Week 3 Flashcards

1
Q

What does section 328(2) of the Scottish Mental Health Act specifically state not to be mental disorders?

A

Sexual orientation

Sexual deviancy

Trans-sexualism

Transvestism

Alcohol/drug dependence (unless psychosis develops)

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2
Q

Who can used Emergency Detention?

Who can use the Short Term Detention and Compulsory Treatment Order?

Who can use a Place of Safety order?

A

Emergency detention - any registered medical practitioner

Short Term Detention/Compulsory Treatment - approved medical practitioners

Place of Safety - only the police

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3
Q

What is an Emergency Detention used for?

A

Detaining a patient in a (any) hospital for the purposes of permitting a full assessment of the person’s mental state. Does NOT include treatment

Usually done with the consent of a Mental Health Officer, but can proceed without if urgent

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4
Q

How long can a patient be detained with an Emergency Detention order?

A

Maximum of 72 hours

It must be likely that the patient has a mental disorder. Patient’s ability to make decisions about medical treatment for said disorder must be significantly impaired

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5
Q

Do patients have a right to appeal an Emergency Detention?

Can patients be treated under this order?

A

NO right of appeal

(If no MHO consent initially, need to specify why)

Does NOT authorise treatment, except in emergency

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6
Q

How long can a patient be detained under a Short Term Detention order?

Can this be appealed by the patient?

A

STDOs last maximum of 28 days

Patients DO have a right to appeal, and it is done to a Tribunal and Mental Welfare Commission

NB - this form of detention MUST be approved by an MHO, and can only be applied by an approved medical practitioner (AMP)

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7
Q

What approvals must be met in order to instigate a Compulsory Treatment Order?

Can this order be appealed?

A

Application must be made by a MHO and be supported by 2 medical reports - one from an AMP and the other usually from the patient’s GP

Patients DO have the right to appeal

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8
Q

How long does a Compulsory Treatment Order last?

Does this have to be in hospital?

A

CTOs can last for up to 6 months

Care plan is prepared by the MHO and consultation team, who can impose residency, attendance to services etc.

Patient can be treated in either the hospital or the community

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9
Q

According to the Tayside Rapid Tranquilisation Policy, if non-pharmacological approaches have failed, how is a patient managed if they have any of the following…

  • unknown history
  • cardiac disease
  • no history of typical antipsychotics
  • current illicit drug use
A

Consider oral therapy of Lorazepam, 1-2mg

If unsuccessful, or if an effect is required in under 30 mins…

Consider IM injection of Lorazepam, 1-2mg

Wait 30 mins and repeat injection once if necessary

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10
Q

According to the Tayside Rapid Tranquilisation Policy, if non-pharmacological approaches have failed, how is a patient managed if they have a confirmed history of significant typical antipsychotic exposure?

A

Consider oral therapy of Lorazepam, 1-2mg and/or Haloperidol 5mg

If unsuccessful, or if effect required within 30 mins…

Consider IM injection of Lorazepam, 1-2mg

In extreme cases, can give both IM Lorazepam AND Haloperidol 5mg (in separate syringes)

Wait 30 mins and repeat injection(s) once if necessary

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11
Q

Regarding follow-up antipsychotic medications, which class are typically first line?

Which medication is used in treatment resistant illness?

A

First line - atypicals

Treatment resistant - Clozapine

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12
Q

What are the 4 areas that may be affected in a personality disorder (at least 2 must be affected)?

A
  1. cognition i.e. ways of seeing or perceiving events, others or self
  2. affectivity i.e. the range, intensity, lability and appropriateness of emotional response
  3. interpersonal functioning
  4. impulse control
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13
Q

What are some of the features of an Anankastic personality disorder?

A

(a.k.a. Obsessive-Compulsive)

Feelings of excessive doubt or caution

Preoccupation with details, rules, lists, order, organization or schedule

Perfectionism that interferes with task completion

Excessive conscientiousness and scrupulousness

Excludes pleasure and interpersonal relationships in favour of prioritising productivity

Rigidity and stubornness

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14
Q

Personality disorders can broadly be broken down into ‘Odd and Eccentric’, ‘Dramatic and Emotional’ and ‘Anxious and Fearful’ according to the DSM-5 - which specific personality disorders fall under each of these categories?

A

Cluster A - Odd and Eccentric - schizoid, paranoid, schizotypal

Cluster B - Dramatic and Emotional - borderline, histrionic (excessive attention seeking), antisocial, narcissistic

Cluster C - Anxious and Fearful - OCD, avoidant, dependent

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15
Q

What % of the general population have a personality disorder?

What is the most common personality disorder?

A

10.6%

OCD

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16
Q

What personality disorder would be indicated if a patient exhibited 4 or more of the following?…

  • suspects without sufficient basis that others are exploiting, harming or deceiving them
  • preoccupied with unjustified doubts about loyalty of friends/associates
  • reluctant to confide in others because of unwarrented fear that info will be used against them
  • reads hidden demeaning or threatening meanings into benign remarks/events
  • persistently bears grudges
  • perceives attacks on their character that others don’t and very quick to counterattack
  • recurrent suspicions regarding fidelity of partner without justification
A

Paranoid PD (cluster A)

17
Q

What personality disorder would be indicated if a patient exhibited 4 or more of the following?…

  • neither desires nor enjoys close relationships, including family
  • almost always chooses solitary activities
  • little/no interest in sexual experienes with another person
  • takes pleasure in few, if any, activities
  • lacks close friends/confidants other than first degree relatives
  • appears indifferent to the praise or criticism of others
  • shows emotional coldness, detachment or flattened activity
A

Schizoid (Cluster A)

18
Q

What personality disorder would be indicated if a patient exhibited 5 or more of the following?…

  • instability of interpersonal relationships, self-image, affects and marked impulsivity
  • frantic efforts to avoid real or imagined abandonment
  • pattern of unstable and intense interpersonal relationships characterised by alternating extremes of idealisation and devaluation
  • impulsivity in at least two areas that are potentially self-damaging e.g. sex, spending, substance abuse etc.
  • recurrent suicidal behaviour, gestures, threats or self-mutilating behaviour
  • affective instability due to marked reactivity of mood
  • transient, stress-related paranoid ideation of severe dissociative symptoms
A

Borderline PD (Cluster B)

NB - ‘borderline’ refers to being between neurotic or psychotic

19
Q

What are the criteria for a learning disability?

