Management

Question 1

Must Add to most qs

Answer 1

• Talk to colleagues, MDT, peer supervision
• Collateral
• File review
• Approach
• Setting – inpatient, outpatient, etc.
• Medicolegal issues – autonomy, MHA, custodial
• Medical history
• Physical examination and investigations
• MSE
• FOLLOW-UP and plans
• Involve ALLIED HEALTH and MDT
• If in doubt break up management answers to biological, psychological, social, cultural/spiritual aspects (i.e. address points in each category) (in older people especially ‘environmental’ also – modifications to environment and routines)

If parents and children – mention COPMI, impact of mental illness on parenting (psychoeducation)
Assess whether children involved in mentally ill beliefs (e.g. delusions, OCD fears)
Remember when mentioning medication (e.g. SSRI’s) it time allows mention ECG and EUC/physical screen also as a part of medication point

Question 2

Compliance and barriers to recovery

Answer 2

Patient factors
-attitudes to med
-stigma
-family attitudes
-cultural beliefs
-personality style
-social isolation

Clinician
-therapeutic alliance

Illness
-hallucinations
-delusions
-depression
-chronic pain
-cognitive distortions e.g. forgetfulness
-abnormal illness behaviour

Meds
-SEs
-complexity
-non effectiveness

System factors
-cost of medication
-transport factors

Question 3

Interventions to support family

Answer 3

Psychoeducation about __ to increase understanding and ability to cope and support __

Safety of children - capacity for the parent to look after children, particularly infant
Risk of abuse, TOSH and suicide, thoughts of harm to children
Involve child protection services if risk of harm is identified

Explanation to children in an age and developmentally appropriate manner about the illness. Use SPIKES method if bad news has to be broken

Assessment of parenting capacity and attachment and bonding
Parent infant work when pt is well
Additional child supports
Mother baby unit if respite required or specific parent infant work needed

Address intergenerational trauma if present

Practical psychosocial interventions - SW, child protection, OT school psychologist, home help, childcare

Question 4

Reasons pt does not engage with treatment

Answer 4

1. Patient factors
   -Lack of belief in MH tx or Western models of care
   -stigma from family
   -negative attitude to meds
   -alternate beliefs in tx e.g. traditional healing
   -sick role, abnormal illness behaviour )secondary gain
   -dependency traits - relies on family
2. Treatment factors
   -Ses
   -cost
   -complexity of med regime or cognitive deficits
   -not effective meds e.g. not appropriate dose or duration
   -poor therapeutic relationship
   -distance to travel
3. Illness factors
   -comorbid illnes e.g. agoraphobia
   -severe anxiety
   -social anxiety
   -comorbid depression resulting in motivation, nihilism
   -hypochondriacal symptoms resulting in fear of S.Es
   -dependent personality disorder
   -schizo-obsessive dx with AHs or delusions or fear of harm from trreatment
   -symptoms of OCD that prevent pt from getting tx e.g. belief that parents will get hurt
   -substance use

Question 5

Difficult management

Answer 5

Second opinion
Contact medicolegal
Document
Support for staff