Mental Health - Review and delete duplicates and drugs Flashcards
+1 Sedation Assessment Tool (SAT) behaviour score description
very anxious/restless
+1 Sedation Assessment Tool (SAT) verbal score description
normal/talkative
+2 Sedation Assessment Tool (SAT) behaviour score description
very anxious and agitated
+2 Sedation Assessment Tool (SAT) verbal score description
loud outbursts
+3 Sedation Assessment Tool (SAT) behaviour score description
combative, violent, out of control
+3 Sedation Assessment Tool (SAT) verbal score description
continual loud outbursts
-1 Sedation Assessment Tool (SAT) behaviour score description
asleep
-1 Sedation Assessment Tool (SAT) verbal score description
slurring or prominent slowing
-2 Sedation Assessment Tool (SAT) behaviour score description
physical stimulation
-2 Sedation Assessment Tool (SAT) verbal score description
few recognisable words
-3 Sedation Assessment Tool (SAT) behaviour score description
no response to stimulation
-3 Sedation Assessment Tool (SAT) verbal score description
nil
0 Sedation Assessment Tool (SAT) behaviour score description
Awake/calm and cooperative
0 Sedation Assessment Tool (SAT) verbal score description
speaks normally
Acute Behavioural Disturbance (ABD) treatments
Verbal de-escalation
Correct any underlying organic causes
Acute Behavioural Disturbance (ABD) treatments
Verbal de-escalation
Correct any underlying organic causes
Are schizophrenia Pts more likely to be aggressive or victims of aggression?
victims
Are schizophrenia Pts more likely to be aggressive or victims of aggression?
victims
Can substance misuse appear like manic behaviour?
yes
Can the physical exertion and resultant acidosis and hyperthermia compound the toxic effects of some poisonings?
yes
Causes of Persistent Depressive Disorder (Dysthymic Disorder)
Can include but not limited to:
* Childhood issues
* Endochrinologic factors
* Genetic factors
* Interpersonal issues
* Substance abuse
* Stress
* Trauma
Define dissociative reactions
a feeling of being disconnected from yourself and the world around you
Do the symptoms in the manic episode severe enough to cause dysfunction and problems with work, family or social activities and responsibilities?
yes
Do we treat the physical signs of panic attacks as chest pain?
yes
Does Bipolar II diagnosis require a manic episode?
no
Does Bipolar II diagnosis require a manic episode?
no
Does capacity fluctuate with improvement or deterioration in the patient’s condition?
Yes
Does hypomania cause impairment for Bipolar II Pts?
not usually
Does the hypmanic or depressive episode precede or follow the manic episode in Bipolar I?
either
Droperidol Adult 13-15 years IM or IV dose for Acute behavioural disturbances (with a SAT Score ≥ 2)
QAS Clinical Consultation and Advice Line consultation and approval required in all patients 65 or older and 13-15 yrs
0.1–0.2 mg/kg
Single max dose 10 mg
Repeated once at 15 minutes
Total max dose 20 mg
Droperidol Adult 13-15 years IM or IV dose for Acute behavioural disturbances (with a SAT Score ≥ 2)
QAS Clinical Consultation and Advice Line consultation and approval required in all patients 65 or older and 13-15 yrs
0.1–0.2 mg/kg
Single max dose 10 mg
Repeated once at 15 minutes
Total max dose 20 mg
Droperidol Adult 16 - 65 years IM or IV dose for Acute behavioural disturbances (with a SAT Score ≥ 2)
10 mg
Repeated once at 15 minutes
Total max dose 20 mg
Droperidol Paediatric 8 - 12 years IM or IV dose for Acute behavioural disturbances (with a SAT Score ≥ 2)
QAS Clinical Consultation and Advice Line consultation and approval required in all situations
0.1 - 0.2 mg/kg
Single max dose 10 mg
Repeated once at 15 minutes
Total max dose 20 mg
Droperidol Adult 16 - <65 years IM or IV dose for Acute behavioural disturbances (with a SAT Score ≥ 2)
10 mg
Repeated once at 15 minutes
Total max dose 20 mg
Droperidol Paediatric 8 - 12 years IM or IV dose for Acute behavioural disturbances (with a SAT Score ≥ 2)
QAS Clinical Consultation and Advice Line consultation and approval required in all situations
0.1 - 0.2 mg/kg
Single max dose 10 mg
Repeated once at 15 minutes
Total max dose 20 mg
Droperidol Adult 65 and older years IM or IV dose for Acute behavioural disturbances (with a SAT Score ≥ 2)
QAS Clinical Consultation and Advice Line consultation and approval required in all patients 65 or older and 13-15 yrs
5 mg
Repeated once at 15 minutes
Total max dose 10 mg
Droperidol Adult 65 and older years IM or IV dose for Acute behavioural disturbances (with a SAT Score ≥ 2)
QAS Clinical Consultation and Advice Line consultation and approval required in all patients 65 or older and 13-15 yrs
5 mg
Repeated once at 15 minutes
Total max dose 10 mg
Droperidol Contraindications
Absolute:
Allergy AND/OR KSAR
Parkinson’s disease
Known Lewy body dementia
Previous dystonic reaction to droperidol
Patients less than 8 years of age
Relative (requires consultation with the QAS Clinical Consultation & Advice Line)
suspected sepsis
Droperidol Contraindications
Absolute:
Allergy AND/OR KSAR
Parkinson’s disease
Known Lewy body dementia
Previous dystonic reaction to droperidol
Patients less than 8 years of age
Relative (requires consultation with the QAS Clinical Consultation & Advice Line)
suspected sepsis
Droperidol Drug Class
antipsychotic
Droperidol Drug Class
antipsychotic
Droperidol Indications
Acute behavioural disturbances (with a SAT Score ≥ 2)
Droperidol Indications
Acute behavioural disturbances (with a SAT Score ≥ 2)
Droperidol Metabolism
Metabolised by the liver with biliary/renal excretion as inactive metabolites
Droperidol Metabolism
Metabolised by the liver with biliary/renal excretion as inactive metabolites
Droperidol Pharmacology
Dopamine-2 receptor antagonist that increases brain turnover of dopamine; and
Mild alpha-adrenergic receptor blockade which can result in mild hypotension
Droperidol Pharmacology
Dopamine-2 receptor antagonist that increases brain turnover of dopamine; and
Mild alpha-adrenergic receptor blockade which can result in mild hypotension
Droperidol Precautions
Hypoperfused state
Concurrent use of CNS depressants
Droperidol Precautions
Hypoperfused state
Concurrent use of CNS depressants
Droperidol Presentation
Vial, 10 mg/2 mL
Droperidol Presentation
Vial, 10 mg/2 mL
Droperidol Routes of Administration
IM
IV
Droperidol Routes of Administration
IM
IV
Droperidol side Effects
Vasodilation/hypotension
Extrapyramidal effects e.g. dystonic reactions (rare)
Droperidol side Effects
Vasodilation/hypotension
Extrapyramidal effects e.g. dystonic reactions (rare)
Droperidol Special Notes
CCP to be requested after second dose of droperidol by ACPII but may be cancelled if the second dose of droperidol achieves the desired sedation effect
Dosages and times of administration prior to QAS arrival must be considerd to ensure compliance with the QAS Droperidol DTP
In Lewy body dementia, antipsychotic (e.g. droperidol) can cause deterioration in cognitive and motor function, and may paradoxically increase agitation and worsen behaviour
For other presentations of dementia (e.g. Alzeheimer’s disease) droperidol is a suitable pharmacological agent for the management of acute behavioural disturbance
Under no circumstances is an IV cannula to be inserted for the sole purpose of droperidol administration. IV droperidol administration is only to occur when an IV cannula is already insitu
Droperidol Special Notes
CCP to be requested after second dose of droperidol by ACPII but may be cancelled if the second dose of droperidol achieves the desired sedation effect
Dosages and times of administration prior to QAS arrival must be considerd to ensure compliance with the QAS Droperidol DTP
In Lewy body dementia, antipsychotic (e.g. droperidol) can cause deterioration in cognitive and motor function, and may paradoxically increase agitation and worsen behaviour
For other presentations of dementia (e.g. Alzeheimer’s disease) droperidol is a suitable pharmacological agent for the management of acute behavioural disturbance
Under no circumstances is an IV cannula to be inserted for the sole purpose of droperidol administration. IV droperidol administration is only to occur when an IV cannula is already insitu
Droperidol Timing
Onset
5-15 minutes
Duration
4-6 hours
Half-Life
N/A
Droperidol Timing
Onset
5-15 minutes
Duration
4-6 hours
Half-Life
N/A
Drug Checks
Right pt - Pt doesn’t have any: Allergies, Contras, Precautions, Meds that may interact, Age appropriate
Right drug - Indication - the right drug to treat this presentation
Right dose - Right dose, expressed as mass only, e.g. “Five milligrams of midazolam”, consider also noting timing & max dose
Right route - Clearly stated, and dose must be correct for this route
Right Strength/Presentation - Mass in volume as provided in the drug kit
Right Appearance & Drug Safety Check - The ampoule is unbroken, does not leak, and the liquid is clear and free of floaties
* The drug is <drug>, <mass>, and expires <sometime></sometime></mass></drug>
E.g.: “This bag of sodium chloride 0.9% is undamaged, does not leak when squeezed, and the fluid is clear and
uncontaminated. Drug check: Sodium chloride 0.9%, 500mL bag, expires 10/2023”
* E.g.: “Ampoule is unbroken with clear liquid; adrenaline; 1mg in 1mL; expires 10/2023”
Emergency Sedation Complications
- Patient loss of consciousness
- Respiratory depression − particularly when associated with other CNS depressants such as alcohol or narcotics
- Depressed cardiovascular system – hypotension, bradycardia
- Unpredictable responses related to the interaction of the sedation medication with other medications or substances (prescribed and unprescribed) that the patient may have taken
- Variation in individual patient responses to the dosage(s) that are recommended and administered
Emergency Sedation Complications
- Loss of consciousness
- Respiratory depression − particularly when associated with other CNS depressants such as alcohol or narcotics
- Depressed cardiovascular system – hypotension, bradycardia
- Unpredictable responses to the interaction of the sedation medication with other medications or substances (prescribed and unprescribed) that the patient may have taken
- Variation in individual patient responses to the dosage(s) that are recommended and administered
Emergency Sedation Contraindications
- confirmed or suspected haemodynamic instability evidenced by one or more of: hypotension, arrhythmias, shortness of breath, decreased peripheral perfusion, cyanosis.
