Unexplained symptoms, sections and capacity

Question 1

What is somatisation disorder?

Answer 1

Multiple physical SYMPTOMS present for at least 2 years

Patient refuses to accept reassurance or negative test results

Question 2

What is hypochondriacal disorder?

Answer 2

Persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
Patient again refuses to accept reassurance or negative test results

Question 3

What is conversion disorder?

Answer 3

Typically involves loss of motor or sensory function
The patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
Patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies

Question 4

What is dissociative disorder?

Answer 4

Dissociation is a process of ‘separating off’ certain memories from normal consciousness
in contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor
Dissociative identity disorder (DID) is the new term for multiple personality disorder as is the most severe form of dissociative disorder

Question 5

What is factitious disorder?

Answer 5

Also known as Munchausen’s syndrome

The intentional production of physical or psychological symptoms

Question 6

What is malingering?

Answer 6

Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain.

Question 7

What is a section 5(4)

Answer 7

Section 5(4) is done by registered mental nurses in the UK allowing them to detain inpatients (ED doesn’t count) who have already been admitted for up to 6 hours for a medical review.

Question 8

What is a section 5(2)

Answer 8

Section 5(2) is done by the registered mental health officer or nominated deputy allowing them to detain inpatients (this is important, can’t be used on those in ED who have not been admitted) for up to 72 hours to allow a formal mental health act to be completed. This cannot be appealed.

Question 9

What is a section 2?

Answer 9

Section 2 is done by 2 doctors (one of which should be section 12(2) approved) and an approved mental health professional. This can occur in the community or as an in-patient (not a prison). This section lasts 28 days to allow a formal diagnosis to be decided upon and treatment to be commenced. This can be appealed within the first 14 days.

Question 10

What is a section 3?

Answer 10

Section 3 is done by 2 doctors (one of which should be section 12(1) approved) and an approved mental health professional. This can occur in the community or as an in-patient (not a prison). This section lasts up to 6 months and is for treatment of a mental disorder. Patients are allowed one appeal to both hospital managers panel and tribunal.

Question 11

What is a section 136?

Answer 11

Section 136 is done by police allowing them to move someone from a public place to a place of safety for an assessment by an approved mental health professional and 1 doctor. This allows them to be held for up to 72 hours.

Question 12

What is a section 135?

Answer 12

Section 135 is done by police allowing them to move someone to (or keep them at) a private place to be assessed by an approved mental health professional and doctor. The police will need a warrant from a magistrate’s court to enter the private area. This section lasts for 36 hours.

Question 13

What is a section 17?

Answer 13

Section 17 allows a patient under section 2 or 3 to have leave home, go outside or out for several hours or overnights or longer.

Question 14

What is a section 117?

Answer 14

Section 117 is for anyone who has been under section 3 entitling them to aftercare from local authorities.

Question 15

What is section 62?

Answer 15

Section 62 of the Mental Health Act – the form is called a C6. This allows two sessions of emergency ECT. A second opinion approved doctor (SOAD) should be applied for at this time in order to provide the required legal framework for ongoing ECT.

Question 16

What is a community treatment order?

Answer 16

Community Treatment order – consider for patents on a section 3 allowing them to go home because they are well enough but gives the health service the opportunity to bring them back if they default their treatment.

Question 17

How should you manage violence?

Answer 17

De-escalation as soon as possible, time-out, placement as appropriate
Always make sure you are closer to the door that they are. Keep and open and relaxed look, always keep your hand open and visible.

Question 18

What medications are used for a rapid tranquilization?

Answer 18

Oral treatment offered first
If on regular antipsychotic, then try lorazepam or promethazine to avoid combining multiple antipsychotics.
If not on regular antipsychotic then try olanzapine, quetiapine, risperidone or haloperidol.
Repeat after 45-60mins
Buccal midazolam may avoid need for IM drugs but is unlicensed.

If oral treatment fails or the patient is putting themselves or others at risk, then IM therapy
Lorazepam, promethazine, olanzapine or haloperidol.

After administering monitor vital signs every 5-10minutes

Question 19

When it comes to capacity what is the difference between what children and adults can do?

Answer 19

Only difference between adults and children is that children can’t refuse lifesaving treatment even if they are considered to have capacity.

Question 20

When can consent be withdrawn and when can’t it?

Answer 20

Consent must be informed and can be withdrawn at any point (unless lifesaving treatment and under 18). Cannot withdraw consent if lost capacity since consenting.

Question 21

If a patient is unconscious what happens about consent?

Answer 21

If a patient can’t give consent because they are unconscious, then you can either act in their best interest or try and delay/change the situation so that are conscious and can give consent. You also have a legal duty to contact their next of kin.

Question 22

What is the two stage capacity test?

Answer 22

Is there an impairment of or disturbance in the functioning of the persons mind?
Has it made the person unable to make a particular decision?

1. A person is unable to make a decision for themselves if they are unable to understand the information relevant to the decision. The assessor needs to decide how much information is essential to make the decision
2. Need to be able to retain the information long enough to make the relevant decision
3. The person should use or weigh the information as part of the process of making a decision and portray their decision back to you. Severe distress can impair capacity

Question 23

What is an anticipatory refusal?

Answer 23

Done when they have capacity if expected to not have capacity in the future to refuse treatment.

Question 24

What is lasting power of attorney?

Answer 24

Allows someone who currently has capacity to appoint someone else to make decisions for them. If anyone is worried about the decision being made by LPA then you must go to a public guardians.

Question 25

What is a deprivation of liberty safeguard?

Answer 25

Allows someone who would not be safe out in public to be kept locked away but gives some allowances. Lead by social workers but assessed by an MDT.