevent omissions of indicated, appropriate medicines in older patients with specific conditions.

Question 341

MHA states that (capacity?

Answer 341

* MHA states that a person must be assumed to have capacity unless it's established that they lack capacity * However, if a person is at imminent risk of suicide there may well be sufficient doubts about their mental capacity at that time. * practitioners need to act in the patients best interests - this may involve sharing critical information

Question 342

Mental capacity act 2005 ?

Answer 342

* a person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain.

Question 343

MCA - a person is unable to make decisions for himself if he is unable to:

Answer 343

* (a)to understand the information relevant to the decision, * (b)to retain that information, * (c)to use or weigh that information as part of the process of making the decision, or * (d)to communicate his decision (whether by talking, using sign language or any other means).

Question 344

Effects of dementia on carers?

Answer 344

* guilt - losing temper, not wanting the responsibility, feelimg embarassed about the person's off behaviour * grief and loss - loss of the future they planned together * anger - at the person, having to be a carer, angry at lack of support * exhaustion

Question 345

support for carers - carers assessment?

Answer 345

* needs assessment used by the LA to decide which support their eligible to receive * works out your abilities and how they affect your caring role * and your needs and which level of support is needed

Question 346

support for dementia on medical issues?

Answer 346

* GP, social services, occupational therapists to support and advise on medical issues

Question 347

local support groups for dementia carers?

Answer 347

* local support groups - local Alzheimer’s Society office, Age UK and Carers UK. 

Question 348

online discussion forums for carers?

Answer 348

* online discussion forums - practical suggestions and letting of steam - e.g. Talking Point

Question 349

therapy for carers?

Answer 349

* talking therapies such as CBT

Question 350

booklets for carers?

Answer 350

* booklets such as Caring for a person with dementia from alzheimer's.org.uk for practical support

Question 351

support that the LA can offer a carer?

Answer 351

* homecare visits * adaptations to the home * respite care * support from professionals, such as a dementia specialist nurse * support groups

Question 352

residential homes provide accomodation and personal care such as help w:

Answer 352

* washing * dressing * taking medicines * going to the toilet

Question 353

nursing homes?

Answer 353

- These also provide personal care but there will always be 1 or more qualified nurses on duty to provide nursing care. - Some nursing homes offer services for people that may need more care and support.

Question 354

who are nursing homes for?

Answer 354

* severe learning disabilities, severe physical disabilities or both * a complex medical condition that needs help from a qualified nurse

Question 355

NHS LTP for older ppl?

Answer 355

* the NHS long term plan will ensure consistent access to mental health care for older adults with functional needs (i.e. depression, anxiety and severe mental illnesses). * NHS talking therapies for anxiety and depression which need to meet the needs of older patients

Question 356

NHS LTP - community based teams

Answer 356

* Community-based mental health crisis response teams will work closely with ‘physical health’/Ageing Well Urgent Community Response services to provide coordinated rapid response, assessment, admission avoidance, and discharge support functions for older people 

Question 357

what are community MH teams?

Answer 357

* support people w mental health problems but also their carers

Question 358

community MH teams involve?

Answer 358

- a community psychiatric nurse (CPN), a psychologist, an occupational therapist, a counsellor and a community support worker, as well as a social worker. * one member is appointed as a care coordinator and keeps in contact to help plan care

Question 359

social/ community care?

Answer 359

* social care is support to carry out day to day tasks * e.g. managing money or improving relationships * can be referred or contacted directly

Question 360

supported housing?

Answer 360

* if the person is finding it difficult to manage in their own home and needs more support * can be: * support in their own home * supported housing and group homes * short stay supported housing

Question 361

support in ur own home floating support?

Answer 361

* benefits * budgeting * accessing care, local activities, education, training or advocacy. * often run by charities

Question 362

community care or home help?

Answer 362

* social services offer them a home * care workers might help with things like household tasks, preparing meals and taking medication. * social services do an assessment on how much help you need

Question 363

short stay supported houses - crises houses?

Answer 363

* They offer short-term housing and are an alternative to going into hospital

Question 364

epidemiology of schizophrenia?

Answer 364

* one in 100 * ages 15-45, but may develop at any age

Question 365

men tend to develop schiz ?

Answer 365

* males and females equally affected but men tend to develop it earlier at around 20 but women 30

Question 366

genetics of schiz?

Answer 366

* Genetics- high genetic linkage to schizophrenia. * One parent with Schizophrenia 10% lifetime(10% increased chance if you have member of family with the condition.

