MH Act, Psych Emerg, ECT Flashcards
What is the purpose of the mental health legislation?
- Provides for assessment, detention and compulsory treatment for people with severe mental illness
- Includes check and balances to ensure compulsory treatment only used where necessary
What are some principles of MH act?
- Mx provided in least restrictive way possible
- rights, dignity, autonomy and respect promoted
- medical and other health needs recognised and responded to
- individual needs recognised and responded to
- person involved in all decisions
What is the role of the second psychiatrist opinion?
- promote self determination for pts by providing information about Rx and possible alternatives
- empower to make decisions
- promote dialogue between stake holders
What is a nominated person?
- person to receive information and to support pt for duration of treatment order
- assist pt to exercise rights and represent their views
- cannot make treatment decisions on their behalf
What is the role of an advocate?
- not in the bill
- visit MH services or provide telephone assistance to help pts participate in decisions about their assessment, treatment and recovery
- discuss concerns re treatment
What is an AO?
- person appears to have serious illness and needs Rx to prevent harm to themselves or others, or serious deterioration in MH
- enables psych to assess and determine whether CTO required
Where can an inpatient AO be conducted?
inpatient MH facility.
If issued in community, 72h to transfer pt thereafter 24h for assessment (up to 72h in special circumstances)
Max duration of TTO?
28 days
Criteria TTO?
person has mental illness and needs immediate Rx to prevent
-serious deterioration in their mental or physical health
-or serious harm to the person
-or to another person.
No less restrictive means reasonably available, including treatment on a voluntary basis.
Why are criteria for TTO strict?
Serious limitation on personal liberty and autonomy. Cannot be placed on TTO simply due to Hx of mental illness.
Max duration TO for young people?
3 months. Ensures greater oversight of treatment of young persons.
Timeframe inpatient v community TO?
6 months max inpatient
12 months max community
Major components of evaluation of a suicidal patient?
CPR
C- urrent plan/intent
P- ast history
R- esources
What are impending violence red flags?
- Speech loud and threatening
- Increased muscle tension
- Hyperactivity (e.g. pacing)
- Slamming doors, knocking furniture
Pharm Mx of arousal?
- Benzo (loraz or diaz) OR OLZ
- Benzo + OLZ
- IM OLZ or Ziprasidone
What is NMS?
Life threatening complication of anti-psychotic treatment, includes:
-muscular rigidity
-autonomic symptoms (elevated temp, sweating, elevated / labile BP, tachycardia)
-akinesia
-mutism
-changed LOC
Ix: elevated CK, leukocytosis
Rx NMS?
- Supportive
- Cease anti psychotic
- Dantrolene or bromocriptine
- ICU
What is serotonin syndrome?
SSRIs (and other serotonergic agents) combines with MAOIs, lithium, tryptophan.
- Neuro: myoclonus, nystagmus, HA, tremor, rigidity, seizures
- MSE: irritability, confusion, agitation, coma
- Other: increased temp, arrhythmias, death
Rx serotonin syndrome?
- Supportive
- Stop all psychotropics
- 5HT receptor antagonists (cyproheptadine) or propranolol
Advances in ECT?
- Improved anaesthesia, muscle relaxants
- Hyperoxygenation, denitrogenation
- Brief pulse stimulus
- Electrode placement
- Adequate seizure duration
- EEG monitoring
- Stimulus dose titration
Indications for ECt?
- Major depressive episode
- Mania
- Schizophrenia, schizoaffective
ECT cognitive side effects?
- Retrograde and anterograde amnesia
- Confusion
- Persistent memory disturbance
ECT and pregnancy?
- May be a safer Rx in 1st trim
- 2/3 trim when meds don’t control or when pt has had good response in earlier episode
What determines seizure threshold?
- Gender: M>F
- Age
- Electrode placement: BL>UL
- Number of ECTs
- Exogenous factors: eg. drugs- benzodiazepines raise; antidepressants and antipsychotics lower
