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MRCPsych Part B > Psychiatric Services > Flashcards

Psychiatric Services Flashcards

1
Q

Aim of Primary Prevention?

A

Reduce incidence of disease by preventing development of new cases

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2
Q

Methods of primary prevention?

A

Elimination of aetiological factors
Increasing host resistance
Reduction of risk factors
Blocking modes of disease transmission

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3
Q

Example of primary prevention in Psychiatry

A

Reducing adverse social factors for psychiatric disorders (public health initiatives)

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4
Q

Aim of secondary prevention

A

Reduce total number of existing cases by more rapid effective interventions that shortens duration of illness

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5
Q

Methods of secondary prevention

A

Early identification

Prompt treatment of illness

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6
Q

Aim of tertiary intervention

A

For individuals to reach their highest level of functioning

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7
Q

Examples of tertiary prevention

A

Relapse prevention

Rehabilitation

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8
Q

What does the Institute of Medicine (IOM) classification focus on?

A

Prevention on interventions occurring before onset of formal disorder

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9
Q

Definition of prevention under IOM

A

Interventions which occur before onset of disorder

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10
Q

Types of prevention under IOM

A

Universal Preventive Intervention
Selective Preventive Intervention
Indicated Preventive Intervention

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11
Q

Who does a universal preventive intervention target?

A

Entire population

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12
Q

Who does a selective preventive intervention target?

A

Members of population with higher than average risk factors.

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13
Q

Who does indicated preventive intervention target?

A

Members of population with subsyndromal symptoms of a disorder, or diagnosed with another associated disorder.

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14
Q

What is the prevention paradox?

A

At population level, high-risk individuals who will get maximum individual benefit from prevention approaches contribute only for a small portion of disease burden.

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15
Q

Who described the prevention paradox?

A

Geoffrey Rose, 1981

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16
Q

Who conducted the first ECT and when?

A

Lucio Cereletti
Ugo Bini
1938

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17
Q

Indications for ECT

A 
Depressive illness
Mania
Schizophrenia
Catatonia
Parkinsons
Neuroleptic Malignant Syndrome
Intractable seizure disorders (raises seizure threshold)
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18
Q

When is ECT first line treatment for depressive illness?

A

Emergency treatment where rapid response is needed

Treatment resistant depression where a person has responded to ECT previously

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19
Q

When is ECT a treatment of choice in depressive illness?

A

Life threatening situation because of refusal of foods and fluids
High suicide risk
Stupor
Marked psychomotor retardation
Psychotic depression
Pregnant and concern about teratogenic effects of medications

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20
Q

When is ECT considered second or third line treatment for depressive illness?

A

If not responding to antidepressant drugs

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21
Q

When is ECT considered as treatment for mania?

A

Life threatening physical exhaustion

Prolonged and severe mania with lack of response to all other appropriate drug treatments

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22
Q

When is ECT considered as treatment for schizophrenia?

A

4th line treatment for treatment-resistant schizophrenia if ineffective treatment with 2 antipsychotic medications and clozapine

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23
Q

When is ECT considered for Catatonia?

A

If ineffective treatment with benzodiazepine

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24
Q

When is ECT considered for Parkinsons?

A

As an adjunctive treatment for motor, psychotic and affective symptoms if severe disability despite medical treatment

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25
Q

Absolute CI of ECT?

A

None

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26
Q

Relative CI of ECT?

A 
Acute respiratory infection
MI in past 3 months
Uncontrolled cardiac failure
Cardiac arrhythmias
CVE in past month
Raised ICP
Untreated cerebral aneurysm
Untreated Pheochromocytoma
Unstable major fracture
DVT - until anticoagulation (to reduce risk of PE)
Acute/impending retinal detachment
High anaesthetic risk
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27
Q

Which ECT is more effective; bilateral or unilateral?

A

Bilateral

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28
Q

Which type of ECT has greater cognitive impairment?

A

Bilateral

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29
Q

Does frequency per week affect efficacy of ECT?

A

No

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30
Q

Does electrical dose correlate with ECT efficacy?

A

Yes in bilateral ECT but not significantly

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31
Q

Side effects of high electrical dose of ECT?

A

In unilateral ECT, higher doses lead to greater time to regain orientation.

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32
Q

Does brief pulse vs sinewave ECT lead to differences in efficacy?

