Management of the psychiatric patient Flashcards

1
Q

key areas of management

A
  1. context and disposition
  2. acute risk management
  3. diagnostic clarification
  4. management of the acute symptoms using B/P/S
  5. psychosocial and contributory factors
  6. long term rehabilitation
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2
Q

patient disposal

A

does the patient need admission?
no = GP, mental health clinic, psychiatrist
yes = voluntary vs involuntary

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3
Q

how to tell the patient they need involuntary treatment

A

inform patient of your concerns for their health, safety, the safety of others
state it is your duty of care to ensure they receive the treatment that they require whilst they are not well enough to make an informed decision

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4
Q

pierce scale of suicide intent

A

to be completed after a suicide attempt
circumstances: isolation, timing, precautions against rescue, acting to gain help, final acts in anticipation, suicide note
self-report: lethality, stated intent, premeditation, reaction to act
risk: predictable outcome, death without medical treatment

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5
Q

what is the potential suicide risk

A

deliberate self harm
suicidal ideation
intent of attempts
homicidal ideation / Hx violence or aggression
what is stopping you from carrying it out
contribution to risk by illnesss or psychosocial factors

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6
Q

immediate risk management measures

A

safety (check for presence of syringes on their body, safety of environment etc)
separate from others
listen to the patient
consider using medication eg. short term benzodiazepines or physical restriants

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7
Q

medium term risk management measures

A

antidepressants
one-on-one special observations
decrease boredom through the OT
clinical psychologist
deal with social crises eg. relationship breakdown, unemployment

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8
Q

diagnostic clarification

A

further history
past medical history
collateral history
ongoing history in ED and on the ward
old patient notes
PSOLIS
MSE
physcial
investigations

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9
Q

physical examination

A

should be done within 24 hours of admission, check if examination performed in ED

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10
Q

bloods

A

FBC - anaemia can mimic depression, some drugs cause decreased WCC, infection may cause delirium
UEC - drugs metabolised by kidneys
LFTs - drugs metabolised by liver, alcohol, cirrhosis
TFTs - high or low levels can mimic depression/anxiety/mania/irritability
Drug levels (Li, Valproate for indication of compliance, toxicity, therapeutic range)
bHCG - pregnancy
fasting BSL - metabolic syndrome can be caused by drugs
fasting lipids - “
B12, folate - deficiency mimics psychiatric syndromes eg. depression, dementia, delirium
Ca, Mg - parathyroid problems can mimic psychiatric syndromes
HSV, syphilis, hepatitis, HIV, chlamydia/gonorhhoea PCR for IVDU groups

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11
Q

urine

A

urine MCS - for UTI in oder people
urine toxicology - opiates, speed

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12
Q

imaging for patients with 1st episode physosis and delirium

A

CT head to exclude space occupying lesion, subdural hematoma, atrophy

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13
Q

other tests for diagnostic clarification

A

ECG - for possible drug side effects
EEG - temporal lobe encephalopathy (wernicke’s), CJD, seizures (temporal lobe epilepsy)

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14
Q

starting new medication s

A

i would discuss with the team but i would anticipate we would start on _
obtain informed consent for new medications
side effects
risks
expectations/onset

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15
Q

ECT

A

Whilst under general anaesthesia (e.g. propofol) and a muscle relaxant (e.g. suxamethonium), electrodes placed on patient’s head and an electrical impulse is passed through the brain continuously and this induces a generalised convulsive seizure. Therapeutic response is correlated with total seizure time.
Most troublesome S/E is short-term memory loss (hours to days)
Other S/E: anaesthetics risk, headaches, myalgia
Contraindications: increased ICP

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16
Q

indications for ECT

A

acute management of cases where the patient is not eating or drinking, or imminently suicidal
severe depression (especially melancholic)
catatonic schizophrenia
severe depression during pregnancy

17
Q

biopsychosocial

A

medication
psychologicla therapies eg. clin psych, individual/group programs
social work/welfare officer: finances, relationships, family meetings, community supports
substance use

18
Q

considerations for patients capacity

A
  • memory
  • can they believe the info told to them is true
  • do they have the ability to reason
  • can they communicate their needs
  • can they persevere with their actions and see them through
19
Q

psychosocial and other contributory factors

A

psychoeducation
implimentation of services and psychotherapy
compliance/adherance

20
Q

psychoeducation

A

education of family members, social supports, carers about condition, treatment prognosis, prognosis

21
Q

SAD PERSONS

A

used to evaluate for risk of suicide
Sex - male>female
Age - risk increases with age
Depression
Previous attempt
ETOH
Rational thinking loss (impulsive)
Social supports lacking
Organised plan
No spouse
S sickness

22
Q

safety

A
  • can you interview the patient alone
  • do they need supervision/observation
  • most appropriate place to interview the patient
  • are they likley to leave before being assessed
  • intoxication
23
Q

SACCIT

A

assessment and management goals in an ED setting
safety
assessment
confirmation of provisional diagnosis
consultation
immidiate treatment
transfer of care

24
Q

Assessment

A

reliable history, MSE, risk, physical and vitals

25
Q

consultation

A

consultant for initial advice/referral
PSOLIS
CMHC
GPs
other services in ED eg. drug and alcohol, social work

26
Q

immidiate treaatment

A

bio: pharmacological, sedation
psycho: therapeutic engagement, supprotive counselling, using de-esclation
social: mobilising social supports, family and others to provide care post discharge, finding emergency accomodation

27
Q

Transfer of care

A

safe and effective transfer of care
voluntary or involuntary
may reuire police transfer
disposition planning

28
Q
A