Violence, Aggression, Legislation and the Management of Psychosis Flashcards
What can violence be defined by?
Can be defined by the nature of the act, the impact of the act upon the victim, aggressor, society
What does the WHO define as violence?
The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.
According to HCR-20 V3 manual, what is violence?
Any actual, attempted, or threatened physical harm of another person that constitutes a violation of explicit social norms. Serious problems include violence that results in severe (potential) physical or psychological harm to victims or in the imposition of severe legal or other consequences…
Give examples of the various types of violence.
- Instrumental.
- Expressive.
- Gang.
- Sexual.
- Intimate partner/domestic.
- Family.
What type of crime is most common?
Crimes of dishonesty
When severe mental illness, substance abuse and history of violence combine, probability of violent behaviour increases
TRUE
Males are less likely to commit violent crimes and commit suicide
FALSE - they are more likely to do both
What is the term used in hospital to replace violence?
Aggression
Outline the difference between aggression and violence.
Violence included the use of a ‘strong physical force’ which can be accompanied by aggression but agression doesn’t always involve physical injury
What are the 3 steps of managing an aggressive patient in hospital?
- Predict
- Prevent
- Intervention
What type of thing can be used to predict the onset of a patients aggressive behaviour?
Body language
What factors can be involved in the prevention of aggressive behaviour?
- De-escalation.
- Observations.
- Room layout.
Give examples of interventions against aggressive behaviour.
Restraint, seclusion, rapid tranquillisation
How can you manage the environment of an aggressive patient?
- Admitting to open/locked ward
Some environments may be stimulating for an aggressive patient.
TRUE
What should immediate management of an aggressive patient include?
Management of substance withdrawal phenomena, and management of acutely disturbed or aggressive behaviour
Outline the principles of the Scottish Mental Health Act
- Participation (Advance Statements)
- Respect for carers
- Informal care
- Benefit
- Non-Discrimination
- Respect for Diversity
- Least Restrictive
- Reciprocity
- Child Welfare
- Equality
Who does the MHA apply to?
The patient
What does the MHA define a patient as?
A person who has or appears to have a mental disorder.
Does the MHA always apply to someone who has been detained?
Not necessarily.
In fact special provisions for informal patients i.e. appeal to tribunal for unlawful detention, ECT to children, request assessment of needs
What groups of disorders come under the heading ‘mental disorder’?
- Any mental illness.
- Personality disorder.
- Learning disability.
A mental disorder is a mental disorder despite how it was caused or manifested?
TRUE
List all the people who can legally use the MHA.
- Any registered medical practitioner
- Approved medical practitioner (anyone trained in psychiatry)
- Police
- Patients
- Nurses
- Mental health tribunal for Scotland
- Courts
How long is the nurses holding power for MHA?
2 hours
Under what circumstances can emergency detention be used?
Where it is necessary as a matter of urgency to detain the patient in hospital for the purpose of permitting a full assessment of the person’s mental state; and where if the patient were not detained in hospital there would be a significant risk to either themselves or others
Who has the authority to carry out an emergency detention?
Any registered medical practitioner (FY2 or above)
What does an emergency detention require?
The consent of a medical health officer
What is the exception to emergency detention requiring the consent of a medical health officer?
Urgency
How long does emergency detention last?
Max of 72 hours
What is the main criteria for emergency detention?
- Must be likely that the patient has a mental disorder
- Patients ability to make decisions treatment of medical disorder must be significantly impaired
- No alternative treatment available
- Short term detention impractical
What does an emergency detention certificate not authorise?
Treatment, except if an emergency – must be reported to MWC on form T4
As soon as practicable, what must be done following an emergency detention?
The emergency detention order must be reviewed by an AMP
If the patient is not already in hospital (when issuing an emergency detention certificate), what must be done?
You or police have 72 hours to get them into hospital
What is a short-term order known as?
‘Gateway order’
Short term detention is applied by ____ and requires ____ consent?
AMP
MHO
Why is a short-term order better than emergency detention?
More rights for patient AND gives the patient the opportunity to elect a named person
AUTHORISES treatment
How long does a short-term order last?
28 days
There is no right of appeal for emergency detention
TRUE
Is there a right of appeal for short-term order?
Yes, there is a right of appeal to Tribunal and Mental Welfare Commission
What 5 things should an AMP consider before issuing a short-term order?
- The patient has a mental disorder
- The patients ability to make decisions about their medical treatment is impaired
- It is necessary to detain the patient in hospital for the purpose of determining what medical treatment should be given to the patient or of giving them medical treatment
- There would be risk to the patient or others
- Granting of STD necessary
When do you decide to give a compulsory treatment disorder?
2 weeks into STD order (i.e 2 weeks before the 28 days STD is over)
Who makes the application for a compulsory treatment order, and who are they supported by?
MHO supported by 2 medical reports
Who must 1 medical report in the application for compulsory treatment disorder be by?
AMP and one from patients GP
Are patients able to appeal the application for compulsory treatment disorder?
Yes - they may have legal representation
For a CTO to be authorised, what is needed?
A tribunal hearing
How long does a CTO last?
6 months
Does a CTO have to be in hospital?
No - it can be in hospital or community
Who is the care plan for a CTO proposed by? What can this impose?
The MHO, in consultation with the team.
Can impose conditions ie. residency, attendance at services.
If someone needs rapidly calmed down, what do you give them?
Lorazepam (1-2mg IM)
How long should you wait before giving a 2nd injection of Lorazepam?
30 mins
If Lorazepam fails to calm the patient, what can you give them?
Haloperidol 5mg IM
What should you do if second injection of Lorazepam helps?
Seek advice from senior experienced doctor
What should be avoided in management via antipsychotics?
Polypharmacy
What should be done if sedation is required for a psychotic patient?
Use BDZ, rather than increase antipsychotics, or use sedating antipsychotics
For how long, at least, should you trial the lowest possible dose of an antipsychotic to see if it works?
2 weeks
What type of antipsychotics are usually first line?
Atypicals
When do depot preparations tend to be used?
If issue with compliance or patient preference
What drug should be used in treatment-resistant illness?
Clozapine