A

No

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33
Q

Early side effects of ECT

A

Headache
Temporary confusion
Nausea/vomiting
Muscular aches

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34
Q

Side effects of ECT

A

Memory deficits
Retrograde amnesia
Anterograde amnesia
Mortality: no greater than for GA in minor surgery

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35
Q

Who is mortality risk greatest for in ECT?

A

Patients with cardiovascular disease

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36
Q

Common causes of mortality with ECT?

A

VF

MI

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37
Q

When are memory deficits worse with ECT?

A

During treatment period

Bilateral ECT

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38
Q

Link between ECT and retrograde amnesia?

A

A time increases, reduction in extent of retrograde amnesia

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39
Q

Which retrograde amnesia is most likely to be recovered after ECT?

A

Personal memories

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40
Q

Link between ECT and anterograde amnesia?

A

Resolves rapidly after ECT is stopped.

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41
Q

Limitations of eCT

A

Time-limited

Poor durability

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42
Q

Relapse rate of ECT

A

51% in 12 months

37% in 6 months

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43
Q

Best antidepressants post-ECT?

A

TCAs

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44
Q

Optimal frequency for ECT

A

Twice weekly

6-12 treatments in total for one course

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45
Q

When is ECT unlikely to bring recovery once started?

A

If no clinical improvement seen over first six bilateral treatments

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46
Q

What should significant cognitive impairment during ECT lead to?

A

Reappraisal of electrical dose and placement

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47
Q

Where are electrodes placed in bilateral ECT?

A

Both temples
Centre of electrode should be 4cms above and perpendicular to midpoint of a line between lateral angle of eye and external auditory meatus

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48
Q

Where are electrodes placed in unilateral ECT?

A

Centre of one electrode is in same position as bilateral ECT.
Other electrode is over parietal surface over non-dominant hemisphere close to vertex of skull.

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49
Q

What is a necessary component for clinical efficacy of ECT?

A

Generalised cerebral seizure activity

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50
Q

Gold standard monitoring for ECT?

A

EEG

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51
Q

EEG monitoring during ECT

A 
Four phases:
Build up of energies
Spike and wave activity
Trains of lower voltage slow waves
Abrupt end of activity followed by electrical silence
(35-130 seconds)
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52
Q

What is effective treatment with ECT defined?

A

Motor seizure lasting at least 20 seconds (from end of EC?T dose to end of observable motor activity)

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53
Q

When should maintenance ECT be considered

A

Index episode of illness responded well to ECT
Early relapse despite adequate continuation of drug treatment
Inability to tolerate continuation drug treatment
Patients attitude and circumstances are conducive to safe administration

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54
Q

When to use bilateral ECT?

A

Speed and completeness of response have priority
Where unilateral ECT has failed
Where previous ECT has produced good response without undue memory impairment
Where determining cerebral dominance is difficult

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55
Q

When to use unilateral ECT?

A

Where speed of response is less important
Where there has been a previous good response to ECT
Where minimising memory impairment is particularly important

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56
Q

Which drugs raise seizure threshold?

A

Benzodiazepines
Barbituates
Anticonvulsants

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57
Q

Which drugs lower seizure thresholds?

A

Antipsychotics
Antidepressants
Lithium

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58
Q

Which drugs need to be stopped 24 hours pre-ECT?

A

Clozapine

Moclobemide

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59
Q

Difficulties with Lithium and ECT?

A

Best avoided as may increase cognitive side effects and increase likelihood of neurotoxic effects of Lithium.

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60
Q

Who developed TMS for brain stimulation?

A

Anthony Barker, 1985

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61
Q

What is TMS used to treat?

A

Depression

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62
Q

How does TMS work?

A

Application of magnetic pulses on scalp surface which creates an electrical activity that stimulates neurons in cortical surface in line with Faraday’s principle of electromagnetic induction.

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63
Q

What is single pulse TMS useful for?

A

Migraine

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64
Q

What type of TMS is used for depression?

A

Repetitive pulses of TMS (rTMS)

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65
Q

How is TMS used for depression?

A

rTMAS is applied to left or right DLPFC for 30-40 minutes a day for at least 4 consecutive weeks.

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66
Q

Effect of TMS on cognition?

A

None

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67
Q

Aim of TMS?