Question 367

environmental insuts and schiz?

Answer 367

winter or spring births and infections, obstetric complications

Question 368

personality inc schiz risk?

Answer 368

* Personality – person with underlying Schizotypalpersonality disorder.

Question 369

stress and schiz?

Answer 369

* upbringing and stressful life events - increased risk of relapse rates * social stresses - social drift hypothesis

Question 370

cannabis and schiz?

Answer 370

* substance miuse - heavy cannabis intake at 18 associated w inc risk of psyhcosis

Question 371

structural brain abn and schiz?

Answer 371

Decreased cortical volume,enlarged ventricles, hypo frontality (associated with negative symptoms and autism.

Question 372

prognosis of schiz?

Answer 372

* 1/3 make complete recovery * 1/3 experience recurrent episodes of psychosis with some degree of social disability * 1/3 may remain chronically disabled.

Question 373

features indicating good prognosis?

Answer 373

* abrupt onset, * an absence of prodromal disturbances, * onset in midlife, * presence of identifiable life stresses, * absence of blunting/flat affect * and/or early treatment

Question 374

schizophrenia involves disruptions in the following dopamine pathways:

Answer 374

- mesolimbic pathway - mesocortical pathway - nigrostriatal pathway - tuberoinfundibular pathway

Question 375

CBT for schiz?

Answer 375

- psycho-education - family therapy

Question 376

Psycho-education?

Answer 376

accepting the illness, addressing routine/activity scheduling, sleep hygiene, breathing techniques, mindfulness

Question 377

family therapy for schiz?

Answer 377

- awareness of relapse symptoms, supporting structure, looking after the patient

Question 378

social interventions?

Answer 378

- rehabiliation - social support

Question 379

rehabilitation?

Answer 379

- Return to education/work, re-establishing family functioning, management of substance-misuse etc.

Question 380

social support for schiz?

Answer 380

- Housing & Accommodation Issues, Access to benefits etc.

Question 381

approach for chronic enduring psychosis

Answer 381

CPA - Care Programme Approach

Question 382

First rank symptoms of schiz?

Answer 382

- auditory hallucinations: - hearing thoughts spoken aloud hearing voices referring to himself / herself, made in the third person - auditory hallucinations in the form of a commentary - thought withdrawal, insertion and interruption - thought broadcasting - somatic hallucinations - delusional perception - feelings or actions experienced as made or influenced by external agents

Question 383

epidemiology of schizophrenia?

Answer 383

* 1% lifetime prevalence of schizophrenia * incidence: around 15 new cases per 100000 per annum

Question 384

onset of schiz: the prodome?

Answer 384

* begins in young adulthood * Children who go on to develop schizophrenia often have subtle premorbid motor, linguistic and social dysfunction * Gradual functional decline: fall off in school/college, loss of friends, odd behaviours, ideas, beliefs etc * May go on for months or years

Question 385

stigma =

Answer 385

refers to a cluster of negative attitudes and beliefs that motivate the general public to fear, reject, avoid, and discriminate against people with mental illnesses.

Question 386

common/ case law is ?

Answer 386

the development of legal standards that have been tested in a court of law over time.

Question 387

statute law =

Answer 387

law passed by Acts of Parliament.

Question 388

common law?

Answer 388

*A person with a mental illness is an autonomous individual, ie is presumed to have capacity to consent to or refuse treatment, unless it is shown to be otherwise.

Question 389

To have capacity to give informed consent a person must be able to:

Answer 389

–Understand the information given –Retain that information long enough to make a decision –Weigh it in the balance free from either internal or external pressures –Communicate the decision

Question 390

mental capacity act?

Answer 390

- enshires principals of common law as regards to the treatment of persons who lack capacity into statute law

Question 391

Mental Health Act (1983)?

Answer 391

* The MHA allows for assessment, treatment and in-patient care for persons with a mental disorder and governs the procedure by which that care is given. * The use of the Mental Health Act is not determined by an assessment of capacity, but rather by the presence or absence of a mental disorder.

Question 392

suicide risk in schiz?

Answer 392

* to oneself - about 10-15% suicide risk in schizophrenia * particularly high in young, educated people early in the course of their illness.

Question 393

risk to others in schiz?

Answer 393

* to others - risk of violence, minor aggression

Question 394

other risks w schiz?

Answer 394

* self neglect - due to postive and negatve symptoms * vulnerability of patients to stigma

Question 395

RF for schiz?