What psychometric assessment is most commonly used to assess if a patient has a learning disability?

A

IQ < 70

Developmental aetiology i.e. under 18

Deficits in adaptive functioning

Most commonly used assessment is the Weschler Adult Intelligence Scale (WAIS)

20
Q

What are the various classifications of severity of learning disability?

A

Borderline - IQ 70+, mental age 12-15

Mild LD - IQ 50-69, mental age 9-12

Moderate LD - IQ 35-49, mental age 6-9

Severe LD - IQ 20-34, mental age 3-6

Profound LD - IQ <20, mental age under 3

21
Q

What major personality disorder is 3 times more common in people with a learning disability?

A

Schizophrenia - earlier age of onset is also seen, with negative symptoms being more common

(also Depressive disorders)

22
Q

What is the triad of symptoms that characterises autistic spectrum disorders?

A

Abnormal social interaction

Communication impairment

Rigid/restrictive or repetitive behaviours, interests and activities

23
Q

What 3 things must someone be able to do to have capacity?

A

Understand and retain the relevant information

Use and weigh that information to make a decision

Communicate that decision

24
Q

What are the 5 principles of the Adults with Incapacity (Scotland) Act 2000?

A
  1. Intervention must benefit the adulty
  2. Such benefit cannot reasonably be achieved without the intervention
  3. Take account of past and present wishes
  4. Consult with other relevant persons
  5. Encourage the adult to use residual capacity
25
Q

What are the main 3 features included within the Adults with Incapacity (Scotland) Act 2000 that you need to know?

A

Power of Attorney

Guardianship

Section 47 certificate of incapacity

26
Q

What is section 47 of the AWI act used for?

A

Authorisation of treatment of a physical disorder in someone without capacity to consent to that treatment

e.g. septis causing delirium

27
Q

What does the Mental Health (Care and Treatment) (Scotland) Act 2003 act allow for?

A

Allows for treatment of mental disorder or physical consequences of mental disorder in someone without the capacity to consent

28
Q

The Mental Health Act includes Emergency Detention, Short Term Detention, Compulsory Treatment Orders, Advance Statements and Nurses’ Holding Power.

What are the criteria that need to be met in order to institute an Emergency Detention (s36)?

A
  1. Likely to have a mental disorder
  2. Significantly impaired decision-making ability regarding treatment as a result of their mental disorder
  3. Detention in hospital is necessary as a matter of urgency to determine what treatment is needed
  4. There is a risk to the health, safety or welfare of the person or the safety of others
  5. Making arrangements for a Short Term Detention (s44) would take too long
29
Q

The Mental Health Act includes Emergency Detention, Short Term Detention, Compulsory Treatment Orders, Advance Statements and Nurses’ Holding Power.

What are the criteria that need to be met in order to institute a Short Term Detention (s44)?

A
  1. Likely to have a mental disorder
  2. Significantly impaired decision-making ability regarding treatment as a result of said mental disorder
  3. Detention in hospital is necessary for assessment or treatment
  4. There is a risk of the health, safety or welfare of the person, or the safety of others

5. Cannot be treated voluntarily

30
Q

What is the age of legal capacity in Scotland, according to the Age of Legal Capacity (Scotland) Act 1991?

A

16

Under 16s can consent to medical treatment on their own behalf if they have the capacity to do so in the opinion of a qualified medical practitioner attending them

31
Q

What is the difference between Anorexia Nervosa and Bulimia?

A

Anorexia Nervosa - self-induced weight loss, BMI equal to or lower than 17.5, body image issues + “fear of fat”, +/- amenorrhoea

Bulimia - persistent preocupation with eating, cravings and binging, followed by purging behaviours

32
Q

What might be seen in the physical assessment of a patient with Anorexia Nervosa?

A

Muscle wasting, hair loss

Lanugo hair

Cold, blue peripheries

Dry skin

Hypercarotenaemia (yellow pigemtation and raised beta-carotin in the blood)

Bradycardia and hypotension

Bruising

33
Q

What condition needs to be planned around when treating someone for severe Anorexia Nervosa?

What guidelines exist?

A

Refeeding Syndrome

The Management of Really Sick Patients with Anorexia Nervosa (MARSIPAN) guidelines

34
Q

What might be seen in the physical assessment of someone with Bulimia?

A

Calluses on knuckles (Russell’s sign)

Parotid hypertrophy and dental carries (as a result of excessive vomiting)

U+Es disturbances

35
Q

How is Bulimia managed?

A

Managed with CBT and therapy

Can also use high dose SSRIs

36
Q

What are Schneider’s First Rank Symptoms of Schizophrenia?

A
  1. (most commonly auditory) hallucinations
  2. thought insertion
  3. thought broadcasting
  4. thought withdrawal
  5. passivity experiences
  6. primary delusions