- A compromised airway or, where securing the airway would be difficult
- Contraindications listed in the DTP, specific to each sedation medication that is to be administered
Emergency Sedation Contraindications
- Where the patient is suffering or suspected to be suffering from haemodynamic instability evidenced by one or more of the following: hypotension, arrhythmias, shortness of breath, decreased peripheral perfusion, cyanosis.
- The patient is suffering from a compromised airway or, where securing the airway would be difficult.
- Contraindications listed in the DTP, specific to each sedation medication that is to be administered.
Emergency Sedation Indications
Acute behavioural disturbance in which the following
applies:
* Patient SAT Score of two (2) or greater; and
* The patient’s behaviour indicates imminent risk of serious harm to themselves and/or others; and
* Verbal de-escalation has been attempted by a QAS clinician and has failed to calm the patient and reduce the risk of harm.
Emergency Sedation Indications
Acute behavioural disturbance in which the following applies:
* Patient SAT Score of two (2) or greater; and
* The patient’s behaviour indicates imminent risk of serious harm to themselves and/or others; and
* Verbal de-escalation has been attempted by a QAS clinician and has failed to calm the patient and reduce the risk of harm
Features of a hypomanic episode
- associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic
- The disturbance in mood and any changes in functioning are observable by others
- The episode is not severe enough to cause marked impairment in social or occupational functioning or necessitate hospitalisation
- The episode cannot be attributed to substance use
Features of deeply disparing level of depression
- Endless, brooding interospection
- Mull over things to an exaggerated degree
- Become paralysed and feel crushed
- Ruminations and regurgitation of past happenings
Features of deeply disparing level of depression
- Endless, brooding interospection
- Mull over things to an exaggerated degree
- Become paralysed and feel crushed
- Ruminations and regurgitation of past happenings
Features of middle ground level of depression
- Depth of emotion
- Experience sorrow
- Fluid state
- Post traumatic growth
- Reasonable amount of introspection
Features of middle ground level of depression
- Experience sorrow
- Depth of emotion
- Reasonable amount of introspection
- Fluid state
- Post traumatic growth
Features of shallow - indifference level of depression
- no introspection
- difficulty learning from mistakes
Features of shallow - indifference level of depression
- no introspection
- difficulty learning from mistakes
Features of the depression Spectrum
- Black and White distinctions are abandoned
- Functioning and severity of presentation can fluctuate
Features of the depression Spectrum
- Black and White distinctions are abandoned
- Functioning and severity of presentation can fluctuate
For cyclothymic disorder to be classifed, what criteria must be met over a 2 year period?
- many periods of hypomanic and depressive symptoms, that do not meet the criteria for hypomanic or depressive episode
- the symptoms have lasted for at least half the time and have never stopped for more than 2 months
Generalised Anxiety Disorder (GAD) treatment plans
- Antidepressants
- Beta Blockers
- Biofeedback
- Cognitive behaviour psychotherapy
- Sedatives
Generalised Anxiety Disorder (GAD) treatment plans
- Cognitive behaviour psychotherapy
- Biofeedback
- Antidepressants
- Beta Blockers
- Sedatives
How late in life can the first episode of Bipolar I be?
60s or 70s
How long can a person be detained for under a VIRCA?
- six hours in the first instance
- doctor or health practitioner examining the patient can extend it for another six hours
How long does a hypomanic episode last?
most of the day, nearly every daye for at least 4 consecutive days
How long does a manic episode last if hospitalised?
any duration
How long does a manic episode last?
present most of the day, nearly every day for at least 1 week
How long to Pts need SIG E CAPSS to be classified as Major Depressive Disorder?
2 weeks
How many symptoms and for what duration are required for a schizophrenia diagnosis?
2 or more for 1 month or more
How many symptoms and for what duration are required for a schizophrenia diagnosis?
2 or more for 1 month or more
How many symptoms are required to be recognised as a hypomanic episode?
3; or
4 if mood is only irritable
How many symptoms are required to be recognised as a manic episode?
3; or
4 if mood is only irritable
If physical restraint is required, what type is to be used?
the least restrictive and minimally forceful options that do not illicit pain
Is it possible for a person to live with a mental illness but still have positive mental health?
yes
Is the clinical information from other informants useful in establishing the diagnosis of Bipolar II?
yes
Is the Gillick Competency assessment speccific to a particular treatment?
yes
List the complications of minor alcohol abuse withdrawal
Confusion
Insomnia
Disorientation
Irritability
Tachycardia
Nausea, abdo pain & loss of appetite
Tremors
Paroxysmal sweats (come & go)
Profuse sweat & flushed appearance
List the complications of minor alcohol abuse withdrawal
Confusion
Insomnia
Disorientation
Irritability
Tachycardia
Nausea, abdo pain & loss of appetite
Tremors
Paroxysmal sweats (come & go)
Profuse sweat & flushed appearance
List the complications of severe alcohol abuse withdrawal
Seizures – usually occur 6 – 48hrs post last drink
Delirium tremors
Anxiety
Agitation
Dysphoria
Hallucinations – may be visual, tactile or auditory
List the complications of severe alcohol abuse withdrawal
Seizures – usually occur 6 – 48hrs post last drink
Delirium tremors
Anxiety
Agitation
Dysphoria
Hallucinations – may be visual, tactile or auditory
What are the intrusive symptoms for Post Traumatic Stress Disorder (PTSD)?
- Recurrent, involuntary distressing memories of the event(s)
- Recurrent distressing dreams relating to the event(s)
- Dissociative reactions such as flashbacks in which the person feels or acts like the event(s) is/are recurring
- Intense or prolonged psychological distress at exposure to internal or external cues that symbolise or resemble the event(s)
- Marked physiological reactions to internal or external cues that symbolise the event(s)
What are the intrusive symptoms for Post Traumatic Stress Disorder (PTSD)?
- Recurrent, involuntary distressing memories of the event(s)
- Recurrent distressing dreams relating to the event(s)
- Dissociative reactions such as flashbacks in which the person feels or acts like the event(s) is/are recurring
- Intense or prolonged psychological distress at exposure to internal or external cues that symbolise or resemble the event(s)
- Marked physiological reactions to internal or external cues that symbolise the event(s)
Midazolam Adult IM Dose - Acute Behavioural Disturbance (SAT score ≥2) unresponsive to droperidol (max dose) administration
QAS Clinical Consultation and Advice Line approval required in all situations
Midazolam Adult IV Dose - Acute Behavioural Disturbance (SAT score ≥2) unresponsive to droperidol (max dose) administration
QAS Clinical Consultation and Advice Line approval required in all situations
Midazolam Adult NAS Dose - Generalised Seizure/Focal Seizure
5mg
Repeat every 10 minutes
Total max dose 20mg
Midazolam Adult IM Dose - Generalised Seizure/Focal Seizure
5mg
Repeat every 10 minutes
Total max dose 20mg
Midazolam Contraindications
allergy and/or adverse drug reaction
Midazolam Drug Class
Benzodiazepine (short acting)
Midazolam Indications
Generalised seizure/focal seizure (GCS ≤12)
Acute behaviour disturbance (SAT score ≥2) unresponsive to droperidol (max dose) administration
Sedation - CCP only
Midazolam Metabolism
Metabolised by the liver, excreted by the kidneys
Midazolam Adult IV Dose - Generalised Seizure/Focal Seizure
If IV already there
5mg
Repeat every 5 minutes
Total max dose 20mg
Midazolam Paediatric IM Dose for Acute Behavioural Disturbance (with a SAT score ≥2), unresponsive to droperidol (max dose) administration
QAS clinical consultation and advice line approval required in all situations
Midazolam Paediatric IV Dose for Acute Behavioural Disturbance (with a SAT score ≥2), unresponsive to droperidol (max dose) administration
QAS clinical consultation and advice line approval required in all situations
Midazolam Paediatric IM Dose for Generalised/Focal Seizures (GCS ≤12)
200 microg/kg
Single dose not to exceed 5 mg
Repeated at half initial dose every 10 min (max 2.5 mg)
Total max dose 10 mg
Midazolam Paediatric NAS Dose for Generalised/Focal Seizures (GCS ≤12)
200 microg/kg
Single dose not to exceed 5 mg
Repeated at half initial dose every 10 min (max 2.5 mg)
Total max dose 10 mg
Midazolam Pharmacology
Short acting CNS depressant that enhances the action of the inhibitory neurotransmitter GABA, inducing amnesia, anaesthesia, hypnosis and sedation
Midazolam Precautions
- Reduced dosages must be considered in:
- low body weight, older or cachectic Pts
- Pts with chronic renal failure, congestive heart failure or shock
- can cause severe respiratory depression in Pts with COPD
- myasthenia gravis
- multiple sclerosis
Midazolam Presentation
Ampoule, 5mg/1mL, midazolam
Midazolam Routes of Administration
NAS
IM
IV
Midazolam Side Effects
hypotension
respiratory depression particularly when associated with other CNS depressants incl alcohol and narcotics
Midazolam Special Notes
Focal seizure activity in an unconscious or altered (GCS_<_12) treated as a generalised seizure - GCS >12 contact QAS Clinical Consultation and Advice Line
Take into account previous doses prior to arrival of midazolam or diazepam
Contact QAS Clinical Consltation and Advice Line if not responding to QAS initiated Tx
First dose of midazolam for seizures must be administered NAS or IM injection unless IV cannula already in situ
All IV doses must be diluted with sodium chloride 0.9% to make 5 mg midazolam in 5 mL presentation
Midazolam Timing
Onset
5-15 minutes (IM)
1-3 minutes (IV)
Duration
Variable
- *Half Life**
2. 5 hours
Objective signs of panic attacks
- Increased muscular tension
- HR increase - palpitations
- Sweating
- Shaking
- Hyperventilation
Objective signs of Social Phobia
- Increased muscular tension
- HR increase - palpitations
- Sweating
- Shaking
- Hyperventilation
Post Traumatic Stress Disorder (PTSD) treatments
- Prolonged exposure therapy
- Cognitive therapy
- Stress management
- Psychodynamic therapy
- Eye movement desensitization and reprocessing (EMDR)
- Pharmacology
- SSRIs – Selective Serotonin reuptake inhibitors
- MAOIs – Monoamine oxidase inhibitors
- SNRIs – Seretonin-nonadrenaline reuptake inhibitors
- TCAs – Tricyclic antidepressants (Mirtazapine)
Post Traumatic Stress Disorder (PTSD) treatments
- Prolonged exposure therapy
- Cognitive therapy
- Stress management
- Psychodynamic therapy
- Eye movement desensitization and reprocessing (EMDR)
- Pharmacology
- SSRIs – Selective Serotonin reuptake inhibitors
- MAOIs – Monoamine oxidase inhibitors
- SNRIs – Seretonin-nonadrenaline reuptake inhibitors
- TCAs – Tricyclic antidepressants (Mirtazapine)
Signs and symptoms of Generalised Anxiety Disorder (GAD)
- Fatigue
- Tension
- Poor concentration
- Insomnia
- Irritability
Questions to ask schizophrenic pts
- Do you suffer from any mental health illnesses?
