General Principles Flashcards
What is the ICD 11 manual
International classification of diseases
- provides diagnostic criteria for all psychiatric disorders
- DSM-5 is similar and can be used for the same purpose
What makes up the biopsychosocial approach
Biological: Neurochemistry / genetics / physical health / drug effects / hormones
Psychological: beliefs / personality / behaviour traits / coping skills
Social: relationships / family / culture / education / social support / stressful events
What is psychiatric formulation (the 4 P’s)
Predisposing factors: bio / genetic history, psycho / personality, social / cultural norms
Precipitating factors: bio - drug binge / psycho - emotional dysregulation / social - life stress
Perpetuating factors: bio - cognitive deficits / psycho - coping skills / social - ongoing stress
Protective factors: bio- no genetic history / psycho - good insight / social - good support
Outline the features of a psychiatric history
Demographics
Reason for referral
PC
HPC
Past psych history
PMH
DH
FH
Personal history
Premorbid personality
Current social circumstances
What are the elements of a MSE
Appearance eg physical state, clothes, self care
Behaviour eg attitude towards interviewer, agitation, retardation
Speech eg rate, pressure, pauses, poverty of speech, quality, flow, volume, stuttering
Disorganised speech is often thought to be a thought disorder
Mood / affect eg subjective and objective. Labile means fluctuating
Blunted / flat affect describes a noticeable reduction in the range of emotional expression
Thoughts eg any abnormal patterns of thinking, thought content, delusions
Perception: hallucinations, illusions or intrusive thoughts
Cognition: orientation to person, place and time
Insight and judgement: does patient believe they are unwell / need treatment
Can they make decisions and come to sensible conclusions when presented with info
What does a risk assessment include
Risks to self
Risk to others
Risk of exploitation
What is a section 2 of the MHA
- assessment order lasting 28 days
- requires 2 doctors and 1 approved mental health professional
- used when there is no clear psychiatric diagnosis at a given time and allows admission and treatment against a patients will
- lasts 28 days and then will decide if needs section 3. (Can’t do section 2 back to back)
What is section 3 of the MHA
- treatment order lasting up to 6 mo
- 2 dr and 1 AMHP needed
- allows ongoing treatment against a patients will
- used when there is a psychiatric diagnosis in place
- can be renewed for a further 6 mo
What is section 4 of the MHA
- emergency treatment order lasting 72 hours
- 1 dr and 1 AMHP required
- allows emergency treatment and admission to psych hospital or place of safety against a patients will
What is a section 5 (2) of the MHA
- emergency holding order lasting up to 72h
- used for hosp inpatients who would be at risk if they left hospital (must have confirmed or suspected psychiatric illness)
- 1 dr required
- can only be used to hold the patient for MHA assessment cannot be used to give treatment
- cannot be applied back to back
- F1s cannot sign
What is section 5 (4) of the MHA
- emergency order similar to a section 5 (2) but only lasts 6 hours
- one mental health nurse required
What is section 135
Allows entry to a persons abode and removal of the person to a place of safety
Patients can be held for 24 hours for assessment only
- extendable for a further 12 hours if assessment is not possible in this timescale
- ordered by a magistrate via a warrant
What is section 136
Allows holding in a place of safety for up to 24h (extendable by 12h)
Performed by police officer in community
Place of safety is usually 136 suite but can also be a police station or A&E
What is a community treatment order
Patient lives in the community but is treated under the MHA
Normally involved treatment with depot antipsychotic injections which may be given against the patients will
This order only relates to the patients psychiatric care with all other healthcare provided as normal
What is the mental capacity act
- statute law implemented in 2007
- can be applied to patients of any age
- assumes all adults have capacity unless proven otherwise
What are the 4 components for assessing capacity
- Understand the information related to the specific decision
- Retain the information for long enough to make the decision
- Deliberate the information provided
- Communicate the decision
What are the 2 stages to assessing a person lacking capacity
Stage 1: does the person have a disturbance of their mind or brain
Stage 2: does this cause a disturbance of an aspect of their decision making process
What is a lasting power of attorney
A legal mechanism allowing someone to specify another adult to look after their financial or medical affairs should they lack capacity in the future
Is performed by a solicitor
What is an advance directive
- decisions made by a patient when they have capacity that come into effect only when the patient no longer has capacity
- enables them to refuse particular treatments in specific situations
- if the treatment is life saving this needs to be in written form, signed by the patient and witnessed
What is the deprivation of liberty safeguards
Framework of safeguards created by the MCA to ensure any deprivation of liberty is in a patients best interests
- deprivation of liberty = continuous care and supervision of a patient that is not free to leave the treatment area
What are independent mental capacity advocates
Independent bodies instructed by local authorities or NHS organisations
- exist to help vulnerable people who lack capacity to make important decisions who have no family or friends to consult
- work with the patients and medical team to ensure decisions are made in the patients best interests
What are the principles of counselling
Brief in duration, recommended for those with minor mental health or interpersonal difficulties or stressful life events.
Therapist is reflective and empathetic allowing patients to discover their own insights
What are the principles of psychodynamic psychotherapy
Aims to facilitate conscious recognition of unconscious processes eg denial, fantasy, repression or humour
Transference: involves the patient transferring attitudes experienced in earlier significant relationship onto the therapist
Counter transference: feelings that are evoked in the therapies during the course of the interview as these may be representative of what the patient is feeling
What are the principles of behaviour therapy
Changing maladaptive behaviour patterns that have arisen through classical or operant conditioning
Eg exposure therapy, exposure with response prevention, relaxation, activity scheduling, target setting
Principles of CBT
Based on the assumption that the way in which individuals think about things determines how they feel / behave
These distortions are challenged and eventually changed by repeated behavioural experiments
CBT is time limited (12-24 sessions), goal oriented and will predominantly focus on present problems
Therapeutic relationship is collaborative and patients are often set homework
What is dialectical behavioural therapy
Adaptation of CBT for those that experience particularly strong emotions
- aims to help patients understand and accept difficult emotions and teach alternate coping strategies to help manage these emotions
What is interpersonal therapy
Assumes that problems with mental health are significantly influenced by problems with interpersonal relationships and social functioning
Attempts to enable patients to evaluate their social interactions and improve interpersonal skills
What are the principles of group therapy
Around 5-10 patients meeting weekly to create a safe environment to discus their issues
Key factor is realising that others are in the same position
What is family therapy
Treats the family as a whole, hopes that increased family communication and conflict resolution will result in an improvement in patients symptoms
