psychiatry Flashcards
Section 2
Duration
Professionals
Evidence
Assessment
28 days (not renewable)
TWO doctors (one S12 approved)
ONE approved mental health professional (AMHP)
When a px is suffering a mental disorder of a nature that warrants detention in hx for assessment (+ they are not consenting)
When a px needs to be detained for their own/others safety
Section 3
Duration
Professionals
Evidence
Treatment
6 months (renewable)
TWO doctors (one S12 approved)
ONE approved mental health professional (AMHP)
When a px is suffering a mental disorder of a nature that makes it appropriate for them to receive tx in hx (+ they are not consenting)
Their tx is in the interests of theirs/others health + safety
There must be appropriate tx available
Section 4
Duration
Professionals
Evidence
Emergency order - urgent necessity to hold px until assessment by S12 doc
72 hrs
ONE doctor, ONE AMHP
There is not enough time for a second doctor to attend
Section 5 (4)
Duration
Professionals
Evidence
For a px already admitted (can be under psych or general hx) + is wanting to leave
6 hrs
NURSES holding power until a doctor can attend
Cannot be tx coercively whilst under this section
Section 5 (2)
Duration
Professionals
Evidence
For a px already admitted (can be under psych or general hx) + is wanting to leave
72 hrs
DOCTORS holding power
Allows time for a section 2/3 assessment
Section S136
Police section
Person suspected of having a mental disorder in a public place (A&E counts!)
24 hrs
Section S135
Police section
Needs court order to access px home + remove them
36 hrs
what are the factors assoc w poor prognosis in schizophrenia
strong FHx
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant
what are first rank sx
thought alienation
passivity phenomena
3rd person auditory hallucinations (he/she)
delusional perception
risk of developing schizophrenia if
monozygotic twin has it
parent
sibling
none
50%
10-15%
10%
1%
RFs for dev schizophrenia (in order of biggest to lowest)
FHx
Black caribbean
Migration
Urban environments
Cannabis use
risk factors for suicide
SAD PERSONS
Sex - male 2.0
Age - <19, >45
Depression
Prev attempt
Excess alcohol/substance use
Rational thinking loss
Social support lacking
Organised plan
No spouse
Sickness
depression sx
fatigue
low mood
anhedonia
mild depression
> 2 wks sx, 2/3 main sx, 5+ generalised sx
how to end SSRIs if gd response
continue for 6 months after remission to decrease relapse risk
then reduce dose over 4 wk period (don’t need to w fluoxetine)
when to avoid citalopram
if taking meds that cld prolong QT interval, check hx cardiac disease
will need to do ECG monitoring
what does paroxetine have increased incidence of
discontinuation sx
which SSRI to used post MI/unstable angina
sertraline
electrolyte abnormality to observe for w SSRIs
hyponatraemia
be careful in elderly especially
which SSRI to use in children
fluoxetine
what to check before starting SNRI
BP as can dev HTN
side effects of mirtazapine (SNRI)
weight gain + sedation
SEs of tricyclic antidepressants
can’t pee, can’t see, can’t shit, can’t spit
weight gain
long QT
SNRI egs
mirtazapine
duloxetine
venlafaxine