Psychiatric Assessment Flashcards
List the sections of a psychiatric history
Presenting complaint History of presenting complaint Past psychiatric history Medication history - for physical and mental illness Past medical and surgical history Family history Personal history (childhood, schooling, employment, relationships) Forensic history Social history Drug and alcohol history Premorbid personality
What are the 8 sections included in a mental state examination?
Appearance and behaviour Speech Affect and mood Risk: Suicidal and risk to others Thought content Perceptions Cognitive state Insight
What is waxy flexibility?
Limbs are maintained in fixed positions which are externally imposed (i.e. If the patient’s arm is moved to an outstretched position, they will not move it back and it will stay like that until moved again)
What is echolalia?
Repetition of another’s sound / voice
What is echopraxia?
Repetition of another’s movements?
Is self harm more common in men or in women?
Women
What is the treatment of paracetamol overdose?
Activated charcoal if within 2 hours
N-acetyl cysteine
What is an AMHP?
Approved mental health professional
Who must be present to complete a Mental Health Act Assessment on a patient?
3 people:
- AMHP (Approved mental health professional)
- 2 x ‘Section 12 Approved’ doctors: It’s preferable for one of these to have prior knowledge of the patient, but one of the doctors must be independent
What is a Section 2? How long does it last?
- Assessment order
- Used for patients who are not known to the services and used to make an assessment of their mental health
- Lasts up to 28 days
True / False: A Section 2 can be renewed after 28 days
False - A Section 2 only lasts for 28 days…after this time the patient must be discharged or given a Section 3
Can treatment be initiated as part of a Section 2?
Long term treatment cannot be initiated, but treatment can be given as part of the assessment e.g. as a trial
What is a Section 3? How long does it last?
- Treatment order
- First one lasts up to 6 month, each subsequent lasts for 1 year
What is a SOAD?
Second Opinion Approved Doctor
What is a Community Treatment Order?
Enforced for patients under a treatment order (e.g. Section 3) who are being discharged back to the community. Issues conditions for the patient which they must comply with e.g. taking their medication and seeing healthcare professionals. Gives the power to re-admit the patient if they do not comply.
Which is the ‘doctor’s holding power’ section of the mental health act?
Section 5(2)
How long does a Section 5(2) last?
Up to 72 hours, within which a full mental health assessment must be carried out in order to assess whether to discharge the patient or to detain them under Section 2 or 3
Which Section of the Mental Health Act allows enter into a patient’s home if they are refusing it?
Section 135
Who issues a Section 135?
Magistrate
Does a Section 136 enable police to take a patient from their home?
No - A Section 136 only allows detention when the person is found in a public place
What is a Deprivation of Liberty Safeguard?
These are safeguards put in place for mentally ill people who are deprived of their liberty but who do not meet the requirements of the Mental Health Act
Who is covered by Deprivation of Liberty Safeguards?
- Over 18 years old
- Mental illness / disability
- Lack capacity
- Where deprivation of liberty is in their best interests for appropriate care
How long does a Deprivation of Liberty Safeguard last?
12 months, with a review at 3 months to check it is in the patient’s best interests
What is the peak age of incidence for self harm in men and women?
Women = 15-24 Men = 25-34
Give 1 protective factor for self harm
Religious affiliation
What is the method for 90% of self harm?
Poisoning
What is N-acetyl cysteine and how does it work in the management of paracetamol overdose?
Precursor to glutathione, which is an antioxidant whose levels are depleted by NAPQI (a metabolite of paracetamol)
What is it important to establish when assessing the future risk of someone who has just self-harmed?
Circumstances i.e. what/where/how? Effort not to be found, leaving a note, etc.
Intent i.e. why did they do it? What did they think / hope might happen? Feelings about being unsuccessful.
Any previous self-harm episodes
Which sex is at highest risk of suicide?
Male
What is the purpose of the Mental Health Act?
To ensure that people with serious mental health disorders who threaten the health or safety of themselves or others can be treated irrespective of their consent in order to prevent them from harming themselves or others.
What is the difference between being detained under the Mental Capacity Act vs. under the Mental Health Act?
Both allow implementation of care against a person’s will:
- Mental Capacity Act is for patients who lack capacity rendering them unable to make a decision themselves
- Mental Health Act is for patients who suffer from a mental disorder of a nature or degree to warrant assessment or treatment
Under what circumstances is detaining under the MHA appropriate following a MHA assessment?
- Patient deemed to be suffering from a mental disorder of a nature and degree which warrants admission
- Patient is refusing to be admitted voluntarily
- There is no alternative option to detaining them
True / False: A section 5(2) can be used by any doctor
False - It does not apply to A+E as the patient has not been formally admitted yet. It applies when doctors want to detain a patient who has already been admitted.
What is a Section 5(4)?
Nurse’s holding power
How long does a Section 5(4) last for?
6 hours
What is perseveration?
When a person repeats themselves, returning to a topic over and over again
What is neologism?
When a person makes up new words which have a meaning to them but no meaning in reality
What is tangentiality?
Wandering from a topic and never quite providing the information required
