Violence, aggression, legislation & psychosis management Flashcards
management of aggressive behaviour (3 steps)?
prediction
(body language)
Prevention
(De-escalation, observations, room layout)
intervention
(restraint, seclusion, rapid tranquillisation)
Scottish mental health act:
-who can use it?
-Any registered practitioner for Emergency detention
Approved medical practitioner for short term detention and compulsory treatment order
Emergency detention
- when used?
- by who?
- last for how long?
- what criteria must patient meet?
- right of appeal?
- is treatment authorised?
- 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”
- a registered medial practitioner, usually with consent of MHO (but can proceed without if urgent)
- 72 hours
- ability to make decisions for treatment of mental disorder must be significantly impaired
- No
- No, unless emergency
Short term detention
- applied by who?
- requires who to consent?
- treatment authorised?
- lasts for how long?
- right to appeal?
- what criteria must patient meet? (4)
- an approved medical practitioner
- MHO
- yes
- max 28 days
- yes
-patient has mental disorder
patient’s ability to make decisions about provision of treatment is significantly impaired as a result
necessary to detain the patient in hospital for to determine treatment or to give treatment
would be a significant risk to the health/safety/welfare of patient or another person if the patient not detained
Compulsory treatment order
- who makes the application?
- can they appeal?
- treatment authorised?
- what is required?
- lasts how long?
- MHO supported by 2 medical reports, one of whom must be an AMP
- yes
- yes
- a tribunal hearing
- up to 6 months
Rapid tranquillisation policy
what are the stages? (6-6)
consider non-drug approaches:
distraction, seclusion, try talking to patient
IF confirmed hx of significant typical antipsychotic exposure then:
->Oral lorazepam (1-2mg) and/or haloperidol 5mg
-> oral unsuccessful
->injected Lorazepam 1-2mg IM
extreme= lorazepam and haloperidol 5mg IM
(monitor resp rate, pulse BP)
->wait 30 mins and repeat
OR Hx unknown, cardiac disease, no hx typical antipsychotics, current illicit drug use:
- > oral lorazepam -2mg
- > oral unsuccessful
- > consider injection lorazepam 1-2mg IM
- > wait 30 mins and repeat
pharmacological management of psychosis?
- what might be used if compliance issue? resistant?
- if competed with mood disorder?
Use antipsychotics
-is there an advanced treatment order?
atypical usually first line
-depot
clozapine
-mood stabilisers, antidepressants, ECT