Answer 395

* Family history * Social isolation * Migrants * Family problems * Heavy cannabis use in adolescence * Intrauterine and perinatal complications * Intrauterine infection, particularly viral * Abnormal early cognitive/neuromuscular development

Question 396

red flags in schiz - suicidal thoughts?

Answer 396

*    Severe social problems *    Self-neglect *    Hallucinations, especially command in nature *    Passivity phenomena

Question 397

For section 2, a person is unable to make a decision for himself if he can't:

Answer 397

(a) to understand the information relevant to the decision, (b) to retain that information, (c) to use or weigh that information as part of the process of making the decision, or (d) to communicate his decision (whether by talking, using sign language or any other means).

Question 398

rehabilitation for psychosis is for thos w ?

Answer 398

* for those w complex psychosis * treatment resistant psychosis * recurrent admissions or extended stays

Question 399

principles of rehabilitation for psychosis?

Answer 399

* recovery-orientated approach - shared ethos and agreed goals, sense of optimism and aims to reduce stihma * deliver individualised, person-centred care through collaboration and shared decision making 

Question 400

rehab for psychosis - be offered the ? envir?

Answer 400

* be offered in the least restrictive environment and aim to help people progress from more intensive support to greater independence * recognise need for supported accomodation

Question 401

MDTs for psychosis rehabiliatation services - who is involved??

Answer 401

* rehabilitation psychiatrists * practitioner psychologists * nurses * occupational therapists * social workers * support workers (including peer support workers) * specialist mental health pharmacists.

Question 402

programmes and interventions for psychosis should develop a ? and offer ? group activities?

Answer 402

* services should develop a culture that promotes improving daily living skills * offer structured group activities (social, leisure or occupational) aimed at improving interpersonal skills. 

Question 403

interventions that can be offered for psychosis rehab?

Answer 403

* educational opportunities such as recovery colleges * substance misuse interventions

Question 404

managing relapse?

Answer 404

* Risk of harm to the person - self harm, suicide, accidental injury, command hallucinations * level of family/ social support * Timing — be aware that the highest risk of suicide tends to be around the time of a psychotic episode and shortly after hospital discharge.

Question 405

risk - history?

Answer 405

* Previous violence, whether investigated, convicted or unknown to the criminal justice system * Relationship of violence to mental state * Lack of supportive relationships * Poor concordance with treatment, discontinuation or disengagement * Impulsivity * Alcohol or substance use, and the effects of these * Early exposure to violence or being part of a violent subculture * stable RF or a change in them? * evidence of recent stressors, losses or threat of loss * Are the family/carers at risk? History of domestic violence * Lack of empathy

Question 406

risk - envir?

Answer 406

* risk on release from restricted settings * Access to potential victims, particularly individuals identified in mental state abnormalities * Access to weapons, violent means or opportunities * Involvement in radicalisation.

Question 407

risk - mental state?

Answer 407

* Evidence of symptoms related to threat or control, delusions of persecution by others, or of mind or body being controlled or interfered with by external forces, or passivity experiences * Voicing emotions related to violence or exhibiting emotional arousal (e.g. irritability, anger, hostility, suspiciousness, excitement * Specific threats or ideas of retaliation * Grievance thinking * Thoughts linking violence and suicide (homicide–suicide) * Thoughts of sexual violence * Evolving symptoms and unpredictability * Signs of psychopathy * restricted insight

Question 408

rates of S across ethnic groups?

Answer 408

* rates of psychotic disorders like schizophrenia can be as much as 5x higher in some ethnic minority groups such as people of black Caribbean or African heritage in the UK.  * Ethnic minority status was associated with more than double the odds of psychotic disorders.

Question 409

what can explain the inc risk of psychosis in ethnic minorties?

Answer 409

* Linguistic distance from the majority group, and social disadvantage, were both associated with nearly double the odds of psychosis, which appeared to mostly explain the increased risk faced by ethnic minority groups

Question 410

culture and schiz diagnosis?

Answer 410

* variation between countries when it comes to diagnosing schizophrenia - overdiagnosis due to ethnic background

Question 411

culture - acceptance of S symptoms in certain cultires?

Answer 411

* One issue is that positive symptoms such as the hallucination or hearing voices may be more acceptable in African cultures because of cultural beliefs in communication with ancestors, and therefore people are more ready to acknowledge such experiences - when reported to psychiatrists this is seen as abnormal, ethnocentric approach

Question 412

culture - over-interpretation of symptoms?