- Are you diagnosed with schizoprenia?
- Do you have any hallucinations? - if yes, ask Do you see them or hear them? if yes - I have to ask you this for my own safety, are the voices/visions telling you to hurt yourself or others including me? If yes - get QPS escort
Questions to ask schizophrenic pts
- Do you suffer from any mental health illnesses?
- Are you diagnosed with schizoprenia?
- Do you have any hallucinations? - if yes, ask Do you see them or hear them? if yes - I have to ask you this for my own safety, are the voices/visions telling you to hurt yourself or others including me? If yes - get QPS escort
Should CCP back-up be considired for all behaviourally disturbed, physically restrained pts?
yes
Should receiving hospitals be notified of the impending arrival of a physically restrained or behaviurally distrubed pts? If so, why?
Yes, to ensure rapid assessment, management and appropriate resource allocation
Steps in the management of an excited delirium patient?
Team brief and role allocation
Prepare resuscitation equipment
Prepare the sedation pharmacology
Ensure everyone is safe
Prepare for complications
Hyperthermia - cool pt
If possible obtain VSS
Transport
What are the steps when completing a mental status assessment (MSA)?
- Assess the Pt -ascertain cause of current presentation
- Exclude and/or treat organic causes
- Treat Pt only if safe
- Observe, question and note relevant information
- Be respectful and empathetic
- Do not judge or interrogate
- Be aware and respectful of possible cultural beliefs
Steps when treating a mental health patient
- Assess the Pt -ascertain cause of current presentation
- Exclude and/or treat organic causes
- Treat Pt only if safe
- Observe, question and note relevant information
- Be respectful and empathetic
- Judgmental attitudes, interrogation or disrespectful stances will only escalate or deteriorate situation
- Be aware and respectful of possible cultural beliefs
What are the steps when completing a mental status assessment (MSA)?
- Assess the Pt -ascertain cause of current presentation
- Exclude and/or treat organic causes
- Treat Pt only if safe
- Observe, question and note relevant information
- Be respectful and empathetic
- Do not judge or interrogate
- Be aware and respectful of possible cultural beliefs
Subjective symptoms of panic attacks
- “I’m having a heart attack”
- “I’m going to die”
- Feeling faint/Light headedness
- Amnesia
- Hallucinations
- Visual disturbances
- Depersonalisation
- Pins & Needles
- Feeling numb
Subjective symptoms of Social Phobia
- Faint/lightheaded
- Visual disturbances
- Depersonalisation
- Pins & Needles
- Feeling numb
Suicide has a strong association with which diagnoses?
- Alcohol and other substance use disorders
- Anxiety
- Borderline personality disorder
- Eating disorders
- Major depression
- Psychosis
- Previous trauma
Symptoms of antisocial personality disorder
Disregard for safety
Impulsivity
Irritability or aggressiveness
Irresponsible behaviour
Lying
Lack of remorse
Violating social norms
Symptoms of antisocial personality disorder
Violating social norms
Lying
Impulsivity
Irritability or aggressiveness
Irresponsible behaviour
Disregard for safety
Lack of remorse
Symptoms of antisocial personality disorder
Violating social norms
Lying
Impulsivity
Irritability or aggressiveness
Irresponsible behaviour
Disregard for safety
Lack of remorse
Symptoms of avoidant personality disorder
Avoiding work with social aspects
Caution with relationships
Feeling inept or inferior
Avoiding risks
Difficulties with intimacy
Difficulties with new relationships
Symptoms of avoidant personality disorder
Avoiding work with social aspects
Caution with relationships
Feeling inept or inferior
Avoiding risks
Difficulties with intimacy
Difficulties with new relationships
Symptoms of Bipolar II
High level of impulsivity leading to suicide attempts and substance use disorder
Heightened creativity noticed in less affected individuals
Symptoms of Bipolar II
High level of impulsivity leading to suicide attempts and substance use disorder
Heightened creativity noticed in less affected individuals
Symptoms of borderline personality disorder
Efforts to avoid abandonment
Identity disturbance
Unstable relationship pattern
Impulsivity
Suicidal/Self Harm behaviour
Feeling of emptiness
Anger
Symptoms of dependent personality disorder
Difficulty with everyday decisions
Avoiding disagreement
Effort to get and keep support
Fear of being left alone
Symptoms of dependent personality disorder
Difficulty with everyday decisions
Avoiding disagreement
Effort to get and keep support
Fear of being left alone
Symptoms of dependent personality disorder
Difficulty with everyday decisions
Avoiding disagreement
Effort to get and keep support
Fear of being left alone
Symptoms of dysphoric mood
anxiety
anger
depression
reversed sleep pattern
lack of interest in food
Symptoms of histrionic personality disorder
Attention seeking
Sexually seductive or provocative
Use appearance to attract attention
Shallow expression of emotion
Impressionistic style of speech
Exaggerated emotions
Suggestible
Symptoms of narcissistic personality disorder
Arrogance
Fantasies of power and success
Feeling special
Grandiosity
Lack of empathy
Need for excessive admiration
Sense of entitlement
Symptoms of obsessive compulsive personality disorder (OCPD) personality disorder
Lists, schedules, order and rules
Perfectionism
Devoted to productivity
Overconscientious
Rigid and stubborn
(
Symptoms of paranoid personality disorder
Suspiciousness
Distrusting
Misinterpreting remarks
Holding Grudges
Worried about infidelity
Symptoms of schizoid personality disorder
No desire for relationships
Solitary
No interest in sex
Little pleasure in activities
Lacking close friends
Indifference to praise or criticism
Cold, detached or flat affect
Symptoms of schizotypal personality disorder
Ideas of reference
Odd beliefs
Magical thinking
Odd behaviour or appearance
Perceptual distortions
Constricted affect
Lacking close friends
Social anxiety
Symptoms of schizotypal personality disorder
Ideas of reference
Odd beliefs
Magical thinking
Odd behaviour or appearance
Perceptual distortions
Constricted affect
Lacking close friends
Social anxiety
To ascertain the degree of schizophreni, ask what question?
How strong are your dreams and visions?
To ascertain the degree of schizophreni, ask what question?
How strong are your dreams and visions?
Treatment plan for Major Depressive Disorder
- Cognitive behaviour psychotherapy
- Antidepressants
- Combination of 1 & 2
Treatment plans for anxiety
Cognitive behaviour psychotherapy
Low dose antidepressants
+/-Mental Health referral
Treatment plans for Persistent Depressive Disorder (Dysthymic Disorder)
- Therapy
- Antidepressants
- Combination of 1 & 2
Treatment plans for Premenstrual Dysphoric Disorder (previously PMS)
- Exercise
- Diet
- Antidepressants
- Hormonal treatment
- Psychotherapy
Treatment plans for Social Phobia
- Cognitive behavior psychotherapy
- Skills training – ‘tools in your tool kit”
- Antidepressants
- Sedatives
- Validation
Treatment plans for Specific Phobias
- Cognitive behaviour psychotherapy
- Desensitisation
- Flooding techniques
What age is the onset of Bipolar II?
mid 20s
What are delusions?
False, irrational beliefs that can’t be changed by evidence and aren’t shared by other people from the same cultural background
What are delusions?
False, irrational beliefs that can’t be changed by evidence and aren’t shared by other people from the same cultural background
What are hallucinations?
Seeing, hearing, feeling, tasting or smelling something that isn’t there
What are hallucinations?
Hearing, seeing, smelling, tasting or feeling something that isn’t there
What are indicators of psychosis?
Depression and anxiety
Preoccupation with a subject
Speech or writing that is very fast, muddled, irrational or hard to understand
Increased anger, aggression or suspiciousness
Decreased or disturbed sleep
Loss of concentration, memory and/or attention
Increased sensitivity to light, noise and/or other sensory inputs
Talking much less
Withdrawing from relationships or hobbies
Inactivity or hyperactivity
Behaving in a way that’s reckless, strange or out of character
Laughing or crying inappropriately, or being unable to laugh or cry
Inattention to personal hygiene
Being unable to feel or express happiness
What are mood stabiliser drugs prescribed for?
to treat or prevent mania or hypomania episodes
Symptoms of negative thoughts and feelings?
- Less interest in activities previously enjoyed
- feeling estranged from others
- ongoing fear, horror, guilt, anger or shame
- distorted beliefs about themselves
What are social cognition deficits?
inability to infer the intent of others
What are some common mood stabiliser drugs?
Carbamazepine (Tegretol)
Divalproex sodium (Depakote)
Lamotrigine (Lamictal) – more useful for treating depression
Lithium – better for treating mania
Valproic acid (Depakene)
What are some common SNRIs?
GENERIC NAME BRAND NAME
Desvenlafaxine Pristiq
Duloxetine Cymbalta
Levomilnacipran Fetzmia
Milnacipran Ixal
Venlafaxine Effexor
What are some common SSRIs?
GENERIC NAME BRAND NAME
Escitalopram Lexapro
Sertraline Zoloft
Citalopram Celexa
Fluoxetine Prozac
Paroxetine Paxil
Fluvoxamine Luvox
What are some examples of arousal and reactive symptoms?
- angry outburst
- difficulty sleeping or concentrating
- easily startled
- irritability
- reckless and destructive behaviour
What are some examples of avoiding reminders?
avoiding particular people, places, activities, situations and objects that bring back distressing memories
What are some mimics of excited delirium?
Diabetic hypoglycaemia
Heat stroke
Neuroleptic malignant syndrome
Serotonin syndrome
What are some names for cannabis?
marijuana
hashish
has oil
weed
pot
grass
dope
mull
reefer
What are some names for opioids?
heroin
smack
hammer
harry
H
junk
gear
What are some of the delierient drugs?
datura (angels dust)
chopped flower and infused in tea
What are some of the delierient drugs?
datura (angels dust)
chopped flower and infused in tea
What are some of the dissociateive hallucinogen drugs?
Ketamine (special K)
Gamma hydroxybutyrate (GHB)
Phencyclidine (PCP, angel dust) dissociative anaesthetic properties nitrous oxide (laughing gas, nangs)
What are some of the dissociateive hallucinogen drugs?
Ketamine (special K)
Gamma hydroxybutyrate (GHB)
Phencyclidine (PCP, angel dust) dissociative anaesthetic properties nitrous oxide (laughing gas, nangs)
What are some of the MDMA drugs?
