OPMH - WB Flashcards
1
Q
Implied vs expressed consent
A
- Implied - no explicitly stated but inferred by persons actions/circumstances eg rolling up sleeve when about to take BP
- Expressed - explicitly given via written/verbal consent
2
Q
Mental capacity is time and decision specific, what does this mean?
A
- Time - capacity can vary over time, must be assessed in the moment decision needs to be made, revisit assessment if timing of decision changes
- Decision - applies only to the decision at hand
3
Q
Why might people lack capacity?
A
- Medical conditions - dementia, delirium, neurological (eg stroke/brain injury)
- MH disorders - psychosis, severe depression, anxiety
- Developmental disorders/learning disability
- Temporary - substance misuse, acute illness, stress, medications
4
Q
5 principles of MCA 2005
A
- Presume capacity
- Support them as much as possible to make decision
- They can make unwise decisions
- Best interests
- Least restrictive option
5
Q
Two stage capacity test
A
Stage 2 - are they able to understand, retain, weigh up and communicate back
6
Q
What is LPA?
A
- Allows patient to appoint someone to make decisions on their behalf if they do not have capacity
- Must have capacity when setting this up
7
Q
What is a deputy appointed by court of protection?
A
- If a patient becomes unable to make decisions and they did not have a lasting power of attorney appointed before losing capacity
8
Q
What is a public guardian?
A
- UK official
- Oversees work of attorneys and deputies
- Ensure acting in best interests and acting properly
- Investigate concerns/complaints
9
Q
Advanced decisions to refuse treatment meaning
A
- Legal document - need capacity at the time
- Refuse certain treatments in future
- Must be specific treatments or specific conditions in which you would refuse treatment (eg if diagnosed with terminal illness)
10
Q
What is an independent mental capacity advocate?
A
- Supports individual who lacks capacity to make decisions about their treatment
- Represent and safeguard someone with best interests
- If they lack a family member/friend who could advocate for them otherwise
11
Q
What is an independent mental health advocate?
A
- Supprts those detained under MH act 1983
- Helps people understand rights, ensures they are involved in decisions and treatment planning/tribunial hearings
- Advocate for best interests
12
Q
Settings DOLS can be used in
A
- Care home/residential home/supported living
- Hospital
- Mental health facilities
13
Q
What is replacing DOLs?
A
Liberty protection safeguards
14
Q
What does the MH 1983 (amended in 2007) allow?
A
- People with a mental disorder to be sectioned - admitted to hospital, detained and treated without their consent either for their own safety or to protect others
15
Q
Define mental disorder
A
- Refers to a range of conditions, including illnesses that affect cognition, mood, perception, and behavior.
- Examples - dementia, psychosis, learning disability, mental illness, neurological conditions eg brain injury, stroke
16
Q
Section 2 of MCA
A
- Detention of person in hopsital for mental health assessment
- Lasts for up to 28 days
- Enforced by doctor (cons psych) or approved mental health professional
17
Q
Section 3 MHA
A
- Provides detention for treatment if person is suffering from mental disorder and needs treatment and are at risk to self or others
- Up to 6 months, possible to extend
- Doctor (consultant psych) and AMHP
Must have pre-diagnosis of MH disorder and need treatment
18
Q
Community treatment order
A
- Patient detained under section 3 to be treated in community rather than hospital while under care of MH services
- Up to 6 months, possible extension
- AMHP and doctor
19
Q
Section 5 (2)
A
- Allow doctor to detain someone for up to 72 hrs if they are already in hospital and Dr believes person is suffering from mental disorder in need of immediate care/treatment
- Any doctor (not necessarily psychiatrist)
20
Q
Section 5(4) MHA
A
- Allow nurse to detain someone for up to 6 hours in hospital if already being treated voluntarily and nurse believes need urgent care/treatment
21
Q
Section 136 MHA
A
- Allows police to remove a person from public place if they appear to be suffering from mental disorder and in need of immediate care
- Up to 24hrs in place of safety (eg hospital)
22
Q
section 135 (MHA)
A
- Allows police to enter persons home (with warrant) to remove them for assessment if they are believed to be suffering from mental disorder and in need of immediate care
- Up to 72hrs in place of safety
23
Q
Section 117 MHA
A
- Provides aftercare for individuals detained under sections 3, 37 or 47
- Ensures get support and care after discharge
- No fixed duration
- Local health and social services responsible
24
Q
DNACPR vs advanced decision to refuse treatment
A
- DNACPR - decision made by healthcare professionals in consultation with patient. Involves CPR and does not apply to other treatments, no legal documentation needed from patient, not legally binding in itself
- ADRT - legal document, patient makes decision about treatments in future, can include CPR, ventilation, blood transfusions, legally valid
25
ReSPECT form function
* Promote advanced care planning - preferences, clinical recommendations
* Good communication
* Shared decision making
* Good documentation
26
Delirium vs dementia
27
Common causes delirium
28
Routine investigations for delirium
* Bedside - ECG, lying and standing BP
* Blood tests (FBC, U&Es, LFTs, coagulation, TFTs, calcium, B12, folate, glucose, blood cultures)
* Urinalysis
* Imaging - CT head, chest X-ray
29
CAM vs MMSE vs AMT for cognition of delirious patient
* Confusion assessment method - specifically designed for delirium screening - detect acute onset and fluctuating course
30
Management of a patient with delirium
Treat cause and Non pharmacological - * quiet, well lit side room
* display date and time
* familiar objects (pictures) around
* food and fluid charts
* stool chart
* falls risk assess
* VTE assessment
* avoid change in environment
31
Role and risk of medication in delirium
* Use only if risk of harm to self or others and non-pharmacological techniques have not worked
* Haloperidol or Lorazepam
32
MCA or MHA for delirium
* Check they have capacity first
* Then make best interests decision if not
33
Alzheimers dementia summary
34
Vascular dementia summary
Only offer Achesterase inhibitors if co-existent alzheimers, parkinsons or dementia + lewy bodies
35
Dementia with Lewy body summary
Levodopa can worsen, monitor closely by specialist
36
Parkinsons disease with dementia
37
Frontotemporal dementia
38
Mixed dementia
39
Reversible dementia
40
Other neurodegenerative dementia eg CJD/syphillus
41
5 preventable causes of dementia
* Alcohol excess
* Lack of physical activity
* Smoking
* Social isolation
* High BP, high cholesterol, diabetes
* Uncorrected vision/hearing loss
42
Cognitive tests over the phone options vs face to face
* F2F = MMSE, MOCA, ACE-III
* Phone - telephone interview for cognitive status (TICS)
* mini cognitive screener for dementia (CSD), 6CIT, AMTS, GPCOG (need to draw)
43
CT head results for Alzheimers
Atrophy of medial temporal lobe (hippocampus)
And parietal lobe
Enlarged sulci and ventricles
44
Non-pharmacological treatment Alzheimers
* Activities to promote wellbeing that are patient preferences
* Group cognitive stimulation therapy
* Group remniscience therapy
* Cognitive rehabilitation
45
Pharmacological management Alzheimers
* the three acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine)
* memantine (an NMDA receptor antagonist) is in simple terms the 'second-line' treatment
46