Answer 412

* over-intrepretation of the symptoms of black people during diagnosis - cultural differences in language and mannerisms, difficulties in relating between black patients and white therapists, 

Question 413

schiz diagnosis - age?

Answer 413

* most commonly diagnosed between the ages 15-35 * women tend to present when older (peak in the late twenties, compared to a peak in the early twenties in men).

Question 414

preventing psychosis - referral to specialist services in patients who are distressed with declining social function and:

Answer 414

* Transient or attenuated psychotic symptoms or * Other experiences or behaviour suggestive of possible psychosis or * A first-degree relative with psychosis or schizophrenia

Question 415

Role of EIPs?

Answer 415

* EIP teams are often the first group to review patients with a new episode of psychosis or schizophrenia. * The teams consist of psychiatrists, psychologists, community psychiatric nurses, social workers and support workers.

Question 416

high vs low risk of harm w a psychotic disorder?

Answer 416

* high risk of harm: same-day mental health assessment by the early intervention in psychosis  * not at high risk of harm: EIP team

Question 417

common law principles which may be used to provide emergency care and treatment to patients that lack capacity:

Answer 417

* necessity * duty of care

Question 418

common law allows?

Answer 418

* allows anyone to take reasonable and proportionate action to prevent immediate significant harm to others * applies whether or not he has capacity

Question 419

principles of common law?

Answer 419

* in an emergency, when it's not possible to find out a patient's wishes, you can treat them without their consent * provided the treatment is necessary to save their life or prevent a serious deterioration of their condition * must be the least restrictive of the patient's future choices

Question 420

under common law, it's acceptable to act in a patient's best interests if:

Answer 420

* the care and treatment is urgent and there is not time to consider the use of alternative legislation (e.g. the patient is unconsious and requires immediate treatment) * care and treatment is necessary to save their life or prevent serious deterioration

Question 421

section II?

Answer 421

* Admission for assessment * 2 doctors need to make the recommendation * lasts for a maximum of 28 days

Question 422

at any time during a section 2, a patient can be put on

Answer 422

a section 3

Question 423

section 3?

Answer 423

* Admission for treatment * long term civil section * An AMHP makes an application for admission, based on the recommendations of two medical practitioners.

Question 424

duration of a section III?

Answer 424

* The initial period for which detention is authorised is six months, but it can be renewed by the RC for a further six months, then for further periods of 12 months.

Question 425

Section IV?

Answer 425

* used when it is of urgent necessity for the patient to be admitted and detained under section 2 * It is similar to s2, but differences include that only one medical recommendation is required, and it lasts up to 72 hours

Question 426

Section V?

Answer 426

* holding powers * A nurse of the specified class may detain certain inpatients for up to 6 hours, and a doctor may detain inpatients for up to 72 hours.

Question 427

SECTION 136?

Answer 427

- police - allows them to take and keep a patient at a place of safety - can do this without a warrant if: * you appear to have a mental disorder, AND * you are in any place other than a house, flat or room where a person is living, or garden or garage that only one household has access to, AND * you are "in need of immediate care or control" (meaning the police think it is necessary to keep you or others safe).

Question 428

how long can police keep a person under section 136?

Answer 428

* police can keep the patient in a place of safety for up to 24 hrs which can be extended for another 12 hours if it was not possible to assess you in that time. 

Question 429

community treatment orders?

Answer 429

*  CTO is an order made by your responsible clinician to give you supervised treatment in the community. * This means you can be treated in the community for your mental health problem, instead of staying in hospital. * But your responsible clinician can return you to hospital and give you immediate treatment if necessary * comes with certain conditions like living in a certain place or going to appointments

Question 430

how long does a CTO last?

Answer 430

* last 6 months from date of order * You can only be put on a CTO if you are in hospital under certain sections, and if certain criteria are met.

Question 431

when can a CTO be made?

Answer 431

* section 3 * section 37 hospital order * Unrestricted transfer direction under section 47 (Notional section 37)

Question 432

Who can't be put on a CTO:

Answer 432

* You are under sections 2, 4 or 5 * You have already been discharged from your section.

Question 433

Criteria for a CTO?

Answer 433

* You are suffering from a mental disorder for which you need to receive medical treatment. * You need to receive this medical treatment for your health or safety, or for the protection of others. * You can receive this treatment without needing to be detained in hospital. * Your responsible clinician needs to be able to recall you to hospital if necessary. * Appropriate medical treatment is available for you in the community

Question 434

what are the human rights?

