Psychosis Management

Question 1

What is violence?

Answer 1

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.

Question 2

What types of violence are common?

Answer 2

instrumental 
expressive 
gang
sexual 
domestic 
family

Question 3

What are the principles of aggression management?

Answer 3

prediction
prevention
intervention

Question 4

What factors can be used to predict aggressive behaviour?

Answer 4

body language

Question 5

What factors are used in prevention of aggressive behaviour?

Answer 5

de-escalation
observations
room layout

Question 6

What is involved in intervention in aggressive behaviour?

Answer 6

restraint
seclusion
rapid tranquillisation

Question 7

Section 328(2) of the scottish mental health act states that a person is not mentally disordered by reason of what?

Answer 7

sexual orientation 
sexual deviancy 
transsexualism 
transvestism 
dependence of alcohol or drugs 
by acting as no prudent person would act.

Question 8

Who can invoke the mental health act?

Answer 8

Any registered medical practitioner - emergency detention

approved medical practitioner - short term detention/compulsory treatment order

police - place of safety order

patients
nurses
courts

Question 9

When is an emergency detention used?

Answer 9

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

Question 10

who can order an emergency detention?

Answer 10

any registered medical practitioner

Question 11

How long does an emergency detention last?

Answer 11

maximum of 72 hours

Question 12

What are the criteria for an emergency detention?

Answer 12

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

Question 13

Does an emergency detention authorise treatment?

Answer 13

Yes but only emergency treatment

Question 14

What is a short term detention?

Answer 14

gateway order applied by an AMP and consented by the MHO.

Question 15

How long does a short term detention order last for?

Answer 15

28 days

Question 16

Is there a right of appeal in Short term detention?

Answer 16

yes - tribunal and mental welfare commission

Question 17

what must be considered by the AMP in application of a short term detention order?

Answer 17

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

Question 18

How long does a compulsory treatment order last?

Answer 18

up to 6 months

Question 19

Does the patient need to be in hospital for a CTO?

Answer 19

no - can be in the community too

Question 20

How many medical reports must support a CTO application made by a MHO?

Answer 20

2 - one from an AMP, other usually patients GP

Question 21

IS there a right of appeal in CTO?

Answer 21

right of appeal, may have legal representation

Question 22

What is a compulsory treatment order?

Answer 22

care plan prepared by MHO in consultation with the team, can impose conditions i.e. residency, attendance at services etc.

Question 23

What is the tayside rapid tranquillisation protocol?

Answer 23

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

Question 24

After repeating a lorazepam injection, if no response, what should be done?

Answer 24

seek advice from senior experienced doctor

Question 25

What is the first line category of antipsychotics?

Answer 25

usually atypical

Question 26

Which antipsychotic is used in treatment resistant illness?

Answer 26

clozapine

Question 27

In psychosis with mood disorders, what other biological treatments are available?

Answer 27

lithium
sodium valproate
carbamazepine
lamotrigine

Question 28

Can steroids cause a manic psychotic state?

Answer 28

Yes