psychiatry

Question 1

when is psychiatric referral indicated?

Answer 1

overdose, deliberate self harm, aggression, psychiatric problem in the past, appears severely depress/ anxious, mania/ schizophrenia

liason psychiatrist can help with this in ED

Question 2

when can sedation be used in an aggressive patient?

Answer 2

last resort

Question 3

what is the modified sad persons score?

Answer 3

1 point for the following: male, age <19 or >45, previous suicide attempts/ psych care, excessive alcohol or drug use, separated/widowed/divorced, no social support

2 points for: depression/ hopelessness, rational thinking loss, organised or serious suicide attempt, stated future suicide intent

score <6 - may be safe to discharge
6-8 - probably requires psych consultation
>8 - probably requires hospital admission

Question 4

what is the mini mental state exam?

Answer 4

asks questions to quickly assess acute confusional state

e.g. what year is it? where are we? spell WORLD backwards, count back from 100 in 7s, name ‘pencil’ or ‘watch’, take piece of paper fold it and place it down, follows commands ‘ close your eyes’ etc

total of 30
abnormal if <24

Question 5

describe the characteristics of delirium

Answer 5

acute/ subacute onset 
fluctuating course
resolves 
impaired consciousness which may fluctuate rapidly 
poor attention span and poor short term memory 
hallucinations 
fleeting systemised delusions 
hyper/hypoactive

Question 6

describe features of dementia

Answer 6

insidious onset
progressive
irreversible
clear consciousness until late in disease
poor short term memory with attention less affected
hallucination and delusions are rare

Question 7

what is the abbreviated mental test?

Answer 7

total of 10 points

how old are you? birth date? year now? time of day? where are we? count back from 20 etc

Question 8

what is section 5(4)

Answer 8

use of mental health act in A+E which gives nurses right to detain someone for up to 6 hours

Question 9

what is section 5(2)

Answer 9

use of mental health act in A+E which gives doctor right to detain someone for up to 72 hours until assessment is available.

Question 10

why may section 5(2) or 5(4) of mental health act have to be used in A+E?

Answer 10

if someone is:

• Thought to have a mental disorder
• assumed to lack capacity
• At least 18years old
• patients best interest / risk to others
• no advanced decisions