Psychosis Management Flashcards
What is violence?
the intentional use of physical force or power - threatened or actual - against oneself, another person or a group or community in which the result has a high likelihood of injury, death, psychological harm, maldevelopment or deprivation.
What types of violence are common?
instrumental expressive gang sexual domestic family
What are the principles of aggression management?
prediction
prevention
intervention
What factors can be used to predict aggressive behaviour?
body language
What factors are used in prevention of aggressive behaviour?
de-escalation
observations
room layout
What is involved in intervention in aggressive behaviour?
restraint
seclusion
rapid tranquillisation
Section 328(2) of the scottish mental health act states that a person is not mentally disordered by reason of what?
sexual orientation sexual deviancy transsexualism transvestism dependence of alcohol or drugs by acting as no prudent person would act.
Who can invoke the mental health act?
Any registered medical practitioner - emergency detention
approved medical practitioner - short term detention/compulsory treatment order
police - place of safety order
patients
nurses
courts
When is an emergency detention used?
where it is necessary as a matter of urgency to detain the patient in hospital for purpose of a full assessment of mental state as they pose a significant risk to themselves or others
who can order an emergency detention?
any registered medical practitioner
How long does an emergency detention last?
maximum of 72 hours
What are the criteria for an emergency detention?
must be likely that the patient has a mental disorder
patients capacity must be impaired
no alternative to treatment in hospital required urgently
short term detention impractical
Does an emergency detention authorise treatment?
Yes but only emergency treatment
What is a short term detention?
gateway order applied by an AMP and consented by the MHO.
How long does a short term detention order last for?
28 days
Is there a right of appeal in Short term detention?
yes - tribunal and mental welfare commission
what must be considered by the AMP in application of a short term detention order?
the patient has a mental disorder
the patients decision making capacity is significantly impaired
it is necessary to detain the patient in hospital to determine what medical treatment should be given or to give medical treatment to the patient.
the patient imposes significant risk to themselves or others if not detained
How long does a compulsory treatment order last?
up to 6 months
Does the patient need to be in hospital for a CTO?
no - can be in the community too
How many medical reports must support a CTO application made by a MHO?
2 - one from an AMP, other usually patients GP
IS there a right of appeal in CTO?
right of appeal, may have legal representation
What is a compulsory treatment order?
care plan prepared by MHO in consultation with the team, can impose conditions i.e. residency, attendance at services etc.
What is the tayside rapid tranquillisation protocol?
consider non-drug approaches
consider oral therapy (1-2mg lorazepam)
consider injection (1-2mg IM lorazepam) - in extreme cases add 5mg haloperidol
wait 30 mins and then repeat if necessary
After repeating a lorazepam injection, if no response, what should be done?
seek advice from senior experienced doctor
What is the first line category of antipsychotics?
usually atypical
Which antipsychotic is used in treatment resistant illness?
clozapine
In psychosis with mood disorders, what other biological treatments are available?
lithium
sodium valproate
carbamazepine
lamotrigine
Can steroids cause a manic psychotic state?
Yes
