General Principles

Question 1

What is the ICD 11 manual

Answer 1

International classification of diseases
- provides diagnostic criteria for all psychiatric disorders
- DSM-5 is similar and can be used for the same purpose

Question 2

What makes up the biopsychosocial approach

Answer 2

Biological: Neurochemistry / genetics / physical health / drug effects / hormones

Psychological: beliefs / personality / behaviour traits / coping skills

Social: relationships / family / culture / education / social support / stressful events

Question 3

What is psychiatric formulation (the 4 P’s)

Answer 3

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

Question 4

Outline the features of a psychiatric history

Answer 4

Demographics
Reason for referral
PC
HPC
Past psych history
PMH
DH
FH
Personal history
Premorbid personality
Current social circumstances

Question 5

What are the elements of a MSE

Answer 5

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

Question 6

What does a risk assessment include

Answer 6

Risks to self

Risk to others

Risk of exploitation

Question 7

What is a section 2 of the MHA

Answer 7

• 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)

Question 8

What is section 3 of the MHA

Answer 8

• 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

Question 9

What is section 4 of the MHA

Answer 9

• 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

Question 10

What is a section 5 (2) of the MHA

Answer 10

• 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

Question 11

What is section 5 (4) of the MHA

Answer 11

• emergency order similar to a section 5 (2) but only lasts 6 hours
• one mental health nurse required

Question 12

What is section 135

Answer 12

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

Question 13

What is section 136

Answer 13

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

Question 14

What is a community treatment order

Answer 14

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

Question 15

What is the mental capacity act

Answer 15

• statute law implemented in 2007
• can be applied to patients of any age
• assumes all adults have capacity unless proven otherwise

Question 16

What are the 4 components for assessing capacity

Answer 16

1. Understand the information related to the specific decision
2. Retain the information for long enough to make the decision
3. Deliberate the information provided
4. Communicate the decision

Question 17

What are the 2 stages to assessing a person lacking capacity

Answer 17

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

Question 18

What is a lasting power of attorney

Answer 18

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

Question 19

What is an advance directive

Answer 19

• 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

Question 20

What is the deprivation of liberty safeguards

Answer 20

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

Question 21

What are independent mental capacity advocates

Answer 21

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

Question 22

What are the principles of counselling

Answer 22

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

Question 23

What are the principles of psychodynamic psychotherapy

Answer 23

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

Question 24

What are the principles of behaviour therapy

Answer 24

Changing maladaptive behaviour patterns that have arisen through classical or operant conditioning
Eg exposure therapy, exposure with response prevention, relaxation, activity scheduling, target setting

Question 25

Principles of CBT

Answer 25

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

Question 26

What is dialectical behavioural therapy

Answer 26

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

Question 27

What is interpersonal therapy

Answer 27

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

Question 28

What are the principles of group therapy

Answer 28

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

Question 29

What is family therapy

Answer 29

Treats the family as a whole, hopes that increased family communication and conflict resolution will result in an improvement in patients symptoms