Psychiatric Assessment + Legislation Flashcards
What do you assess in the thought category of MSE? What are common pathological findings?
Thought content and thought form
CONTENT:
- worries/ preoccupations
- delusions: grandiose, persecutory (people are trying to cause them harm), nihilistic (absence of something vital e.g. patient is dead, organs are rotting, of reference, of control (outside force controlling them), passivity, thought interference e.g. withdrawl, jealousy- of infidelity, amorous/ erotomanic- someone in love w/ patient, guilt- committed bad crime, hypochondrial- have an illness.
- overvalued ideas- reasonable ideas pursued beyond reason.
- obsessions: recurrent unwanted intrusive thoughts/ impulses that the patient is unable to resist. They know these are irrational.
FORM (assessed via person’s speech):
•flight of ideas: ideas are linked but are random and usually linked with fast speech. Feature of mania
•loosening of associations/derailment/ knight’s move thinking: completely unconnected thoughts common in schizophrenia
•thought block: stopping mid-sentence very suddenly/ without warning. sometimes in schizophrenia
•poverty of thought: usually seen in depression and few words/ thoughts are expressed
How do you characterize speech as part of MSE?
Rate, Rhythm, Volume- i.e. amount not how loud, tone - emotional quality of speech, flow- spontaneous, hesitant, uninterruptable, neologisms- made up words.
How would you assess a patient’s insight?
•Awareness that behaviour/ symptoms are seen as abnormal by others:
- Do you think your friends would say that you’re different to usual?
•Agreement that behaviour/ symptoms are abnormal.
- Do you think there’s anything wrong with you at the moment?
•Understanding that problems are due to a mental illness.
- What do you think is causing these behaviours? Could it be stress/ mental illness?
•Agreement that illness requires tx
- Do you think that the doctor’s tx will help? Are you willing to try the tx?
What is the difference between the Mental Health Act Section 2 and 3? What does the MHA permit and why is it used?
Section 2 purpose: admission for assessment for max duration of 28d
Section 3 purpose: admission for tx for max duration of 6m
It permits the detention and/or tx of people suffering from mental illness to safeguard them and others and is used when they are seen to pose a threat to either themselves/ others and refuse admission/ tx.
Section 2 is used in cases where no clear diagnosis has been reached and following on from a dx, a decision is made as to whether a Section 3 needs to be put in place or if a patient can be treated informally. Section 2 orders cannot be ordered back-to-back. 2 Doctors and 1 AMPH is required for this to be put in place. Section 3 can be renewed more than once back to back but is reserved for pts w/ a confirmed psych diagnosis. Again 2 docs and 1 AMPH req for Section 3 to be confirmed.
The tx provided must only be to do w/ their MH condition.
What is covered in the assessment of appearance and behaviour?
Appearance: sex, age, build, ethnicity, clothing (is this at all inappropriate?), well kempt, physical problems, scars/ piercings/ tattoos. Body language- facial expression, eye contact, posture, activity level, what are they doing (pacing?), slowed/ sped up movements, EPS e.g. tremor, restlessness, repeated movements.
What is the relevance of Section 5(2) or 5(4) of the MHA?
5(2) is referred to as a Dr's "Holding Power" and detains a patient for the purpose of doing an assessment for either Section 2/3. Tx is not permitted under this clause. It is reserved for at risk patients, in patients w/ MH illness, those req assessment for Section 2/3 or those who do not want to be admitted. Cannot be done in OP/A&E and must not be done by a psychiatrist, usually signed by most snr Dr (F1 not permitted to sign). Pts cannot be granted leave on 5(2). You need to tell a reg psychiatrist/ AMPH Approved MH Professional. Both 5(2) and 5(4) are used in an Emergency to allow detention for up to 72hrs and require the involvement of just 1 Dr, or 1 Registered Mental Health Nurse.
What are the risk assessment domains that must be covered?
- Risk to self: neglect, deliberate self- harm/ suicide, reputation, finances, exploitation, further deterioration in physical or mental health
- Risk to others: aggression/ violence INCLUDING KIDS!
- Risk to property/ driving, pets
If someone is deemed to lack capacity, how should decisions be made on their behalf?
A decision which promotes their best interests and is the least restrictive option on the person’s rights available.
What are the four components required to have capacity? What is the 2 stage technique for assessing capacity?
The ability to:
1. Understand decision required 2. Retain information to allow deliberation 3. Deliberate: i.e. weigh risk and benefits 4. Communicate
- Does this patient have a disturbance in the functioning of the mind or brain to make a specific decision?
- Is the patient able to do 1-4 above?
** BUT a diagnosis does not mean that a person lacks capacity to make all decisions/ at all times.**
What is the lasting power of attorney?
a legal mechanism that allows someone to specify another adult to look after their affairs - financial and/or medical should they lack capacity in the future. If someone is the donee of an LPA they act and make decisions as if they were the person themselves
What is Deprivation of Liberty Safeguards? (DoLS)
Under article 5(1) of the human rights act everyone has a right to liberty, except in specific circumstances (e.g. detained under Mental Health Act (1983). DoLS created by the MCA and apply to people being deprived of their liberty in hospital or care homes when the person lacks capacity in this matter.
How would you document admitting and treating a patient who has taken an OD and wants to go home?
You document that you are using the Mental Capacity Act to keep her in the hospital for treatment of the overdose as she appears to have a depressive episode which is impairing her mind, and her capacity to deliberate on the information regarding requiring medical treatment. Consequently, at present, she lacks capacity to decide to go home and she lacks capacity to refuse medical treatment. You also document that she will be at serious harm and probably death if allowed to go home without having received treatment for her overdose. Therefore it is in her best interests to be restrained from leaving and to receive treatment for the overdose.
What are Section 135 + 136?
They last for 72h and are used by the police or magistrates to move someone with a mental illness to a “place of safety” usually a special place/ A&E/ police st.
What is a CTO?
Community Tx Order- patient is being treated under the Mental Health Act and living in the community. This only relates to the patient’s psych care, and if the said person was to seek healthcare services, that person’s healthcare should be given as normal and their psychiatric condition does not necessarily need discussion. If their mental health deteriorates then they must be given psych tx.
Can a patient withdrawing consent override their previous written consent?
Yes A patient may withdraw consent at any point which overrides any previously given consent.