E
ecstasy
eccies
What are some of the MDMA drugs?
E
ecstasy
eccies
What are some of the medications used to treat alcoholics that you might see on road?
Naltrexone (Depade)
Acamprosate (Campral)
Diulfram (Antabuse)
What are some of the medications used to treat alcoholics that you might see on road?
Naltrexone (Depade)
Acamprosate (Campral)
Diulfram (Antabuse)
What are some of the possible triggers for self harm?
- alcohol or drug abuse
- physical illness
- poor living circumstances
- mental illness
- stressful life events
- trauma
What are some of the psychedelic drugs?
Lysergic acid diethylamide (LSD)
acid
Magic Mushrooms – (gold tops, mushies)
What are some of the psychedelic drugs?
Lysergic acid diethylamide (LSD)
acid
Magic Mushrooms – (gold tops, mushies)
What are some of the second generation or atypical antipsychotics?
Aripiprazole
Clozapine
Olanzapine
Quetiapine
Risperidone
Ziprasidone
What are some of the types of hallucinogens?
psychedelics
MDMA
DMT
delirients
Dissociative
What are some other names for excited delirium (ExD)?
acute delirious mania
malethal catatonia
nic-depressive exhaustion
typhoma
What are some signs of dementia?
language impairment/aphasia
agigation
pacing
fiddling
repeated questioning
What are some suicidal behaviours?
- self-poisoning (overdose)
- jumping from a height or in front of a moving vehicle
- driving a car into a tree at a high speed
- poisoning from gases and vapours (including motor vehicle exhaust)
- use of a lethal weapon
- hanging
What are the 2 names for self harm?
Deliberate Self Harm (DSH)
Deliberate Self Injury (DSI)
What are the 2 requirements for Post Traumatic Stress Disorder (PTSD) symptoms for diagnosis?
- present for > 1 month
- cause clinically significant distress or impairment in social, occupational or other areas of functioning
What are the 2 requirements for Post Traumatic Stress Disorder (PTSD) symptoms for diagnosis?
- present for > 1 month
- cause clinically significant distress or impairment in social, occupational or other areas of functioning
What are the 3 depressant drugs?
benzodiazepines
cannabis
opioids
What are the 3 most common diagonsis in sufferers of Post Traumatic Stress Disorder (PTSD)?
Major Depressive Disorder
Alcohol abuse
Anxiety Disorders
What are the 3 most common diagonsis in sufferers of Post Traumatic Stress Disorder (PTSD)?
Major Depressive Disorder
Alcohol abuse
Anxiety Disorders
What are the 3 stimulants?
amphetamines
methylamphetamines
cocaine
What are the 5 domains of Post Traumatic Growth (PTG)?
Spiritual Development
(contented - I accept)
Personal Strength
(optimistic - I can)
Close Relationships
(intimate - I cherish)
Greater appreciation for life
(grateful - I thank)
New Possibilities
(thriving - I dream)
What are the 5 domains of Post Traumatic Growth (PTG)?
Spiritual Development
(contented - I accept)
Personal Strength
(optimistic - I can)
Close Relationships
(intimate - I cherish)
Greater appreciation for life
(grateful - I thank)
New Possibilities
(thriving - I dream)
What are the 7 ethical principles on which codes of ethics are based?
autonomy
beneficence
confidentiality
fidelity
justice
nonmaleficence
veracity
What are the 7 ethical principles on which codes of ethics are based?
autonomy
beneficence
nonmaleficence
justice
confidentiality
fidelity
veracity
What are the ABD post sedation measures?
- Position the Pt in lateral position or other appropriate position where face can be viewed, airway maintained and VSS monitored.
- Record Pts SAT score and vitals every 5 minutes
- If SAT score <0 apply nasal prong ETCO2 if tolerated
- Remove restraints when safe to do so
- Early hospital prenotification
What are the ABD post sedation measures?
- Position the Pt in lateral position or other appropriate position where face can be viewed, airway maintained and VSS monitored.
- Record Pts SAT score and vitals every 5 minutes
- If SAT score <0 apply nasal prong ETCO2 if tolerated
- Remove restraints when safe to do so
- Early hospital prenotification
What are the alterations in arousal and reactivity in cognition or mood in Post Traumatic Stress Disorder (PTSD)?
- Exaggerated startle response
- Difficulty concentrating
- Hypervigilance
- Irritability and angry outbursts
- Reckless or self-destructive behaviour
- Sleep disturbance - insomnia or increased sleep
What are the alterations in arousal and reactivity in cognition or mood in Post Traumatic Stress Disorder (PTSD)?
- Exaggerated startle response
- Difficulty concentrating
- Hypervigilance
- Irritability and angry outbursts
- Reckless or self-destructive behaviour
- Sleep disturbance - insomnia or increased sleep
What are the avoidance symptons in Post Traumatic Stress Disorder (PTSD)?
- Avoidance or efforts to avoid distressing memories, thoughts or feelings associated or closely associated with the traumatic event(s)
- Avoidance or efforts to avoid external reminders that bring about distressing memories, thoughts or feelings about the event(s)
What are the avoidance symptons in Post Traumatic Stress Disorder (PTSD)?
- Avoidance or efforts to avoid distressing memories, thoughts or feelings associated or closely associated with the traumatic event(s)
- Avoidance or efforts to avoid external reminders that bring about distressing memories, thoughts or feelings about the event(s)
What are the cascade of events in sepsis that leads to cellular dyfunction?
Capillary leak
Cell adhesion
Tissue hypoxia
Impaired Vascular tone
Free Radical damage
What are the categories of symptoms in Post Traumatic Stress Disorder (PTSD)?
Intrusive symptoms
Avoidance symptoms
Negative Alterations in cognition or mood
Alterations in arousal and reactivity
What are the categories of symptoms in Post Traumatic Stress Disorder (PTSD)?
Intrusive symptoms
Avoidance symptoms
Negative Alterations in cognition or mood
Alterations in arousal and reactivity
What are the cluster C personality disorders?
avoidant
dependent
obsessive compulsive personality disorder (OCPD)
What are the cognitive deficits seen in schizophrenia?
memory
language
slower processing speeds
What are the cognitive deficits seen in schizophrenia?
memory
language
slower processing speeds
What are the components of a POP assessment?
Person
Object
Place
What are the components of a POP assessment?
Person
Object
Place
What are the components to the Axis of Vigilance?
- vigilance is necessary to avoid danger
- more vigilance = more likely to progress to clinical anxiety
- recklessness – lack of ability to properly evaluate risk
- emotional effect on selective attention
- justification of fear or lack of fear
What are the criteria that are required for involuntary detention of a mental health patient?
- The person is experiencing a mental health illness and are a danger to themselves or others
- Immediate treatment is required
- Appropriate treatment in approved mental health setting is available
- The person has impaired decision –making capacity in relation to their mental illness
What are the criteria that are required for involuntery dentention of a mental health patient?
- The person is experiencing a mental health illness
- The person is a danger to themselves or others
- Immediate treatment is required
- Appropriate treatment in approved mental health setting is available
- The person has impaired decision –making capacity in relation to their mental illness
What are the de-escalation strategies for Acute Behavioural Disturbances (ABD)?
Approach the situation with the right attitude and maintain self-control
Non-aggression – voice and body language
Match energy levels - ??
Empathise and active listening
Focus on the issue at hand
What are the de-escalation strategies for Acute Behavioural Disturbances (ABD)?
Approach with the right attitude
maintain self-control
Non-aggression – voice and body language
Match energy levels - ??
Empathise and active listening
Focus on the issue at hand
What are the early signs of dementia?
Progressive and frequent memory loss
Confusion
Personality change
Apathy and withdrawal
Loss of ability to perform everyday tasks
What are the exclusions to panic disorder symptoms?
- The disturbance is attributable to the physiological effects of a substance or another medical condition
- The disturbance is not better explained by another mental disorder
What are the features of major depressive episode?
- symptoms cause clinically significant distress or impairment in social,
- occupational, or other important areas of functioning
- The episode cannot be attributed to substance use
What are the features of schizophrenia?
- Manifests slowly with gradual development of clinical signs/symptoms
- ½ complain of depressive symptoms
- Early age onset usually a predictor of worse prognosis
- Psychotic symptoms tend to diminish over life of the illness
- Cognitive symptoms appear to worsen over life of the illness
What are the features of schizophrenia?
- Manifests slowly with gradual development of clinical signs/symptoms
- ½ complain of depressive symptoms
- Early age onset usually a predictor of worse prognosis
- Psychotic symptoms tend to diminish over life of the illness
- Cognitive symptoms appear to worsen over life of the illness
What are the four types of methylamphetamines?
crystal - looks like crushed ice
powder - looks like white or coloured powder
pills - looks like prescription ppills
base - looks like gluggy paste
What are the general categories of Acute Behavioural Disturbance (ABD)?
Organic disorders
Psychiatric disorders
Substance related
Situational
What are the general categories of Acute Beavioural Disturbance (ABD)?
Psychiatric disorders
Substance related
Organic disorders
Situational
What are the indicators of complicated grief?
agitated, aggressive and demanding behaviours
depressive disorders
life-depleting behaviours (compulsive or excessive behaviours)
post-traumatic stress reactions
persistent grief reactions.
suicidal thoughts and gestures
What are the indicators of complicated grief?
suicidal thoughts and gestures
depressive disorders
post-traumatic stress reactions
persistent grief reactions.
life-depleting behaviours (compulsive or excessive behaviours)
agitated, aggressive and demanding behaviours
What are the Kuber-Ross 5 stages of grief?
Denial
Anger
Bargaining
Depression
Acceptance
What are the Kuber-Ross 5 stages of grief?
Denial
Anger
Bargaining
Depression
Acceptance
What are the limitations for the prone position when restraining patients?
not in prone position for longer than 2 minutes as it may impede breathing and result in positional asphyxia
What are the negative alterations in cognition or mood in Post Traumatic Stress Disorder (PTSD)?
- Inability to remember an important aspect of the traumatic event(s)
- Persistent and exaggerated negative beliefs or expectations about oneself, others or the world
- Persistent distorted cognitions about the cause or consequences of the traumatic event(s) that lead to the person blaming themselves or others
- Persistent negative emotional state – e.g. fear, anger, guilt
- Markedly diminished interest or participation in significant activities
- Feelings of detachment or estrangement from others
- Persistent inability to experience positive emotions
What are the negative alterations in cognition or mood in Post Traumatic Stress Disorder (PTSD)?