Answer 434

* right to life * right not to be tortured or treated in a inhuman or degrading way * right to liberty * right to respect for private and family life. home and correspondence * right not to be discriminated against * Right to freedom of thought, conscience and religion * Right to peaceful enjoyment of possessions

Question 435

right to life?

Answer 435

* If people with mental health/capacity issues have their physical health needs ignored which could risk their life

Question 436

right to be free from inhuman or degrading treatment?

Answer 436

* neglect or lack of care leading to serious harm or suffering * a person presenting a risk of serious self-harm or harming others including staff and others using the service * failing to provide treatment to reduce serious harm experienced by the person

Question 437

right to liberty?

Answer 437

* decisions preventing a person from leaving a place (such as a care home or hospital) and ensuring the correct processes are followed * when a person requires constant supervision or monitoring and ensuring they have access to the relevant safeguards

Question 438

restricting the right to liberty?

Answer 438

* this right can be restricted but only in specific circumstances e.g. * detaining a person under the MA * depriving a person of their liberty under theMental Capacity Act either where

Question 439

the right to not be tortured?

Answer 439

* not to be treated in a way that causes intense physical or mental suffering * This could include police violence, poor prison conditions, or neglect or abuse in a care home

Question 440

which AP carry high risk of weight gain?

Answer 440

Olanzapine and Clozapine

Question 441

when does neuroleptic malignant syndrome occur?

Answer 441

commonly occurs due to initiation of anti-dopaminergic medication or withdrawal of dopamine agonists. S

Question 442

what is secure attachment?

Answer 442

Support mental processes that enable the child to regulate emotions, reduce fear, attune to others, have self-understanding and insight, empathy for others and appropriate moral reasoning

Question 443

insecure attachment?

Answer 443

If a child cannot rely on an adult to respond to their needs in times of stress, they are unable to learn how to soothe themselves, manage their emotions and engage in reciprocal relationships.

Question 444

when is attachment behaviour most prominent?

Answer 444

6 and 36 months

Question 445

differential smiling at ? months

Answer 445

6 months

Question 446

stranger anxiety at ? months

Answer 446

9 months

Question 447

factors promoting attachment ?

Answer 447

* maternal sensitiity * warmth * emotional responsiveness * involvement * reciptocity

Question 448

what is secure attachment (3)

Answer 448

◦Secure base effect, distressed on separation, greets positively on return

Question 449

insecure attachment (4)?

Answer 449

◦ Difficult to settle/angry/ ignores on reunion ◦ Explores with no anxiety, ◦ Little distress on separation, ignore on reunion ◦ Fear of or for the care giver

Question 450

insecure attachment is often associated w?

Answer 450

poor parenting/ abuse

Question 451

 Assessment of attachment?

Answer 451

* Behaviours on separation and reunion * Patterns of comfort seeking when hurt/ upset * Reliance on caregivers when help needed * Affection shown to caregivers * Exploratory behaviour in different settings * Co-operativeness * Controlling behaviour (seeking to control caregiver)

Question 452

Factors presenting risk to the quality of attachment between child and parent:

Answer 452

*  Poverty * Parental mental health difficulties * Exposure to neglect, domestic violence or other forms of abuse * Alcohol/drug taking during pregnancy * Multiple home and school placements * Premature birth * Abandonment * Family bereavement

Question 453

secure attachments constitute ?

Answer 453

65%

Question 454

child's behaviour in secure attachment?

Answer 454

* explores room * actively distressed if mother leabes * positive reunion and accepts comfort eaily * more confident and with positive self esteem

Question 455

mother's behaviour in secure attachment?

Answer 455

* seen as available * dependable and warm * responsive to child's cues, quick

Question 456

anxious attachment constitutes ?

Answer 456

10-15%

Question 457

child's behaviour in avoidant attachment?

Answer 457

* not distressed by mother leaving * avoids mother on return, focusing on environment * has learnt to suppress behaviours normally used to alert mothers

Question 458

mother's behaviour in avoidant attachment?

Answer 458

* rejecting angry hostile if child makes demands in stresful situation

Question 459

ambivalent/ resistant attachment constitutes?

Answer 459

8-10%

Question 460

what is the child's behaviour like in ambivalent/ resistant attachment?