A

Stimulate focal brain region without inducing generalised stimulation that results in seizure.
rTMS possibly harnesses inherent plasticity of brain circuits to strengthen connectivity between brain regions which are malfunctioning in depression.

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68
Q

Results for rTMS in depression

A

40% response rate that is sustained for 6 months

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69
Q

ECT vs rTMS short-term?

A

ECT is significantly superior

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70
Q

Side effects of TMS?

A

Discomfort over site of application
Transient headaches (not beyond treatment period)
Facial muscular twitching during stimulation

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71
Q

What other conditions has TMS been found to be effective in?

A

Resistant auditory hallucinations when applied to left temporoparietal cortex (close to Wernickes area)

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72
Q

Who carried out the first pre-frontal leucotomy and when?

A

Moniz and Lima

1995

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73
Q

Critera for psychosurgery

A

Severe mood disorder or OCD that has been resistant to all other appropriately reasonable evidence-based treatments tried in adequate dose for adequate duration.
Patient is competent and provides informed consent for the surgery.

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74
Q

How is psychosurgery carried out?

A

Employ stereotactic methods using pre-op MRI to establish target co-ordinates and a fixed stereotactic frame.
Lesions are localised to the orbito-frontal and anterior cingulate loop (limbic loop) which is implicated in the regulation of mood and emotions.

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75
Q

How are lesions produced inpsychosurgery?

A

Radio-frequency thermoregulation or gamma radiation (the gamma knife).

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76
Q

What are the stereotactic procedures used in psychosurgery?

A

Subcaudate tractotomy
Anterior cingulotomy
Limbic leucotomy
Anterior capsulotomy

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77
Q

What happens in subcaudate tractotomy?

A

Lesion made beneath head of caudate nucleus in rostral part of orbital cortex

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78
Q

What happens in anterior cingulotomy?

A

Bilateral lesions within cingulate bundles

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79
Q

What happens in limbic leucotomy?

A

Combining subcaudate tractomy and anterior cingulotomy

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80
Q

What happens in anterior capsulotomy?

A

Bilateral lesions in anterior limb of internal capsule

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81
Q

Side effects of psychosurgery

A 
Headache & nausea
Confusion
Personality change 
Change in social functioning
Post-op seizure
Weight gain
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82
Q

What happens to cognitive function after psychosurgery?

A

Tends to improve

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83
Q

Most response psychiatric disorders to psychosurgery?

A

Chronic intractable major depressive disorder

OCD

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84
Q

Which type of psychosurgery is used for OCD?

A

Stereotactic limbic leucotomy and anterior capsulotomy

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85
Q

What type of psychosurgery is used for mood disorders?

A

Stereotactic subcaudate tractomy

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86
Q

How does DBS work?

A

Use of fine wire implants in certain brain regions that can be triggered using a subdermal pacemaker device placed in the chest wall. High frequency electrical stimulation can temporarily arrest activity of brain region.

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87
Q

Indications for DBS

A

Parkinsons
Essential Tremor
Tourrette’s
Dystonia

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88
Q

Where can DBS be used for Parkinsons?

A

Subthalamic Nucleus

Internal globus pallidus

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89
Q

Where can DBS be used for OCD?

A

Internal capsule

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90
Q

Surgical side effects of DBS

A

Infection
IC haemorrhage
Lead erosions, fracture, migration
Post-op seizures.

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91
Q

Neuropsychiatric side effects of DBS

A 
Depression, anxiety, mania
Impulsivity
Speech and language disorders
Decrease in cognitive performance
Postural instability - increased risk of falls
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92
Q

What is vagus nerve stimulation?

A

Stimulation of left cervical vagus nerve

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93
Q

What is vagus nerve stimulation used for?

A

Resistant partial-onset seizures in epilepsy

94
Q

What are the key competencies for multidisciplinary working according to the Sainsbury Centre for MH?

A 
Assessment
Treatment and care management
Collaborative working
Team management and administration
Interpersonal skills
95
Q

What is capability?

A

The ability to apply the necessary knowledge, skills and attitudes to a range of complex and changing settings.

96
Q

What key functions did Moss identify for multidisciplinary teams?

A

Continuing proactive care of those with long-term serious MH problems
Uninterrupted access to information and support, intervention and treatment before and during crises
An organised response to requests for help from primary care

97
Q

Benefits of MDTS/CMHTs

A

Maximise clinical effectiveness
Reduce bed use
Ensure patients maintain service contact after discharge from hospital
Cost-effective
Enable provision of wide range of services and resources without prolonged referral processes
Enhance continuity of care

98
Q

What are the National Service Framework for MH standards?