- Inability to remember an important aspect of the traumatic event(s)
- Persistent and exaggerated negative beliefs or expectations about oneself, others or the world
- Persistent distorted cognitions about the cause or consequences of the traumatic event(s) that lead to the person blaming themselves or others
- Persistent negative emotional state – e.g. fear, anger, guilt
- Markedly diminished interest or participation in significant activities
- Feelings of detachment or estrangement from others
- Persistent inability to experience positive emotions
What are the negative symptoms of schizophrenia?
- Diminished emotional expression
- Avolition - a total lack of motivation that makes it hard to get anything done
- Alogia - a poverty of speech that results from impairment in thinking that affects language abilities
- Anhedonia - the inability to feel pleasure
What are the negative symptoms of schizophrenia?
- Diminished emotional expression
- Avolition - a total lack of motivation that makes it hard to get anything done
- Alogia - a poverty of speech that results from impairment in thinking that affects language abilities
- Anhedonia - the inability to feel pleasure
What are the physical and emotional symptoms of Premenstrual Dysphoric Disorder (previously PMS)?
- Anger
- Anxiety
- Irritability
- Mood swings
- Outbursts
- Severe depression
What is Premenstrual Dysphoric Disorder (previously PMS)
- physical and emotional symptoms prior to the onset of menstruation
- 1 week prior is typical
- Range in severity from mild to severe disruptive changes
- Symptoms resolve or substantially improve once menstruation begins
- Pt’s lives are restricted by their cycle
- Can be exhausting and exasperating*
What are the positive symptoms of schizophrenia?
- Hallucinations
- Delusions
- Disorganised thinking
- Grossly disorganized or abnormal motor behaviour
What are the positive symptoms of schizophrenia?
- Hallucinations
- Delusions
- Disorganised thinking
- Grossly disorganized or abnormal motor behaviour
What are the presentations of Acute Behavioural Disturbance (ABD)?
Agitation
Anxiety
Delusions
Hallucinations
Impulsivity
Panic
Thought disorders
Unpredictabity
What are the presumptive causes in Post Traumatic Stress Disorder (PTSD)?
- Personal experience
- itnessing an event first hand
- earning of a traumatic event that occurred to a close friend or family member
- experiencing repeated or extreme exposure to aversive details of traumatic events (First responders)
What are the presumptive causes in Post Traumatic Stress Disorder (PTSD)?
- Personal experience
- itnessing an event first hand
- earning of a traumatic event that occurred to a close friend or family member
- experiencing repeated or extreme exposure to aversive details of traumatic events (First responders)
What are the reasons that a pt can not be involuntarily detained?
- political, religious or personal beliefs
- sexual preferences
- criminal behaviour
- illegal drug use
- intellectual disability
What are the side effects of antipsychotics?
Drowsiness
Dizziness
Eyesight problems
Weight gain
Unusually dry or watery mouth
Nausea
Restlessness
Trembling, especially in the limbs
Extrapyramidal symptoms
Issues with libido
Constipation
Pain or irregularity in menstruation
Increased sweating
What are the signs of benzodiazepine intoxication?
confusion and disorientation
extreme dizziness
decreased RR
What are the signs of cannabis intoxication?
talkative
increased hunger
What are the signs of excited delirium?
aggressive behaviour
paranoia,
panic
excessive sweating
violence towards others
incredible strength
hyperthermia
What are the signs of hallucinogen intoxication?
Autonomic arousal
Uncontrolled body movement
Pupil dilation
Clenched Jaw
Tachycardia
Chest pain
What are the signs of heroin intoxication?
anxiety disorders
chronic constipation
loss of sex drive
What are the signs of hypoglycaemia?
ALOC/confusion
seizures
anxiety
lethargy
headaches
change in behaviour
dizziness
visual disturbances
slurred speech
tachycardia
tremors
What are the signs of sepsis?
presumed or known site of infection and 2 or more of:
ALOC
Temp less than 36 or greater than 38.3
HR greater than 90
RR greater than 20
BGL greater than 6.6 (unless diabetic)
What are the signs of severe sepsis?
presumed or known site of infection and 2 or more of:
ALOC
Temp less than 36 or greater than 38.3
HR greater than 90
RR greater than 20
BGL greater than 6.6 (unless diabetic)
and one or more of:
SBP less than 90 or MAP less than 65
SPO2 less than 90
no urine for greater than 8 hours
prolong bleeding from minor injury or gums
What are the signs of stimulant intoxication?
Seizures
Psychosis
Dysphoria
Depression
Delirium
Sleep disorders
Dilated pupils
Damaged septum
Sore throat, bloody sputum
Tachypneoa
Tachycardia
Hypertension
Cardiovascular collapse
Increased body temperature
Sexual dysfunction
What are the ABD pre sedation checks?
- Appropriate QAS and QPS resources available?
- Assign team roles
Sedation Supervisor
Sedation Assistant
Additional Personnel as required - Review DTP for Droperidol
- Consult if required
- Paramedic at Pts head for ongoing monitoring of airway and physical condition (avoid prone position and pressure on head, neck, chest or back)
- Defibrillator pads or 12 lead on for continuous monitoring of ECG
- Resuscitation equipment immediately available
- All sedation team members briefed.
What are the ABD pre sedation checks?
- Appropriate QAS and QPS resources available?
- Assign team roles
Sedation Supervisor
Sedation Assistant
Additional Personnel as required - Review DTP for Droperidol
- Consult if required
- Paramedic at Pts head for ongoing monitoring of airway and physical condition (avoid prone position and pressure on head, neck, chest or back)
- Defibrillator pads or 12 lead on for continuous monitoring of ECG
- Resuscitation equipment immediately available
- All sedation team members briefed.
What are the steps in emergency sedation?
- Assign team roles
- Review DTP for Droperidol
- Consult if required
- Attempt to obtain baseline VSS
- Complete ABD checklist (each administration of pharmacology)
- Remove pt restrainds
- Posture pt appropriately
- Continaul moitoring of VSS
- Consider EtCO2
- Ensure early hospital prenotification
What are the symptoms of a hypomanic episode?
Exaggerated self-esteem or grandiosity
Less need for sleep
Talking more than usual, talking loudly and quickly
Easily distracted
Doing many activities at once, over scheduling
Increased risky behaviour
Uncontrollable racing thoughts or quickly changing ideas or topics
Less severe than manic episode
What are the symptoms of a hypomanic episode?
Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than normal
Flight of ideas
Distractibilty
Increase in goal-directed activity or psychomotor agitation
Excessive imvolvementr in activities that have a high potential for painful
consequences
What are the symptoms of a major depressive episode?
Intense sadness or despair
Feeling helpless, hopeless, worthless or guilty
Feeling restless or agitated, or slowed speech or movements
Frequent thoughts of death or suicide
Difficulty concentrating, remembering making decisions
Sleep problems – too little or too much
Loss of interest in activities once enjoyed
Changes in appetite - increase or decrease
Loss of energy, fatigue
What are the symptoms of a manic episode?
Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than normal
Flight of ideas
Distractibilty
Increase in goal-directed activity or psychomotor agitation
Excessive imvolvement in activities that have a high potential for painful
consequences
What are the symptoms of a manic episode?
Exaggerated self-esteem or grandiosity
Less need for sleep
Talking more than usual, talking loudly and quickly
Easily distracted
Doing many activities at once, over scheduling
Increased risky behaviour
Uncontrollable racing thoughts or quickly changing ideas or topics
What are the symptoms of bipolar I?
Dramatic mood swings
Manic episode
Hypomanic episode
Major Depressive Episode
Perods of normal mood between episodes
What are the symptoms of cyclothymic disorder?
hypomania
depression
What are the symptoms of psychosis?
delusions
hallucinations
disordered thinking
disordered behaviour
What are the symptoms of schizophrenia?
- Delusions
- Hallucinations
- Disorganised speech – derailment or incoherence
- Grossly disorganised or catatonic behaviour
- Negative symptoms – diminished emotional expression or avolotion
What are the symptoms of schizophrenia?
- anosognosia
- anxiety and phobias
- attention reduction
- cognitive deficits
- display inappropriate affect, eg laughing without stimulus
- dysphoric mood
- depersonalisation, derealization, and somatic concerns
- hostility and aggression
- lack of insight
- sensory processing and inhibition abnormalities
- social cognition deficis
- vocational and functional abilities
What are the symptoms of schizophrenia?
- Delusions
- Hallucinations
- Disorganised speech – derailment or incoherence
- Grossly disorganised or catatonic behaviour
- Negative symptoms – diminished emotional expression or avolotion
What are the symptoms of schizophrenia?
- anosognosia
- anxiety and phobias
- attention reduction
- cognitive deficits
- display inappropriate affect, eg laughing without stimulus
- dysphoric mood
- depersonalisation, derealization, and somatic concerns
- hostility and aggression
- lack of insight
- sensory processing and inhibition abnormalities
- social cognition deficis
- vocational and functional abilities
What are the symptoms of social phobia?
Hate being in the spotlight or drawing attention
Interacting with strangers is painful for them
Avoid situations in “public”
Limit social, educational and career opportunities
What are the symptoms of suicide?
- make a plan
- become withdrawn
- mood swings
- become destructive & Act recklessly
- increased alcohol and/or drug misuse
- continually talk about death, dying and/or suicide
- withdrawn from family and friends
What are the three conditions of bipolar?
Bipolar I
Bipolar II
cyclothymic disorder
What are the three conditions of bipolar?
Bipolar I
Bipolar II
cyclothymic disorder
What are the three main questions for a POP Assessment?
Is the scene safe to enter?
On entering the scene is there imminent danger to QAS personnel?
Can personnel safely withdraw from scene?
What are the three main questions for a POP Assessment?
Is the scene safe to enter?
On entering the scene is there imminent danger to QAS personnel?
Can personnel safely withdraw from scene?
What are the three main questions for a POP Assessment?
Is the scene safe to enter?
On entering the scene is there imminent danger to QAS personnel?
Can personnel safely withdraw from scene?
What are the treatment options for bipolar disorder?
Medication – mood stabilisers and antidepressants
Psychotherapy
Electroconvulsive therapy (ECT) – if medications and psychotherapy
have not been helpful
Antipsychotics (e.g. Haloperidol, Loxapine, Risperidone)
What are the two requirements for a Post Traumatic Stress Disorder (PTSD) diagnosis?
presumptive cause
symptoms
What are the two requirements for a Post Traumatic Stress Disorder (PTSD) diagnosis?
presumptive cause
symptoms
What are traumatic events for those suffering Post Traumatic Stress Disorder (PTSD)?
events that threatened the life or safety of the person or those around them
What are traumatic events for those suffering Post Traumatic Stress Disorder (PTSD)?
events that threatened the life or safety of the person or those around them
What areas should not have pressure placed on them when the patient is sedated?
head
neck
back
What areas should not have pressure placed on them when the patient is sedated?
head
neck
back
What behaviours are included in Deliberate Self Harm (DSH) or Deliberate Self Injury (DSI)?