Answer 460

* very distressed when mother leaves * ambivalence on return both seeking comfort and then rejecting/ resisting on reunion

Question 461

mother's behaviour in ambivalent attachment?

Answer 461

* inconsistent care giving * unresp and insentive to childs needs and demands

Question 462

disorganised attachment constitutes ?

Answer 462

15-19%

Question 463

disorganised attachment behaviours?

Answer 463

* contradictory behaviours strong proximity seeking and strong avoidance * distress, anger, freezing and stereotypes

Question 464

mother's behaviour in disorganised attachment?

Answer 464

* frightened or frightening * abusive

Question 465

management of attachment difficulties?

Answer 465

* psychoeducation * formulation of difficulties * liason w other agencies * systemic work w whole family

Question 466

conduct disorders?

Answer 466

* > 6m duration *  Umbrella term, range of behavioural difficulties inc. CD and ODD *  At the most severe end will involve antisocial and criminal acts

Question 467

higher rates of conduct disorders in?

Answer 467

adhd and autism

Question 468

opositional defiant disorder?

Answer 468

younger children; defiant, disobedient, disruptive but not aggressive or antisocial behaviour

Question 469

management of behav and conduct disorders?

Answer 469

* prevention * psychoeducation * family therapy * parenting support via social care * Parenting interventions have evidence for 11 and under; child-focused groups recommended for older children but often not available

Question 470

emotional disorders?

Answer 470

* includes anxiety disorders * depressive disorders * mania * bipolar

Question 471

higher ates of emotional disorders in?

Answer 471

girls

Question 472

precipitating factors for emotional disorders?

Answer 472

* bullying * school transitions * exams * house moves * physical illness * parental separation * frienship problems * new step parents * domestic discord * bereavement

Question 473

CBT model of anxiety

Answer 473

Question 474

prev of self harm in adolescence?

Answer 474

* prev of 5-15% * peaks in adolescent years and early 20s * higher rates in females

Question 475

RF for self harm?

Answer 475

* disputes - parents, peers, siblings * difficulties w relationships * school problems * physical ill health * prev history of abuse * intercultural stresses * depression * bullying * sexual problems * alc and drug use * awareness of self harm by friends/ family

Question 476

factors associated w inc suicide risk?

Answer 476

*  Conducted in isolation * Timed so that intervention was unlikely * Precautions to avoid discovery * Preparation in anticipation of death e.g. giving things away * Act considered for hours/days beforehand * Suicide note * Adolescent told others beforehand about thoughts of suicide * Or, they did not alert others

Question 477

strategies to keep self harming children safe?

Answer 477

* Strategies that help when upset/distressed. * Talking with an understanding adult. * Ringing a helpline. * Going to see a GP/ CAMHS professional. * Speak to parents or guardians about how they can help to keep that young person safe.

Question 478

Common characteristics of adolescents who die by suicide

Answer 478

* Broken home (separation/ divorce/ death). * Family psychiatric disorder or suicidal behaviour. * Psychiatric disorder or behavioural disturbance. * Substance misuse. * Previous self-harm  (~¼ to ½ of suicides have previously self-harmed).. * Older male teenagers. * Violent methods of self-harm.

Question 479

red flags in self harm?

Answer 479

- Current suicidal thoughts * Previous suicide attempts * Detailed plans of how to carry out self harm * Suicide note * Depression, anxiety, psychosis and other mental illness * Feeling of hopelessness * Poor social support * Family history of self-harm or suicide * Child in care

Question 480

CAHMS?

Answer 480

* service for young people up to 18yrs * works w families and young people

Question 481

CAHMS liases w other agencies like?

Answer 481

social services, education, voluntary sector, health

Question 482

referral process to CAHMS?

Answer 482

* SPA - single point of access - call from GP or self referral * triage system * then referred to main CAHMS

Question 483

Tier 1 in CAHMS?

Answer 483

primary care, early intervention: GP, HV

Question 484

Tier 2 at CAHMS?

Answer 484

individual CAMHS therapists at LTs

Question 485

Tier 3 at CAHMS?

Answer 485

specialist teams, community teams

Question 486

Tier 4 at CAHMS?

Answer 486

tertiary services, inpatient service, dead service

Question 487

What are some tier 3 teams?

Answer 487

* eating disorder teams * family therapy * ASD and ADHD * CAHMS crisis team * psychosis pathway w the EIT

Question 488

CAHMS crisis team?