A

Promote MH, reduce discrimination and exclusion
Better primary healthcare
Ensure crises care, timely access to secure and safe place, as close to home as possible.
Ensure carers needs are addressed.
Public health target on suicide

99
Q

What is the National Service Framework for MH?

A

Agenda for MH services with clear emphasis on community psychiatry. Emphasised seven key standards for service development.

100
Q

When was the National Service Framework for MH published and by whom?

A

Department of Health, 1999

101
Q

When was the NHS Plan proposed?

A

2000

102
Q

What is the NHS Plan?

A

Provides targets and funds to realise the NSF proposals - particularly to improve intensive community care teams.

103
Q

Targets of NHS Plan?

A

50 early intervention teams to be in place by 2004
335 CRHTTS by 2004
220 assertive outreach teams by 2003

104
Q

When was a new MH strategy for England published?

A

2011

105
Q

What were the shared objects of the MH strategy for England in 2011?

A

More people will have good MH
More people with MH problems will recover (improve QoL)
More people with MH problems will have good physical health
More people will have a positive experience of care and support (offer timely evidence based interventions)
Fewer people will suffer avoidable harm (improve confidence in services)
Fewer people will experience stigma and discrimination (improve public understanding)

106
Q

Models of providing community care

A 
Brokerage model
Case management
Assertive community treatment (ACT)
Intensive case management
Personal strengths model
Rehab model
107
Q

What is the Brokerage model?

A

Main worker acts as a broker coordinating various services while not actively providing any input

108
Q

What is the case management model?

A

Single professional is responsible for long term supportive care for all aspects.

109
Q

What is case management based on?

A

Continuity of care similar to key worker model proposed in Building Bridges documented by Department of Health in 1995

110
Q

What does clinical care involve in the case management model?

A 
Engagement
Assessment
Planning Interventions
Delivering Interventions
Monitoring Effectiveness
111
Q

What is Assertive Community Treatment (ACT) based on?

A

Stein & Test (1980) evaluated training in community living. Main issue was transfer of learning in social skills training in real life when patients move from inpatient units to community.

112
Q

What did the UK 700 study report?

A

Caseload is the most important predictor of outcome of an ACT service.

113
Q

What as ACT been shown to do?

A

Reduce admissions
Reduce acute presentations to A&E
Increase compliance with secondary care

114
Q

What does research show about ACT?

A

Cochrane review showed no clear advantage between ACT and intensive community management.

115
Q

Who is intensive case management for?

A

Hard to engage patients

116
Q

Drawback of intensive case management?

A

Heavy staff burnout and responsibility

117
Q

How does intensive case management work?

A

Follows principles of ACT but individual case load to reduce redundant time spent discussing cases

118
Q

What is another name for the Personal strengths model?

A

Development-acquisition model

119
Q

What are the ideas behind the Personal strengths model?

A

Patient is the primary director of the process
Acknowledges that the patient is able to grow and change inherently
Therapeutic relationship is given primary importance
No goals imposed on patient - community is seen as a valuable resource

120
Q

What happens in the rehab model?

A

Assessment based comprehensive rehab plan is drawn.
Patient directed process but deficit focus is retained
Increased patient autonomy and independence is stressed.

121
Q

What led to the introduction of the CPA?

A

Case of Sharon Campbell who killed her SW (DSHH, 1991)

122
Q

Requirements of the CPA

A

Thorough assessment of health and social needs
Each service user must have a written care plan
Service user must be involved in drafting the care plan
This plan must be reviewed regularly or as necessary
Named MH worker must coordinate care delivery

123
Q

What types of CPA are there?

A

Enhanced

Standard

124
Q

Who are enhanced CPA for?

A

Those whose care needs are best served by regular MDT meetings

125
Q

Who developed the filter model?

A

Goldberg

Huxley

126
Q

What are the five levels of mental illness occurrence?

A 
Community
Primary Care Attendees
Diagnosed primary care attendees
Level of Psychiatrist
Level of psychiatric inpatient care
127
Q

Who proposed the concept of a critical period?

A

Birchwood

128
Q

What does critical period refer to?

