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Psychiatry > Violence, Aggression, Legislation and the Management of Psychosis > Flashcards

Violence, Aggression, Legislation and the Management of Psychosis Flashcards

1
Q

What can violence be defined by?

A

Can be defined by the nature of the act, the impact of the act upon the victim, aggressor, society

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2
Q

What does the WHO define as violence?

A

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.

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3
Q

According to HCR-20 V3 manual, what is violence?

A

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…

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4
Q

Give examples of the various types of violence.

A
  • Instrumental.
  • Expressive.
  • Gang.
  • Sexual.
  • Intimate partner/domestic.
  • Family.
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5
Q

What type of crime is most common?

A

Crimes of dishonesty

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6
Q

When severe mental illness, substance abuse and history of violence combine, probability of violent behaviour increases

A

TRUE

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7
Q

Males are less likely to commit violent crimes and commit suicide

A

FALSE - they are more likely to do both

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8
Q

What is the term used in hospital to replace violence?

A

Aggression

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9
Q

Outline the difference between aggression and violence.

A

Violence included the use of a ‘strong physical force’ which can be accompanied by aggression but agression doesn’t always involve physical injury

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10
Q

What are the 3 steps of managing an aggressive patient in hospital?

A
  1. Predict
  2. Prevent
  3. Intervention
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11
Q

What type of thing can be used to predict the onset of a patients aggressive behaviour?

A

Body language

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12
Q

What factors can be involved in the prevention of aggressive behaviour?

A
  • De-escalation.
  • Observations.
  • Room layout.
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13
Q

Give examples of interventions against aggressive behaviour.

A

Restraint, seclusion, rapid tranquillisation

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14
Q

How can you manage the environment of an aggressive patient?

A
  • Admitting to open/locked ward
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15
Q

Some environments may be stimulating for an aggressive patient.

A

TRUE

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16
Q

What should immediate management of an aggressive patient include?

A

Management of substance withdrawal phenomena, and management of acutely disturbed or aggressive behaviour

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17
Q

Outline the principles of the Scottish Mental Health Act

A
  • Participation (Advance Statements)
  • Respect for carers
  • Informal care
  • Benefit
  • Non-Discrimination
  • Respect for Diversity
  • Least Restrictive
  • Reciprocity
  • Child Welfare
  • Equality
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18
Q

Who does the MHA apply to?

A

The patient

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19
Q

What does the MHA define a patient as?

A

A person who has or appears to have a mental disorder.

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20
Q

Does the MHA always apply to someone who has been detained?

A

Not necessarily.

In fact special provisions for informal patients i.e. appeal to tribunal for unlawful detention, ECT to children, request assessment of needs

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21
Q

What groups of disorders come under the heading ‘mental disorder’?

A
  • Any mental illness.
  • Personality disorder.
  • Learning disability.
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22
Q

A mental disorder is a mental disorder despite how it was caused or manifested?

A

TRUE

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23
Q

List all the people who can legally use the MHA.

A
  • Any registered medical practitioner
  • Approved medical practitioner (anyone trained in psychiatry)
  • Police
  • Patients
  • Nurses
  • Mental health tribunal for Scotland
  • Courts
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24
Q

How long is the nurses holding power for MHA?

A

2 hours

25
Q

Under what circumstances can emergency detention be used?

A

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

26
Q

Who has the authority to carry out an emergency detention?

A

Any registered medical practitioner (FY2 or above)

27
Q

What does an emergency detention require?

A

The consent of a medical health officer

28
Q

What is the exception to emergency detention requiring the consent of a medical health officer?

A

Urgency

29
Q

How long does emergency detention last?

A

Max of 72 hours

30
Q

What is the main criteria for emergency detention?

A
  • 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
31
Q

What does an emergency detention certificate not authorise?

A

Treatment, except if an emergency – must be reported to MWC on form T4

32
Q

As soon as practicable, what must be done following an emergency detention?

A

The emergency detention order must be reviewed by an AMP

33
Q

If the patient is not already in hospital (when issuing an emergency detention certificate), what must be done?

A

You or police have 72 hours to get them into hospital

34
Q

What is a short-term order known as?

A

‘Gateway order’

35
Q

Short term detention is applied by ____ and requires ____ consent?

A

AMP

MHO

36
Q

Why is a short-term order better than emergency detention?

A

More rights for patient AND gives the patient the opportunity to elect a named person

AUTHORISES treatment

37
Q

How long does a short-term order last?

A

28 days

38
Q

There is no right of appeal for emergency detention

A

TRUE

39
Q

Is there a right of appeal for short-term order?

A

Yes, there is a right of appeal to Tribunal and Mental Welfare Commission

40
Q

What 5 things should an AMP consider before issuing a short-term order?

A
  • 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
41
Q

When do you decide to give a compulsory treatment disorder?

A

2 weeks into STD order (i.e 2 weeks before the 28 days STD is over)

42
Q

Who makes the application for a compulsory treatment order, and who are they supported by?

A

MHO supported by 2 medical reports

43
Q

Who must 1 medical report in the application for compulsory treatment disorder be by?

A

AMP and one from patients GP

44
Q

Are patients able to appeal the application for compulsory treatment disorder?

A

Yes - they may have legal representation

45
Q

For a CTO to be authorised, what is needed?

A

A tribunal hearing

46
Q

How long does a CTO last?

A

6 months

47
Q

Does a CTO have to be in hospital?

A

No - it can be in hospital or community

48
Q

Who is the care plan for a CTO proposed by? What can this impose?

A

The MHO, in consultation with the team.

Can impose conditions ie. residency, attendance at services.

49
Q

If someone needs rapidly calmed down, what do you give them?

A

Lorazepam (1-2mg IM)

50
Q

How long should you wait before giving a 2nd injection of Lorazepam?

A

30 mins

51
Q

If Lorazepam fails to calm the patient, what can you give them?

A

Haloperidol 5mg IM

52
Q

What should you do if second injection of Lorazepam helps?

A

Seek advice from senior experienced doctor

53
Q

What should be avoided in management via antipsychotics?

A

Polypharmacy

54
Q

What should be done if sedation is required for a psychotic patient?

A

Use BDZ, rather than increase antipsychotics, or use sedating antipsychotics

55
Q

For how long, at least, should you trial the lowest possible dose of an antipsychotic to see if it works?

A

2 weeks

56
Q

What type of antipsychotics are usually first line?

A

Atypicals

57
Q

When do depot preparations tend to be used?

A

If issue with compliance or patient preference

58
Q

What drug should be used in treatment-resistant illness?

A

Clozapine

Psychiatry (31 decks)

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