Answer 488

* works at hospital 24/7 * assesses young people who self harm who are admitted to hospital * complete risk assessment and follow up intevention * team meet to discuss cases, interventions but also offers home based treatment

Question 489

MDT at CAHMS?

Answer 489

* MDT assessment, diagnpsis, risk assessment, formulatiom, treatment planning

Question 490

benefits of MDT working?

Answer 490

* skill mix - EBD treatment * shared responsibility and knowledge * sharing of skills * range of interpersonal approaches * supervision and support

Question 491

6 weeks - gross motor milestones?

Answer 491

* good head control - raises head when on tummy * stabilises head when raised to sitting position

Question 492

6 weeks - fine motor/ vision?

Answer 492

* tracks objects/ face

Question 493

6 weeks - speech/ language?

Answer 493

* stills, startles at loud noise

Question 494

6 weeks - social?

Answer 494

* social smile

Question 495

6 months - gross motor?

Answer 495

* sit without support, rounded back * rolls tummy (prone) to back (surprise)

Question 496

6 months - fine motor?

Answer 496

* palmar grasp * transfer hand to hand

Question 497

6 months - language/ speech?

Answer 497

* turns head to loud sounds * understands bye * babbles (monosyllabic)

Question 498

6 months - social?

Answer 498

* puts objects to mouth (stops at 1 yr) * reaches for bottle/ breast

Question 499

3 months - gross motor?

Answer 499

head control

Question 500

3 months - fine motor?

Answer 500

reaches for objects, fixes and follows

Question 501

3 months - hearing and lanuage?

Answer 501

cries, laughs, vocalises (4 months)

Question 502

social at 3 months?

Answer 502

laughing

Question 503

gross motor @ 9 months?

Answer 503

- sits alone - crawls

Question 504

9 months - fine motor and vision?

Answer 504

pincer grip - 9 to 12 months

Question 505

9 months - language?

Answer 505

inappropriate sounds

Question 506

9 months - social?

Answer 506

stranger anxiety

Question 507

12 months - gross motor?

Answer 507

stands alone

Question 508

12 months - fine motor?

Answer 508

pincer grip

Question 509

12 months - speech?

Answer 509

- babbles, understands simple commands * says Mamma/ Dadda

Question 510

12 months - social?

Answer 510

* social: socially responsive * wave bye

Question 511

18 months - gross motor?

Answer 511

walks alone

Question 512

18 months - fine motor?

Answer 512

uses spoon

Question 513

18 months - language?

Answer 513

uses words

Question 514

18 months - social?

Answer 514

stranger shyness, tantrums

Question 515

2 years - GM?

Answer 515

* runs * stairs (2 feet per step)

Question 516

2 years - fine motor?

Answer 516

circ scribbles and lines

Question 517

2 years - social?

Answer 517

knows identity, parallel play

Question 518

3-4 yrs: gross motor?

Answer 518

* stand on one foot * stairs (1 foot per step at 3)

Question 519

3-4 yrs - fine motor?

Answer 519

builds bridge w bricks

Question 520

3-4 yrs - hearing and language?

Answer 520

short sentences, knows colours

Question 521

3-4 yrs: social?

Answer 521

interactive play

Question 522

5 yrs: GM?

Answer 522

skips/ hops

Question 523

5 yrs: fine motor?

Answer 523

full drawings

Question 524

5 yrs: hearing and language?

Answer 524

fluent speech

Question 525

5 yrs: social?

Answer 525

dresses self

Question 526

how do children learn?

Answer 526

* children learn by observing, family members and caregivers are also the main influencers that determine how a child will socialize and learn—contributing to their overall physical, social and intellectual development.

Question 527

what do CAHMS offer - therapy?

Answer 527

* Talking therapies - 1 on 1 * group therapy * family therapy

Question 528

what do CAHMS offer - other?

Answer 528

* creative therapy - using arts to explore feelings with a creative therapist * medication - advising on drugs and prescribing them * inpatient hospital care * physical checks and medical reviews * crisis support

Question 529

CBT in cahms?

Answer 529

* helps them overcome negative thoughts, unhelpful behaviours, difficult emotions * low self esteem, depression, anxiety, OCD, PTSD

Question 530

Family therapy in CAHMS?

Answer 530

* helps families work together to improve relationships and support each other in finding solutions to problems resulting from mental health difficulties

Question 531

support and services available to carers of children with autism spectrum disorders?