- Deliberately cutting the body
- Scratching
- Hitting
- Head banging
- Burning and scalding
- Hair pulling
- Excessive use of substances such as alcohol and illicit drugs
- Self-poisoning (overdose)
- Jumping from a height or in front of a moving vehicle
What conditions does mental illness/mental disorder cover?
a range of conditions where the impact of the symptoms is clinically significant and can be diagnosed according to standard criteria
What do hallucinogens do?
Distort a persons perception
What do you look at when assessing the appearance of your patient?
Grooming
Posture
Build
Clothing
Cleanliness
When doing an MSA, what do you look at when assessing the appearance of your patient?
Build
Clothing
Cleanliness
Grooming
Posture
When doing an MSA, what do you look at when assessing the appearance of your patient?
Build
Clothing
Cleanliness
Grooming
Posture
What do you look for when assessing the affect of your patient?
Blunt
Restricted
Labile
What do you look for when assessing the affect of your patient?
Blunt
Restricted
Labile
What do you look for when assessing the affect of your patient?
Blunt
Restricted
Labile
When doing and MSA, what do you look for when assessing the affect of your patient?
Blunt
Labile
Restricted
When doing and MSA, what do you look for when assessing the affect of your patient?
Blunt
Labile
Restricted
What do you look for when assessing the behaviour of your patient?
Eye contact
Mannerisms
Gait
Activity level
When doing and MSA, what do you look for when assessing the behaviour of your patient?
Activity level
Eye contact
Gait
Mannerisms
When doing and MSA, what do you look for when assessing the behaviour of your patient?
Activity level
Eye contact
Gait
Mannerisms
When doing and MSA, what do you look for when assessing the insight and judgement of your patient?
Cause and effect
Cognition
Illness
Understanding
When doing and MSA, what do you look for when assessing the insight of your patient?
- Is there an appreciation that their illness may affect their life
- Do they even think they have an illness
- Do they partially or fully understand the situation
- Can they explain why an ambulance was actually called
What do you look for when assessing the insight of your patient?
- Is there an appreciation that their illness may affect their life
- Do they even think they have an illness
- Do they understand the situation either fully or partially
- Can they explain why an ambulance was actually called
What do you look for when assessing the judgement of your patient?
- Are the judgements socially appropriate
- Are judgements about personal relationships appropriate
- Are they able to manage their own finances
When doin an MSA what do you look for when assessing the judgement of your patient?
- Are their judgements socially appropriate
- Are their judgements about personal relationships appropriate
- Are they able to manage their own finances
When doing and MSA, what do you look for when assessing the mood of your patient?
Anxious
Cheerful
Depressed
What do you look for when assessing the mood of your patient?
Anxious
Depressed
Cheerful
What do you look for when assessing the mood of your patient?
Anxious
Depressed
Cheerful
What do you look for when assessing the mood of your patient?
Anxious
Depressed
Cheerful
When doing and MSA, what do you look for when assessing the mood of your patient?
Anxious
Cheerful
Depressed
When doing and MSA, what do you look for when assessing the perceptions of your patient?
- Broadcasting
- Hallucinations – Auditory, Visual, Olfactory, Gustatory & Tactile
- Illusions – misinterpretation of an actual external stimulus
- Thought insertion
What do you look for when assessing the perceptions of your patient?
- Hallucinations – Auditory, Visual, Olfactory, Gustatory & Tactile
- Illusions – misinterpretation of an actual external stimulus
- Thought insertion
- Broadcasting
When doing and MSA, what do you look for when assessing the perceptions of your patient?
- Broadcasting
- Hallucinations – Auditory, Visual, Olfactory, Gustatory & Tactile
- Illusions – misinterpretation of an actual external stimulus
- Thought insertion
When doing and MSA, what do you look for when assessing the speech of your patient?
Flow
Pitch
Pressure
Rate
Tone
Volume
What do you look for when assessing the speech of your patient?
Rate
volume
Pitch
Tone
Flow
Pressure
When doing and MSA, what do you look for when assessing the speech of your patient?
Flow
Pitch
Pressure
Rate
Tone
Volume
What do you look for when assessing the thought content of your patient?
Disturbances
Delusions
Suicidal
Obsessions
When doing an MSA, what do you look for when assessing the thought content of your patient?
Disturbances
Delusions
Obsessions
Suicidal
When doing an MSA, what do you look for when assessing the thought content of your patient?
Disturbances
Delusions
Obsessions
Suicidal
What do you look for when assessing the thought form of your patient?
Rate
Amount
Flight of ideas
Derailment
What does a mental status assessment do?
assesses a persons current neurological & psychological functionings
What does a mental status assessment do?
assesses a persons current neurological & psychological functionings
What does a mental status assessment include?
- Appearance
- Behaviour
- Perceptions
- Speech
- Affect
- Mood
- Thought content
- Thought form
- Insight & Judgement
What does a mental status assessment include?
- Affect
- Appearance
- Behaviour
- Insight
- Judgement
- Mood
- Perceptions
- Speech
- Thought content
- Thought form
What is a POP assessment for?
Hazard identification - pre-empting what could cause harm
What is a POP assessment for?
Hazard identification - pre-empting what could cause harm
What does a Selective Serotonin Reuptake Inhibitor (SSRI) do?
blocks the 5-HT transporter (T) reuptake process, in turn allowing more 5-HT (Serotonin) to act on postsynaptic 5-HT receptors
What does a Selective Serotonin Reuptake Inhibitor (SSRI) do?
blocks the 5-HT transporter (T) reuptake process, allowing more 5-HT (Serotonin) to act on postsynaptic 5-HT receptors
What does a Serotonin and Norepinephrine Reuptake Inhibitor (SNRI) do?
block both NET (noradrenalin uptake transporter) and T, increasing the availability of NA (Noradrenalin) and 5-HT for receptor action
What does a Serotonin and Norepinephrine Reuptake Inhibitor (SNRI) do?
block both NET (noradrenalin uptake transporter) and T, therefore increasing the availability of NA (Noradrenalin) an 5-HT for receptor action
What does capacity mean with regards to VIRCA?
the ability to understand their current medical position and the consequences involved in refusing treatment.
What does SAFETY stand for?
Safety
Aggression
Fix
Evaluate
Tactical
Yes
What does SAFETY stand for?
Safety
Aggression
Fix
Evaluate
Tactical
Yes
What does SAFETY stand for?
Safety
Aggression
Fix
Evaluate
Tactical
Yes
What does SIG E CAPSS stand for?
Sleep
Interest
Guilt/hopelessness
Energy
Concentration
Appetite
Psychomotor
Sexuality (sex drive)
Suicidality
What does SIG E CAPSS stand for?
Sleep
Interest
Guilt/hopelessness
Energy
Concentration
Appetite
Psychomotor
Sexuality (sex drive)
Suicidality
What does the mental status assessment affect component assess?
Emotion as observed (Objective)
What does the mental status assessment appearance component assess?
the general appearance of your pt
What does the mental status assessment beviour component assess?
attitude
manner
observed behaviours
What does the mental status assessment behaviour component assess?
attitude
manner
observed behaviours
What does the mental status assessment insight component assess?
degree to which the client understands the importance of their illness or current state
What does the mental status assessment insight component assess?
degree to which the Pt understands the importance of their illness or current state
What does the mental status assessment judgement component assess?
ability to evaluate and make appropriate choices
What does the mental status assessment judgement component assess?
ability to evaluate and make appropriate choices
What does the mental status assessment judgement component assess?
ability to evaluate choices and make appropriate
choices
What does the mental status assessment mood component assess?
Emotion as described (Subjective)
What does the mental status assessment mood component assess?
Emotion as described (Subjective)
What does the mental status assessment perceptions component assess?
How they perceive their world
What does the mental status assessment perceptions component assess?
How they perceive their world
What does the mental status assessment speech component assess?
volume at which they speak
What does the mental status assessment speech component assess?
volume at which they speak
What does the mental status assessment thought content component assess?
the content of their thoughts
What does the mental status assessment thought content component assess?
the content of their thoughts
What does the mental status assessment thought form component assess?
the amount of thought and the rate of
production
What does the mental status assessment thought form component assess?
the amount of thought and the rate of
production
What does VIRCA stand for?
Voluntary
Informed
Relevant
Capacity
Advice
What does VIRCA stand for?
Voluntary
Informed
Relevant
Capacity
Advice
What effect do depressants have on the CNS?
slow down, depress
What effect do depressants have on the CNS?
slow down, depress
What effect do stimulants have on the CNS?
Speed up or excite
What follows hyperthermia in excited delirium?
acidosis
hyperkalaemia
What i the aetiology of psychosis?
genetics
early childhood development
adverse life experiences
drug use
mental illness
What influences mental illness?
- poverty
- education level
- marital status
- culture
- environment
- political factors
What is a hypomanic episode?
A distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal-directed activity or energy
What is a manic episode?
A distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal-directed activity or energy
What is a panic attack?
an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes,with 4 or more of the following:
* Sweating
* Trembling or shaking
* Unsteadiness, feeling dizzy
* Depersonalisation/Derealisation
* Heart Palpitations, tachycardia, pounding heart
* Nausea or abdominal distress
* Paraesthesias (tingling sensation)
* Shortness of breath
* Fear of dying
* Fear of losing control or ‘going crazy’
* Chest pain or discomfort
* Chills or heat sensations
* Feelings of choking
What is a psychosis prodrome?
the time just prior to symptoms being severe enough for a diagnosis
What is ACPII level emergency
sedation?
the administration of a pharmacology to produce a state of calm
What is ACPII level emergency
sedation?
the administration of a pharmacology to produce a state of calm
What is an additional risk factor for sudden death in psychostimulant use and/or pts with the existence of underlying heart or chronic disease?
physical restraint
What is an EEA?
legal mechanism where a person can be taken involuntarily to a public sector health facility if their behaviour indicates they are at immediate risk of serious harm due to their mental capacity
What is an EEA?
legal mechanism where a person can be taken involuntarily to a public sector health facility if their behaviour indicates they are at immediate risk of serious harm due to their mental capacity
What is anxiety?
- warning system for our body and mind
- a small amount needed for fight or flight response
What is anxiety?
- warning system for our body and mind
- a small amount needed for fight or flight response
What is Bipolar I?
Classic manic-depressive disorder or affective psychosis
What is Bipolar I?
