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1
Q

Core principles/objectives of mental health act

A
  1. Least intrusive/restrictive methods of assessment and treatment
  2. People should get to make decisions about their care
  3. Rights, dignity and autonomy
  4. Holistic care
  5. Children and young people prioritised
  6. Caters recognised and supported
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2
Q

Authorised persons

A

Police
Paramedics
Medical practitioners (in mental health services)
Mental health practitioners

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3
Q

The act permits authorised persons to…

A
  1. Enter premises
  2. Apprehend
  3. Restrain
  4. Transport
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4
Q

Mental health and well-being definition components

A
  1. Realises potential
  2. Cope with normal stressors
  3. Work productively
  4. Make a contribution to community
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5
Q

Medical definition mental illness

A

Clinically significant disturbance in
1. Cognition
2. Emotion regulation
3. Behaviour

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6
Q

Legal definition mental illness

A

Significant disturbance in
1. Thought
2. Mood
3. Perception
4. Memory

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7
Q

How many Australians have a mental or behavioural condition?

A

5.0 million / one in five

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8
Q

Competency components

A
  1. Communicate decision
  2. Understand information
  3. Appreciate consequences
  4. Manipulate information in a reasonable fashion
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9
Q

Organic causes that can mimic mental health

A
  1. Alcohol/drugs
  2. Medications
  3. Infection
  4. BGL
  5. Hypoxia
  6. Brain injury
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10
Q

Crisis management plan

A
  1. Identify history/problem
  2. Identify pt and carer’s intended outcome
  3. What do you think needs to happen?
  4. Give pt/carer options and engage in planning
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11
Q

High risk symptoms

A
  1. Attempted suicide/self harm (current)
  2. Intentional overdose/poisoning
  3. Severe intoxication where you can’t do MSA
  4. Section 351
  5. Requires sedation
  6. Dangerous social situation
  7. Acute psychosis, mania or delirium
  8. Any red flags
    Transport to hospital
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12
Q

Types of delusions

A

Persecution/paranoia (“they” are out to get me)
Reference (special meaning in neutral things)
Grandeur (famous/important/unusual powers)
Control (thoughts or actions controlled)

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13
Q

5 domains of psychopathology for schizophrenia spectrum/psychotic disorders

A
  1. Delusions
  2. Hallucinations
  3. Disorganised thinking
  4. Disorganised/catatonic behaviour
  5. Negative symptoms
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14
Q

Schizophrenia positive symptoms cause

A

Increased dopamine in mesolimbic DA neurons

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15
Q

Schizophrenia negative symptoms cause

A

Decreased dopamine activity in mesocortical and nigro-striatal systems

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16
Q

Acute behavioural disturbance AV CPG care objectives

A
  1. Maintain safe environment
  2. Use least restrictive measures/deescalation
  3. Consider clinical causes
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17
Q

5 key features of delirium

A
  1. Disturbance in attention
  2. Short period of time
  3. Disturbance in cognition
  4. Not caused by neurocognitive disorder
  5. Is caused by a medical condition, substance intoxication/withdrawal, toxin exposure or multiple aetiologies
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18
Q

SAT +3

A

Combative, violent, out of control
Continual loud outbursts
Manage with ketamine

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19
Q

SAT +2

A

Very anxious and agitated
Loud outbursts
Manage with droperidol (or midazolam)

20
Q

SAT +1

A

Anxious/restless
Normal or talkative
Manage with olanzapine

21
Q

SAT -1

A

Asleep but rouses if name is called
Slurring or prominent slowing
(Aim for this when sedating)

22
Q

SAT -2

A

Responds to physical stimulation
Few recognisable words

23
Q

SAT -3

A

No response
No speech

24
Q

Olanzapine dose/route

A

10mg oral ODT (5mg for elderly/frail/<60kg/sedation from alcohol/drugs)
Repeat once only after 20 min

25
Olanzapine onset/duration
Onset: 15min Duration: 12-24 hours
26
Olanzapine precautions
1. Less effective for drug intoxication and alcohol withdrawal - use benzodiazepines first 2. Elderly/frail and children more susceptible to adverse effects
27
Droperidol dose/route
5-10mg IM or IV (5mg for elderly/frail/<60kg/sedation from alcohol/drugs) Repeat after 15min once only If ineffective after 2 doses use midazolam
28
Droperidol precautions
1. Elderly/frail more susceptible to adverse effects 2. Parkinson’s disease 3. Lewy body dementia 4. Can cause QT prolongation rarely
29
Droperidol onset/peak/duration
Onset: 3-10 min Peak: 20-30 min Duration: 2-4 hours
30
Midazolam dose/route
5-10mg IM (2.5-5mg for elderly/frail/<60kg/sedation from alcohol/drugs) Repeat after 10 min once only 2.5-5mg IV (1-2mg elderly/frail/<60kg/sedation from alcohol/drugs) Repeat at 5 min intervals Max dose 20mg for both
31
Midazolam precautions
1. Reduce doses for elderly/frail/renal failure/CCF/shock 2. Enhanced effects with narcotics and alcohol 3. Respiratory depression in COPD pt 4. Myasthenia gravis
32
Midazolam onset/peak/duration
IM Onset: 3-5 min Peak: 15 min Duration: 30 min IV Onset: 1-3 min Peak: 10 min Duration: 20 min
33
Ketamine dose/route
IM <60 kg: 200mg 60-90 kg: 300mg >90 kg: 400mg IV: 50-100mg (dilute 200mg/2mL with 18mL saline) Request MICA
34
Ketamine onset/duration
IM Onset: 3-4 min Duration: 12-25 min IV Onset: 30 sec Duration: 5-10 min
35
Post sedation care
1. Airway management 2. Supplemental O2 (routine with ketamine) 3. Capnography 4. Perfusion management 5. Temperature management (administer midazolam for hyperthermia) 6. Reassessment and management of clinical causes 7. IV insertion 8. Management of hypersalivation (ketamine)
36
Mood disorders
Persistent depressive disorder Major depressive disorder Disruptive mood dysregulation disorder Premenstrual dysphoric disorder Antenatal and postnatal depression Psychotic depression Bipolar I disorder Bipolar II disorder Cyclothymic disorder Seasonal affective disorder
37
First line antidepressants
SSRI, NASSA, melatonergic agonist, NDRI, SNRI
38
Second line antidepressants
NARI, TCA, MAOI
39
Signs of TCA toxicity ECG
QTC prolongation QRS widening Right axis deviation (late sign) Right bundle branch block Tachycardia
40
Cluster A personality disorders
Odd, bizarre, eccentric Paranoid, schizoid, schizotypal
41
Cluster B personality disorders
Dramatic, erratic Antisocial, borderline, histrionic, narcissistic
42
Cluster C personality disorders
Anxious fearful Avoidant, dependent, obsessive-compulsive
43
Asylum seeker definition
Fled their own country and applies for protection as refugee
44
Refugee definition
Outside own country and can’t return due to well founded fear of persecution
45
Displaced person
Forced to flee home because of violence, human rights violation or natural/man-made disasters
46
5 key concepts of MHiMA framework
1. Cultural responsiveness 2. Risk and protective factors 3. Culturally responsive practice Consumer and cater participation 5. Recovery and cultural diversity

mental health (2 decks)

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