A

First 3-5 years of psychosis wherein psychosocial plasticity is higher and the greatest impact can be made if interventions are institutions.

129
Q

What are the aims of early intervention?

A

Reducing duration of untreated psychosis
Promoting recovery
Minimizing secondary morbidity and mortality
Reducing psychosocial damage
Engagement with patient at early stages to facilitate longer treatment
Reducing comorbidities such as substance use

130
Q

What is used for the criteria of early intervention?

A

PACE-UHR (Personal assistance and Crisis Evaluation service)

131
Q

What are the PACE-UHR criteria?

A

Uses ‘close in’ strategy
Specificity>sensitivity
Ages 14-30
Considers experiencing attenuated positive symptoms or episodes of frank psychosis (BLIPS - brief limited intermittent psychotic sx)
Having schizotypal personality or FHx of schizophrenia

132
Q

What is used to assess prediction of sx from basic to schizophrenia?

A

Bonn Scale for Assessment of Basic Symptoms

133
Q

How good is Bonn Scale for Assessment of Basic Symptoms?

A

Predicts conversion from basic symptom to schizophrenia in 78% of individuals

134
Q

Which studies show that the initial gain from early intervention may not be sustained if it is discontinued after 2 years?

A

PEPP (London, Ontario)

TIPS (Norway)

135
Q

What did the SOCRATES study show?

A

Compared CBT with supportive counselling for first or second-episode schizophrenia.
At 18 month follow-up, addition of both CBT + counselling showed significant improvement.

136
Q

What did the PRIME study show?

A

Olanzapine at low dose prevents progression of psychosis.

137
Q

What did EPPIC study from Melbourne (McGorry et al) show?

A

Combination of CBT and Risperidone reduced conversion rate at 6 months.

138
Q

What did the Lambeth Early Onset (LEO) study show?

A

Compared specialised care (low dose antipsychotic, CBT, family counselling) based on assertive outreach with standard care and found relapse rates were lower with the former.

139
Q

Problems with Early Intervention

A

Low specificity of screening instrument results in high rights of false positivity and unnecessary treatment of those false positives.

140
Q

Who recognised ‘Duration of Untreated psychosis’ (DUP) as a prognostic marker?

A

Wyatt

141
Q

Who suggested that DUP may be neurotoxoci?

A

Wyatt

142
Q

Does DUP correlate with outcome?

A

No

143
Q

What is the national intervention target for DUP in uk the UK?

A

Reducing DUP to a service median of 3 months and an individual maximum of 6 months.

144
Q

Factors that suggest that DUP is not neurotoxic

A

No cell death is evident. No gliosis is evident with cumulative psychosis.
Cognitive impairment would be cumulative if each episode were neurotoxic, which it isn’t.
Number of episodes is less important than age of onset of psychotic illness.

145
Q

Define recovery

A

Complete cure

Free of any psychopathology

146
Q

Define remission

A

Reduction in core signs and symptoms to an extent that they no longer interfere with behaviour and not justifiable for making an initial diagnosis at that point

147
Q

What was the first study that challenged the pessimism about schizophrenia recovery?

A

Vermont Longitudinal study

148
Q

Recovery rate of schizophrenia

A

38% at 15 and 25 years

149
Q

Who identified internal and external conditions for recovery?

A

Jacobson and Greenley

150
Q

What are the internal conditions for recovery?

A

Hope
Healing as primary aim
Empowerment
Connection with other services and patients

151
Q

What are the external conditions for recovery?

A

Valuing human rights
Services orientated towards recovery
Appraising positive value of healing

152
Q

Impact of skills development?

A

Improves rehab results
Diminishes demand for clinical services
Increases likelihood of gaining employment

153
Q

When did Transitional Employment programmes emerge?

A

1948 from the clubhouse model by Fountain House

154
Q

What is transitional employment?

A

Time-limited

Supported work experience

155
Q

What are clubhouses?

A

Provide members with a meaningful day, educational opportunities, in-house vocational training and social options.
Some employment positions usually time-limited.

156
Q

What is sheltered employment?

A

Reserved entry to jobs - e.g. quota for mentally ill etc.

Segregated workforce.

157
Q

What is the supported employment programme?

A

Individual is placed in a job supported by an employment consultant. Usually a minimum of prevocational training.

158
Q

Aim of supported employment programme?

A

To get the individual into a job and then support them as they perform.