Classic manic-depressive disorder or affective psychosis
What is Bipolar II?
the lifetime experience of at least 1 episode of major depression and at least 1 hypomanic episode
What is Bipolar II?
the lifetime experience of at least 1 episode of major depression and at least 1 hypomanic episode
What is Bipolar?
a bridge between the Schizophrenia spectrum and other psychotic/depressive disorders
What is Bipolar?
a bridge between the Schizophrenia spectrum and other psychotic/depressive disorders
What is Bipolar?
a bridge between the Schizophrenia spectrum and other psychotic/depressive disorders
What is Bipolar?
a bridge between the Schizophrenia spectrum and other psychotic/depressive disorders
What is Cyclothymic disorder?
a milder form of bipolar disorder involving mood swings, hypomania and depressive symptoms
What is Cyclothymic disorder?
a milder form of bipolar disorder involving mood swings, hypomania and depressive symptoms
What is depression?
One of the deepest forms of human suffering which features suicide and/or suicidal idealisations
What is depression?
One of the deepest forms of human suffering which features suicide and/or suicidal idealisations
What is diffuse axonal injury?
brain injury in which scattered lesions in white matter tracts as well as gray matter over a widespread area
What is disordered behaviour?
agitation
childishness
mutter, swear or otherwise act inappropriately
neglect their personal hygiene and housework
unresponsive to the world around them
What is disordered thinking?
Thoughts and speech that become jumbled or slowed
What is Disruptive Mood Dysregulation Disorder?
Frequent outbursts combined with persistent angry and irritable baseline in children between 6-10yrs
What is excited delirium?
a condition that presents with psychomotor agitation, delirium, and sweating
What is Generalised Anxiety Disorder (GAD)?
A worrier - less acute & overwhelming than panic disorder BUT still causes considerable distress
What is Gillick Competency?
is used to decide whether a child (a person under 18 years of age) is able to consent to their own medical treatment, without the need for parental permission or knowledge
What is Gillick Competency?
is used to decide whether a child (a person under 16 years of age) is able to consent to their own medical treatment, without the need for parental permission or knowledge
What is panic disorder?
Recurrent (1 month or more) panic attacks and followed by 1 or both of:
* persistent concern or worry about additional panic attacks or their consequences
* significant maladaptive change in behaviour relating to the panic attacks
- intense anxiety
- terrifying to Pts
- initial episode is remembered in vivid detail
- comprised of discrete episodes of panic and frequently also a significant component of anticipatory anxiety
What is Persistent Depressive Disorder (Dysthymic Disorder)?
Consolidates:
* Major Depression
* Recurrent / Chronic Depression
What is personality disorder?
persistent traits that are maladaptive
What is Post Traumatic Growth (PTG)?
Sorrow and introspection are tolerated and turned into useful growth
What is psychosis?
a state of being experienced by a person who has lost touch with reality
What is Schizoaffective Disorder?
Mixture of Schizophrenia and Mood Disorders
(Bipolar/Depression)
What is Schizoaffective Disorder?
Mixture of Schizophrenia and Mood Disorders
(Bipolar/Depression)
What is Schizophrenia?
losing touch with reality - a perception without an assoc stimulus
What is Schizophrenia?
losing touch with reality - a perception without an assoc stimulus
What is sedation?
an individual having a reduced awareness of their environment and/or a decreased level of consciousness, which has been drug induced
What is selective attention?
to select and focus on particular input for further processing while simultaneously suppressing irrelevant or distracting information
What is sepsis?
a syndrome of infection complicated by systemic inflammation and can result in organ dysfunction, shock and death
What is Social Phobia?
A chronic mental health condition in which social interactions cause irrational anxiety
What is Specific Phobia?
Broad range of fears arising in relation to a specific stimulus:
* heights
* snakes
* spiders
- Avoidance tactics are often used by Pts
What is substance misuse?
over use of substances causing a variety of social, physical and
mental health problems
What is substance use?
use of substances without significant adverse consequences
What is suicidal ideation?
the thoughts, ideas or plans a person has about causing their own death
What is suicide?
the act of a person intentionally causing their own death
What is the adaptive aspect of anxiety?
confronting problem directly and changing your reactions to it
What is the adaptive aspect of anxiety?
confronting problem directly and changing your reactions to it
What is the aetiology of bipolar disorder?
family Hx
environmental factors (extreme stress sleep disruption, drugs, alcohol)
What is the aetiology of PTSD?
Acts of terrorism
Domestic Violence
Natural disasters
Serious accidents
Sexual Violence
War/Combat
What is the aetiology of PTSD?
Acts of terrorism
Domestic Violence
Natural disasters
Serious accidents
Sexual Violence
War/Combat
What is the Agression component of SAFETY?
Be aware of common triggers of aggression and violence
What is the Agression component of SAFETY?
Be aware of common triggers of aggression and violence
What is the aim of sedation?
to ensure safety of patient and paramedics, a safe transfer to medical care and to facilitate assessment and management of any underlying organic disorders
What is the appropriate positioning for pts who are physically restrained?
on their side with hands in front of their body
What is the CNS stimulant cocaine derived from?
cocoa plant
What is the definition of advice in VIRCA?
Comfort and safety measures
What to look out for – Red Flags
Advise to seek further medical assistance or call 000 if any issues arise in the future
What is the definition of advice in VIRCA?
The Pt is advised of:
Comfort and safety measures
What to look out for – Red Flags
Advise to seek further medical assistance or call 000 if any issues arise in the future
What is the definition of bereavement?
The experience of grief and mourning
What is the definition of bereavement?
The experience of grief and mourning
What is the definition of capacity in VIRCA?
The patient has the ability to understand their current medical position and the consequences involved in refusing treatment
What is the definition of capacity in VIRCA?
- A patient must have capacity in order to make a choice about
- their own health care.
- Capacity is the ability to understand their current medical position and the consequences involved in refusing treatment.
- Young people (<18 years old) – Gillick Competency
- Capacity fluctuates with improvement or deterioration in the patient’s condition
What is the definition of grief?
The emotional component of mourning, including the painful feelings associated with the loss (e.g. sadness, anger, guilt, shame, anxiety)
What is the definition of grief?
The emotional component of mourning, including the painful feelings associated with the loss (e.g. sadness, anger, guilt, shame, anxiety)
What is the definition of informed in VIRCA?
- Information about suspected or known condition
- Treatment options
- Risks associated with NOT seeking medical aid
- Explanation must be understood by pt
What is the definition of informed in VIRCA?
Informed about the suspected or known condition, treatment options and risks associated with not seeking medical aid and they understand the information
What is the definition of loss?
Being parted from someone or something
that the person values
What is the definition of loss?
Being parted from someone or something that the person values
What is the definition of mental health?
- the well-being and effective functioning of individuals
- the ability to think, learn, and understand one’s emotions and the reactions of others
- a state of balance, both within and with the environment
What is the definition of mental health?
the well-being and effective functioning of individuals, their ability to think, learn, and understand their emotions and the reactions of others
What is the definition of mental illness/mental disorder
the presence of cognitive, affective and/or behavioural symptoms which are persistent and pervasive and impair the individual’s functioning
What is the definition of mourning?
The behavioural component of bereavement, which includes biological reactions, behavioural responses, and cognitive and defensive reactions related to the loss
What is the definition of mourning?
The behavioural component of bereavement, which includes biological
reactions, behavioural responses, and cognitive and defensive reactions related to the loss
What is Post Traumatic Stress Disorder (PTSD)?
the long-term anxiety reaction and health complications following a traumatic or catastrophic event
What is Post Traumatic Stress Disorder (PTSD)?
the long-term anxiety reaction and health complications following a traumatic or catastrophic event
What is the definition of relevant in VIRCA?
Any refusal must be relevant to the current situation with the information made available to the Paramedic and Patient
What is the definition of relevant in VIRCA?
Any refusal must be relevant to the current situation with the information made available to the Paramedic and Patient
What is the definition of self harm?
a range of intentional behaviours that can be planned, impulsive or hidden to deliberately injure oneself
What is the definition of voluntary in VIRCA?
- Decision made voluntarily by Pt
- NIL coercion (from anyone)
- Decisions cannot be made under duress
What is the definition of voluntary in VIRCA?
- Decision made voluntarily by Pt without coercion (from anyone) and not be made under duress
What is the Environment component of LIFEMORTS?
Personal Space
What is the Environment component of LIFEMORTS?
Personal Space
What is the Evaluate component of SAFETY?
VSS (vital sign survey)
PSA (perfusion status assessment)
RSA (respiratory status assessment)
NSA (neurological status assessment)
SAT Score
SAMPLE
What is the Evaluate component of SAFETY?
VSS (vital sign survey)
PSA (perfusion status assessment)
RSA (respiratory status assessment)
NSA (neurological status assessment)
SAT Score
SAMPLE
What is the Family component of LIFEMORTS?
Instincts tell us to protect our nearest and dearest
What is the Family component of LIFEMORTS?
Instincts tell us to protect our nearest and dearest
What is the Fix component of SAFETY?
Fix underlying organic causes – Focus on de-escalation
What is the Fix component of SAFETY?
Underlying organic causes – Focus on de-escalation
What is the goal of ACPII level emergency
sedation?
remove the threat and allow for safe transport
What is the goal of ACPII level emergency
sedation?
remove the threat and allow for safe transport
What is the increase in suicide ideations in sufferers of Post Traumatic Stress Disorder (PTSD) pts?
3-5x
What is the increase in suicide ideations in sufferers of Post Traumatic Stress Disorder (PTSD) pts?
3-5x
What is the Insult component of LIFEMORTS?
Verbal or Physical
What is the Insult component of LIFEMORTS?
Verbal or Physical
What is the Life or Limb component of LIFEMORTS?
Self defence against a perceived threat
What is the Life or Limb component of LIFEMORTS?
Self defence against a perceived threat
What is the LIFEMORTS mnemonic?
identifies riggers of sudden aggression
What is the LIFEMORTS mnemonic?
identifies triggers of sudden aggression
What is the maladaptive aspect of anxiety?
using alcohol and/or drugs to cope
What is the maladaptive aspect of anxiety?
using alcohol and/or drugs to cope
What is the management for all substance abuse patients?
treat symptomatically
verbal de-escalation
QPS assistance
EEA
Consider:
12 Lead
oxygen
IPPV
IV access
fluids
antiemetics
droperidol
What is the management for all substance abuse patients?
treat symptomatically
verbal de-escalation if required
QPS assistance if required
EEA
Consider:
12 Lead
oxygen
IPPV
IV access
fluids
antiemetics
droperidol
What is the management/treatment for mild alcohol abuse withdrawal
destimulate the environment
communicate in a calm, quiet, reassuring and confident manner
continue to reorientate the person if required
consider paracetamol, anti emetics and fluids
transport
What is the management/treatment for severe alcohol abuse withdrawal
destimulate the environment
communicate in a calm, quiet, reassuring and confident manner
continue to reorientate the person if required
consider paracetamol, anti emetics and fluids
transport
What is the management/treatment for mild alcohol abuse withdrawal
destimulate the environment
communicate in a calm, quiet, reassuring and confident manner
continue to reorientate the person if required
consider paracetamol, anti emetics and fluids
transport
What is the management/treatment for severe alcohol abuse withdrawal
destimulate the environment
communicate in a calm, quiet, reassuring and confident manner
continue to reorientate the person if required
consider paracetamol, anti emetics and fluids
transport
What is the Mates component of LIFEMORTS?
