Principals/Legislation Flashcards
Describe Mental health triage in the ED
ATS 1
- definite danger to life of slef or others
- severe behavioural disorder with immediate threat of dangerous violence
- –possession of a weapon
- –self destruction in ED
- –Etreme agitation or restless ness
ATS 2
- Immediate threat to self or others
- requires physical restraint
- severe agitation
- hallucinations/delusions/paranoia
ATS 3
- Possible danger to slef or orther
- –severe distress
- –Moderate agitated restless
- intrusive behaviour
- not likley to wiat for treatment
ATS 4
- no immediate ris to slef or others
- moderate distress
- no agitations
- irritable wihtout agressive
- co-operative
ATS 5
No danger to self or others
Describe assessment area for mental health
Standard ED treatment areas are usually inappropriate for the management of patients with mental illness
- self harm usually possible
- too much stimulation in the ED environement
- lack of privacy/confidentiality
- lack of security for other patients/carers
- difficulties in performing restraint if required
Describe ED staffing issues in regards to management of mental health patients
ED staff -Appropriate training is required in
- recognition of potential violence
- techniques to help calm and agitated patients
- techniques of chemical restraint
- techniques of physical restraint
- Adequate secrurity should be available to manage violence in the ED
- Debriefin should be avialable to all staff who suffer distress
Describe a brief mental state exam
ASEPTIC
GENERAL APPERANCE
- body habitus
- hygeine
- cosmesis
- dress
Motor activity (part of apperance)
- psychomotor agitation or retardation
- abrnomal posturing
- tics
- invountary movements
- mannerisms
- nail biting
- Tardive dyskinesia
SPEECH
- spontaneous
- fluency
- articulation
- rate
- pressure (difficulty interrupting the flow - do not confuse with rate)
- prosody (infelction and rhythm)
EMOTION
Mood - described as patients pervasive and sustained emotion
Affect- the observable behaviour that expresses the current feeling and state
PERCEPTION
1) illusion (false sensory perception in the presence of an external stimulus)
- misinterpretation of external stimuli
- more common in organic brain syndromes
2) hallucinations
- auditory most common
- visual and olfactory hallucinations may occur in schizophrenia or mania although more common in organic disease
THOUGT
1) Form
- patient should be able to give history in logical chronological order and pick up their train of thought
- concrete
- tangential (getting of topic)
- flight of ideas (move quickly from topic to topic but there is a logical thread)
- Incoherent
- thought blocking
2) Content
- impoverished
- suicidal or homicidal
- delusions (fixed beliefs, delusions of control by an external agent, delusions of though broadcasting or insertion)
- ideas of reference
- pre-occupation
INSIGHT and JUDGMENT
COGNITION
1) Attention
- refers to two different mental function
- - ability to notice stimuli in all sensory spheres
- -vigilance and concentration
- must be accessed prior to other cognitive testing
2) orientation to person place and time + memory
Discuss clues to an organic cause of mental illness/psychosis
Age at onset -
-Psychiatirc disorders almost always present prior to the age of 40
Rate of onset
-Acute onset is suggestive of underlying medical or substance related cause - insidious onset is suggestive of underlying psychiatric illness
Type of hallucinations
- nonauditory hallucinations are more suggest of medical or substance related causes
- auditory haluccinations are suggestive of a primary psychiatric illness
Family history of mental illness
Emergence of psychosis in general medical ICU setting
Delirium
- acute onset
- fluctuating
- attentional deficits
- generalised severe disorganisation of behaviour
- typically involved other cognitive defect
Examination
- Focal neurolgoical signs
- progressive congitive decline - consider neurodegenerative decline
- Head injury trauma, seizure
Discuss detention of patients with mental illness
In order for mental health act legislation to be imposed, it is necessary for two conditions to be satisified
1) the patient must be suffering from a mental illness
2) hospital admission is required because the patient is considered to be a dange to himself or herself or others
Detention under the Mental Health Act does not permit treatment for psychiatric or physical illness. Treatment can be given under common law where the patient is considered to pose a serious threat to himself or others.
SECTION 2 of the act facilliatates compulsory admission to hospital for assessment and treatment for up to 28 days.
SECTION 3 of the act covers compulsory admission for treatment. Again two docotrs one of whom is ually the GP and the other a psychiatrist
SECTION 4 covers emergency admission for assessmenty and attempts to avoid delay in emergency situation when obtaining a second reccomendation could be dangerous. Can be made by any doctor who has seen the patient in the past 24 hours and last for 72 hours.
Discuss assessment of capacity
TO have capacity about a decision a patient should be able to comply with the following 4 steps
1) understand the information relevant to the decision
2) Retain the information as part of the process making
3) Use or weigh that information as part of a process of making a decision
4) communicate their decisions.
Discuss emergency treatment
Treatment can be given to patients who lack capacity but must consider the following
1) any action must be in the best interest of the patients
2) anything done must be the least restrictive of the patients rights and freedoms
3) where time can be afforded every effort should be made to enable the patient to make his or her own decision
4) treatment should not be delayed while attempts are made to establish the validity of any advance decision
5) medical staff have a duty of care to the incapacitated patient
Discuss the use of chemical and physical restraint
Sedation and restraint must be the minimum that is necessary to prevent the patient from self harming or harming others.
TO use physical restraints four pre-conditions must be met
- the patient has a medical or psychiatric condition requiring care
- the person is at the time incapable of responding to reasonable request for health staff to cooperate and other self control measures are impractical of have failed
- The person’s behaviour is putting themselves or others at serious risk
- less restrictive alternatives are not appropriate
Discuss DSM classifications of mental health disorders
AXIS 1 disorders
- CLinical syndrom of mental disorder
Axis 2
-personality disorder and developmental disorders
Axis 3
- general medical conditions
- ie. acquired brain injury
Axis 4
-psychosocial or environemtnal disorders
Axis 5
0 global assessment of dunctioning