159
Q

What is the treatment gap?

A

The gap between effectiveness and efficacy of treatment

160
Q

Causes of the treatment gap

A 
Drug factors (SEs)
Patient factors (co-morbidities, beliefs)
161
Q

Who reported on the treatment gap in MH?

A

Kohn 2004 in the WHO Bulletin

162
Q

What is the treatment gap for psychosis?

A

32% worldwide untreated
18% in Europe
40% in Europe with Bipolar untreated
>50% with depression and anxiety untreated

163
Q

What is the most important factor that increases the risk of hospitalization in the severally mentally ill?

A

Non-adherence

164
Q

Who reported that improving adherence can have a greater impact on population health than anything else?

A

Haynes in 2001 Cochrane Review

165
Q

What is the median continuous use of lithium?

A

76 days

166
Q

Advantages of the term adherence

A

More dynamic sense

Implies a spectrum of behaviours

167
Q

Disadvantages of the term adherence

A

Concentrates on outcome

168
Q

Advantages of the term concordance

A 
'Expert patient'
Differences between doctor and patient are legitimized
Negotiation is implied as a key factor
Gives respect to patient preference
Stresses on process rather than outcome
169
Q

What so studies show about subjective measures of compliance?

A

Both patients and clinicians overestimate actual rates of compliance

170
Q

Who did a study on Psychiatry and Human Rights?

A

Drew et al. 2011

171
Q

What did Drew et al. 2011 find re Human rights in MH?

A

The right to marry and hvae children is often denied on the grounds of mental illness.

172
Q

What is Article 2?

A

Right to Life

173
Q

Impact of Article 2 on Psychiatry

A

State has the duty to protect lives.

All deaths that occur in state detention must be investigated; both formal and informal patients.

174
Q

What is Article 3?

A

Prohibition of torture

175
Q

What is Article 5?

A

Right to liberty

176
Q

How can Article 5 apply to MH?

A

Issues around delays in tribunal reviews, detentions that do not comply with the MHA, MCA and DOLS, prolonged restraint/seclusion and delayed discharges

177
Q

What is Article 6?

A

Right to a fair hearing

178
Q

What is Article 8?

A

Right to a private/family life

179
Q

When can Article 8 impact on MH?

A

Permitting family visits, home leave, restricting correspondences, prohibiting activities such as smoking in care homes

180
Q

What is Article 9?

A

Freedom of thought & religion

181
Q

What does it mean that Article 9 is a qualified right?

A

Can be interfered with in certain circumstances such as to protect public safety, public order etc.

182
Q

When can Article 9 affect MH?

A

Failure to provide place of worship, type of food and staying in mixed wards.

183
Q

What is Article 10?

A

Freedom of expression

184
Q

When can Article 10 be restricted?

A

In the interest of national security, territorial integrity and public safety

185
Q

When can Article 10 affect MH?

A

Proceedings from MHA tribunals and COP are usually private.

186
Q

What is Article 12?

A

Right to marry

187
Q

How can MH affect Article 12?

A

People detained under Section 2 may not be able to enter a marriage contract

188
Q

What is Article 14?

A

Right not to be discriminated against

189
Q

What is the legal responsibility of the DVLA?

A

To decide if a person is medically fit or unfit to drive.

190
Q

What is the duty of doctors with regards to the DVLA?

A

To inform patients how their conditions could impair driving.

191
Q

Rules for drivers with acute psychosis, mania/hypomania and schizophrenia re Group 1 for the DVLA?

A

Driving must cease during acute illness.

192
Q

When can relicensing be considered for a Group 1 driver who had psychosis?

A

All must be fulfilled:
Patient has remained well and stable for at least 3 months
Compliant with treatment
Free from adverse effects of medication which could impair driving
Subject to specialist favourable report
Regained insight in case of bipolar mania or hypomania

193
Q

Psychosis and Group 2 drivers?

A

Driving should cease pending outcome of medical enquiry.

194
Q

When can Group 2 drivers with psychosis drive again?

A

Person must be well and stable for minimum of 3 years with insight into condition before driving can be resumed.

195
Q

What are Group 2 drivers?

A

HGV

196
Q

Group 1 drivers with severe anxiety or depression?

A

Driving should cease pending medical enquiry

197
Q

When can Group 2 drivers drive when having severe anxiety of depression?

A

Person must be stable for 6 months.