Answer 531

* physical help - such as assistance in the home, help with gardening, help with laundry * other forms of support - such as trips/holidays, travel assistance, training, or short breaks (see below for more information about short breaks). * a direct payment so you can purchase agreed services or items yourself

Question 532

Short breaks for carers?

Answer 532

* respite * break from caring responsibilities * home-based respite care – eg a sitting service for a few hours a week or a personal assistant to stay overnight

Question 533

family based short term respite care?

Answer 533

this is where a disabled person is linked with a family who they then go to stay with on a regular basis

Question 534

other types of short breaks?

Answer 534

* after school clubs * centre-based short term residential care

Question 535

early bird for autism?

Answer 535

* for parents whose child has received a diagnosis of autism and is aged under 5 * The programme aims to support parents in the period between diagnosis and school placement, empowering and helping them facilitate their child's social communication and behaviour in their natural environment. * It also helps parents to establish good practice in supporting their child at an early age.

Question 536

early bird helps parents...

Answer 536

understand autism and develop ways of interaction and communication

Question 537

early bird - parents will have weekly?

Answer 537

commitment of a two-and-a-half hour training session or home visit, and to ongoing work with their child at home.

Question 538

early bird plus?

Answer 538

* 4-9 * The programme aims to promote a consistent approach across setting e.g. home and school, by encouraging parents/carers to attend the sessions with a professional who is working regularly with their child.  * aims to build parents confidence to problem solve

Question 539

teen life?

Answer 539

* 6 session programme * aged 10-16

Question 540

the teen life programme?

Answer 540

* The Teen Life programme aims to empower parents and supporting professionals to understand more about how autism is experienced by autistic teenagers. * Topics covered include understanding autism in teenagers, women and girls, self-esteem, spending time with other people, stress and anxiety, behaviour, puberty, independence skills, education strategies and planning for the future.

Question 541

what does teen life aim to do?

Answer 541

* aims to bring parents together to share info, experiences and ideas in a structured way * emphasises importance of autistic perspectives

Question 542

national charities?

Answer 542

* national autistic society * ambitious about autism

Question 543

# Search local support groups for autism?

Answer 543

* search using the national autistic society services directory

Question 544

social media and forums for autism?

Answer 544

* online groups - e.g. national autistic society facebook group * groups ran by autism charities * forums - national autistic society community

Question 545

local offer?

Answer 545

* people under 25 can ask their local council about their local offer - support they provide for young people with special educational needs. * every council has one

Question 546

role of schools in MH?

Answer 546

* mental health support teams * teaching about MH in school * identifying mental ill health and providing targeted interventions * prevention - positive school culture * addressing social deprivation will address one of the root causes of mental illness

Question 547

role of health visitors in MH?

Answer 547

* offer preventative health promotion * referral to specialist MH services * trained to support family relationships * recognition of early cues and reduction in post natal depression * specialist health visitors in perinatal and infant mental health

Question 548

role of social services in MH?

Answer 548

* many social workers have therapeutic training and offer individuals or group therapy to children, young people and their families.  * risk management, community in-reach, safeguarding knowledge * can refer a child to CAHMS

Question 549

Role of educational psychologists?

Answer 549

* concerned w children's learning and development , support schools and the LA to improve the child's exp of learning * They use their specialist skills in psychological and educational assessment techniques to help those having difficulties in learning, behaviour or social adjustment

Question 550

what do EPs help to do?

Answer 550

* they help to understand the child's strengths and weaknesses and the quality of their learning envir * encouraging equal access and opportunities to the curriculum for all children * offering intervention strategies for individuals and organisational situations, for example in schools, classrooms

Question 551

signs of physical abuse?

Answer 551

* bruises - particularly indicative of abuse if observed in infants and immobile children * broken/ fractured bones * burns/ scalds * bite marks * The effects of poisoning (e.g. vomiting, drowsiness, seizures) * Breathing problems from drowning, suffocation, or poisoning * head injuries * Seeming frightened of parents, reluctant to return home after school * Displays frozen watchfulness * Constantly asking in words/actions what will happen next * Shrinks away at the approach of adults

Question 552

signs of online sexual abuse?

Answer 552

* seem distant, upset or angry after using the internet or texting * spending a lot more/ lot les time online than usual * be secretive over who they're talking to

Question 553

signs of physical sexual abuse?

Answer 553

* bruises * bleeding, discharge, pains or soreness in their genital or anal area. * STIs * pain/ sore throat * Pregnancy. * Difficulty in walking/sitting that are not usual for the child.