Can be perceived as attractive
(cool to be aggressive in front of mates)
What is the Mates component of LIFEMORTS?
Can be perceived as attractive
(cool to be aggressive in front of mates)
What is the mean age of onset for first episode of Bipolar I?
18 yrs
What is the mental status assessment based on?
family, social, medical, recreational and employment hx,
developmental hx
What is the mental status assessment based on?
Hx of:
family
social
recreational
employment
medical
developmental
What is the Order component of LIFEMORTS?
Threat to disrupt an established system of rules
What is the Order component of LIFEMORTS?
Threat to disrupt an established system of rules
What is the order of preference for restraint of a patient?
simple reassurance
verbal de-escalation
pharmacological
physical restraint
What is the peak age of onset of schizophrenia?
Early to mid 20s for males
Late 20s for females
What is the peak age of onset of schizophrenia?
Early to mid 20s for males
Late 20s for females
What is the pharmacology of amphetamines?
stimulate dopaminergic, serotonergic & noradrenergic activity
gives the feeling of euphoria
What is the pharmacology of amphetamines?
stimulate dopaminergic, serotonergic & noradrenergic activity
gives the feeling of euphoria
What is the psychosis management pathway?
Antipsychotic medication
Specialist psychological therapies
Community support programs
What is the Resources component of LIFEMORTS?
money or valuables
What is the Resources component of LIFEMORTS?
money or valuables
What is the Safety component of SAFETY?
POP assessment, constant reassessment of all parties
What is the Safety component of SAFETY?
POP assessment, constant reassessment of all parties
What is the SAFETY mnemonic?
QAS acronym for the treatment of acute behavioural disturbance
What is the SAFETY mnemonic?
QAS acronym for the treatment of acute behavioural disturbance
What is the Sedation Assessment Tool (SAT) score for combative, violent, out of control?
+3
What is the Sedation Assessment Tool (SAT) score for continual loud outbursts?
+3
What is the Sedation Assessment Tool (SAT) score for combative, violent, out of control with continual loud outbursts?
+3
What is the Sedation Assessment Tool (SAT) score for no response to stimulation?
-3
What is the Sedation Assessment Tool (SAT) score for nil?
-3
What is the Sedation Assessment Tool (SAT) score for no response to stimulation and nil?
-3
What is the Sedation Assessment Tool (SAT) score for responds to physical stimulation?
-2
What is the Sedation Assessment Tool (SAT) score for few recognisable words?
-2
What is the Sedation Assessment Tool (SAT) score for responds to physical stimulation and few recognisable words?
-2
What is the Sedation Assessment Tool (SAT) score for very anxious and agitated?
+2
What is the Sedation Assessment Tool (SAT) score for very anxious/restless?
+1
What is the Sedation Assessment Tool (SAT) score for loud outbursts?
+2
What is the Sedation Assessment Tool (SAT) score for normal/talkative?
+1
What is the Sedation Assessment Tool (SAT) score for very anxious and agitated and loud outbursts?
+2
What is the Sedation Assessment Tool (SAT) score for very anxious/restless and normal/talkative?
+1
What is the Sedation Assessment Tool (SAT) score for awake/calm and cooperative?
0
What is the Sedation Assessment Tool (SAT) score for speaks normally?
0
What is the Sedation Assessment Tool (SAT) score for very awake and calm/cooperative and speaks normally?
0
What is the Sedation Assessment Tool (SAT) score for asleep?
-1
What is the Sedation Assessment Tool (SAT) score for slurring or prominent slowing?
-1
What is the Sedation Assessment Tool (SAT) score for asleep but rouses if name is called and slurring or prominent slowing?
-1
What is the Stopped component of LIFEMORTS?
Being obstructed by a situation or person
What is the Stopped component of LIFEMORTS?
Being obstructed by a situation or person
What is the suffix for benzodiazepine drugs?
pam
What is the Tactical component of SAFETY?
Communication – active listening, empathy, rapport, influence & behaviour change
What is the Tactical component of SAFETY?
Communication – active listening, empathy, rapport, influence & behaviour change
What is the Tribe component of LIFEMORTS?
Defend those with whom we identify
What is the Tribe component of LIFEMORTS?
Defend those with whom we identify
What is the triggers of sudden aggression - LIFEMORTS stand for?
Life or Limb
Insult
Family
Environment
Mates
Order
Resources
Tribe
Stopped
What is the triggers of sudden aggression - LIFEMORTS?
Life or Limb
Insult
Family
Environment
Mates
Order
Resources
Tribe
Stopped
What is the Yes component of SAFETY?
I have the right resources – QPS, CCP & other
What is the Yes component of SAFETY?
I have the right resources – QPS, CCP & other
What law is an EEA written under?
Public Health Act 2005 – Chapter 4A
Pages 137 – 158
What observations should be undertaken on the restrained patient?
BGL - initially
Temp - intially and then every 15 minutes
continual visual for signs of distress/difficulty
vital signs every 5 minutes of:
GCS
RR
HR
BP
SPO2
Perfusion assessment distal to mechanical restraint
What organic disorders can cause acute behavioural disturbances (ABD)?
Hypoglycaemia
Sepsis
Dementia
Head Injury
What phrase should you avoid saying when dealing with someone greiving?
“I know how you feel”
What phrase should you avoid saying when dealing with someone greiving?
“I know how you feel”
What position should be avoided in sedation?
prone
What position should be avoided in sedation?
prone
What pt behaviours warrant an EEA/when is it needed?
- Pts at risk of serious harm
- Pt requires urgent examination or treatment and care for the disturbance
- Risk due to major disturbance in mental capacity by illness, disability, injury, intoxication or another reason
What pt behaviours warrant an EEA?
- Pts at risk of serious harm
- Risk due to major disturbance in mental capacity by illness, disability, injury, intoxication or another reason
- Pt requires urent examination or treatment and care for the disturbace
What pt behaviours warrant an EEA/when is it needed?
- Pts at risk of serious harm
- Risk due to major disturbance in mental capacity by illness, disability, injury, intoxication or another reason
- Pt requires urent examination or treatment and care for the disturbace
What should you consider when doing an MSA?
- Your personal safety
- Approach slowly
- Be confident
- Don’t invade personal space
- Gain a rapport and trust with the client
- Making sure the client feels safe
- Privacy
What should you consider when doing an MSA?
- Personal safety
- Approach slowly
- Be confident
- Make sure the client feels safe
- Don’t invade personal space
- Gain a rapport and trust with the client
- Privacy
What symptom is the main cause for suicide in schizophrenic pts?
hallucinations
What symptom is the main cause for suicide in schizophrenic pts?
hallucinations
What tool is used to assess competency in Pts <18 yrs?
Gillick Competency
What tools can be used in communicating with someone grieving?
Empathy
Time (give them time to process, give yourself time to think what to say)
Space
Listen
Explain (what you’ve done and why - in manner fit for audience)
Accept
Actions (can i make you a cuppa, get you a glass of water, ring somebody)
What traits are seen in personality disorder?
difficulty with daily functioning
externalise blame
exhibit rigidity & inflexibility
problems relating to others
What type of drug is DMT
short acting plant based psychedelic
What type of drug is DMT
short acting plant based psychedelic
What type of drug is excited delirium (ExD) generally associated with?
psychostimulants
What type of hallucinogens contain contains atropine & scopolamine?
delirients
What type of jobs do we see Loss & Grief?
Miscarriage
ROLE
Suicide
Stroke
Traumas – Injuries & Property
What type of jobs do we see Loss & Grief?
Traumas – Injuries & Property
ROLE
Miscarriage
Suicide
Stroke
Others
What type of neurotransmitter and hormone excess causes excited delirium?
dopamine
When do Bipolar II Pts often present?
during a depressive episode
When do Bipolar II Pts often present?
during a depressive episode
When do withdrawal symptoms for alcohol abuse start?
usually within 6 – 24 hrs after last drink
When do withdrawal symptoms for alcohol abuse start?
usually within 6 – 24 hrs after last drink
When does hospitilisation occur in manic episodes?
to prevent harm to self or others
psychotic features
When does schizophrenia psychotic features usually emerge?
late teens to mid 30s
When does schizophrenia psychotic features usually emerge?
late teens to mid 30s
When should you be suspicious of an organic aetiology in Acute Behavioural Disturbances (ABD)?
- 40 years of age with 1st presentation of psychosis or altered mental state
- Disorientation/ALOC
- Altered VSS
- Visual, tactile or olfactory hallucinations
- Sudden onset
- Fluctuating conscious state
When should you be suspicious of an organic aetiology in Acute Behavioural Disturbances (ABD)?
- 40 years of age with 1st presentation of psychosis or altered mental state
- Disorientation/ALOC
- Altered VSS
- Visual, tactile or olfactory hallucinations
- Sudden onset
- Fluctuating conscious state
Who do pts suffering from Acute Behavioural Disturbance (ABD) pose a risk to?
themselves and others around them (incl health professionals)
Who has the power to make an EEA?
QAS Officers
QPS Officers
Who has the power to make an EEA?
QAS Officers
QPS Officers
Who is at higher risk for suicide amongst schizophrenic pts?
young males with co-morbid substance use
Who is at higher risk for suicide amongst schizophrenic pts?
young males with co-morbid substance use
Why do people with Mental Health Issues often turn to substance use?
- Self-medication – to manage the symptoms of mental illness
- Self-medication – to manage side effects of psychotropics
- Lower levels of coping or capacity to deal with stress
- Boredom
- Loneliness
Why do we do a MSA?
- To collect information about the client
- To allow them to tell their story
- To gain a full picture and make a formulation
- To develop an action plan and/or treatment plan
Why do we do an MSA?
- To collect information about the client
- To allow them to tell their story
- To gain a full picture and make a formulation
- To develop an action plan and/or treatment plan
Why does excited delirium lead to hyperthermia?
increased dopamine causes increased metabolic activity