198
Q

Patients with dementia and group 1 driving?

A

License in early stages is subject to annual review

199
Q

Patients with dementia and Group 2 driving?

A

License will be revoked

200
Q

What does consent require?

A

Information
Competency
Autonomy

201
Q

What leads to understanding?

A

Competence

Information

202
Q

What leads to a decision?

A

Understanding

Autonomy

203
Q

What leads to consent?

A

Decision

Communication

204
Q

What study looked into the decision-making capacities of people in hospital with MI?

A

MacArthur Treatment Competence Study 1988

205
Q

What tool did the MacArthur Treatment Competence Study create?

A

MacCAT:
Choosing: ability to state a choice
Understanding: understand relevant information
Appreciating: appreciate nature of ones own stiuation
Reasoning: reason with information

206
Q

Which MacCAT is used for clinical research?

A

MacCAT-CR

207
Q

Which MacCAT is used for treatment decisions?

A

McCAT-T

208
Q

Which MacCAT is used for criminal adjudication?

A

MacCAT-CA

209
Q

Who developed the MacCAT for a defendants fitness to plead based on legal theory of competence?

A

Hoge et al

210
Q

When can confidentiality be broken?

A

Court order
Statutory requirement to aid legal proceedings e.g. Misuse of Drugs, Road Traffic Act, Police and Criminal Evidence Act, Terrorism Prevention
Venereal Diseases Regulation

211
Q

What is seclusion?

A

Involuntary confinement of a patient within a physical space from which they are physically prevented from leaving

212
Q

What is restraint?

A

Use of physical, manual, material or mechanical method to immobilise or reduce the ability to move their body freely

213
Q

What is pharmacological restraint?

A

Use of a drug that is not a part of the standard treatment or dosage for the patients condition in order to achieve a restriction of the patients behaviour or freedom of movement

214
Q

What is a vulnerable adult?

A

One who is or may be in need of community care services by reason of mental or other disability, age or illness and who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation

215
Q

Most frequent locations of abuse?

A 
Persons home (41%)
Care Home (34%)
216
Q

Perpretrators of abuse?

A 
Family members (25%)
Care Home staff (25%)
217
Q

What leads to institutional abuse?

A

Poor training

Inflexible treatment regimes

218
Q

What does Safeguarding Adults by DoH 2011 state?

A

Empowerment to allow person-led decisions and consent
Protection, support and representation for those in greatest need
Prevention of harm or abuse
Proportionality and least intrusive appropriate response to the risk
Partnerships to provide local solutions through community-based services
Accountability and transparency when safeguarding an abused person

219
Q

Four domains of risk factors associated with child abuse

A

Parent/caregiver
Family
Child
Protective

220
Q

What are the parent risk factors of child abuse?

A 
Personality & psychological wellbeing
History of maltreatment
Substance abuse
Attitudes & knowledge
Age
221
Q

How many individuals who were maltreated will subject their children to maltreatment?

A

One third

222
Q

What age of parents are more likely to abuse children?

A

Teenage/young

223
Q

What family risk factors are linked with child abuse?

A

Specific life situations e.g. marital conflict, DV
Single parent household (twice as high)
Domestic Violence (30-60%)

224
Q

Child risk factors for child abuse?

A

Disabilities

Aged between birth to 3 years of age

225
Q

Protective factors for child abuse

A

Emotionally satisfying relationships

Network of relatives or friends

226
Q

When are parents who were abused less likely to abuse their own children?

A

If they have resolved internal conflicts and pain related to abuse and have intact, stable and supportive non-abusive relationship with their partner

227
Q

Who created the Traumagenic Dynamics Model?

A

Finkelhor (1988)

228
Q

What is the Traumagenic Dynamics model?

A 
Adverse effects of child sexual abuse depend on four factors:
Powerlessness
Betrayal
Traumatic sexualisation
Stigma
229
Q

What does child abuse accommodation syndrome refer to?

A

Children/families susceptive for continuous on-going abuse without reporting them.

230
Q

What are the elements of child abuse accommodation syndrome?

A

Need to keep quiet due to fear of consequences
Helplessness with threat of on-going abuse
Entrapment and accommodation with a destructive effect on personality deveopment
Delayed and unconvincing disclosure
Retraction of disclosure due to threat of disintegration of family

MRCPsych Part B (64 decks)

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