2: Management of psychosis

Question 1

Patients with psychosis have the potential to behave ___ towards you or others.

Answer 1

violently

Question 2

Over the last 20 years, the rate of crime has (increased / decreased) overall.

Answer 2

decreased

Question 3

What three factors increase the chances that someone will commit an act of violence?

Answer 3

Substance misuse

Mental illness

History of violence

Question 4

What is the difference between violence and aggression?

Answer 4

Violence is a physical act

Aggression esp. in hospital is an attempt to gain an advantage over someone which MAY take the form of violence

Question 5

How might you predict that a patient will become aggressive?

Answer 5

Body language

Question 6

How is the risk of aggression against hospital staff reduced?

Answer 6

De-escalation of the situation - talking down, isolation or tranquilisation

Observers

Room layout i.e make sure there’s a quick exit, don’t stand between the patient and the door

Question 7

What are some interventions to prevent an aggressive patient from doing harm?

Answer 7

Restraint

Isolation

Tranquilisation

Question 8

If you think a patient is at risk of self harm or becoming aggressive, how can their observation be stepped up?

Answer 8

Change from routine observation to 1-1 or 2-1 observation

Question 9

What is an advance statement?

Answer 9

Instructions given by a patient before they are unwell

So they can be treated properly if they lose capacity to decide for themselves

Question 10

Which acts give you the power to

a) treat patients with mental disorders
b) treat physical disorders in patients with mental disorders?

Answer 10

a) Mental Health Act

b) Adults with Incapacity Act

Question 11

Who does the Mental Health Act apply to?

Answer 11

Patients with mental disorders

Question 12

Which diseases are included under the umbrella of “mental disorder”?

Answer 12

Mental illness

Personality disorder

Learning disability

WHATEVER THE CAUSE

Question 13

Is intoxication with drugs or alcohol a valid reason to detain someone using the MHA?

Answer 13

No

but if they develop a mental disorder e.g psychosis as a result, you can

Question 14

What are the three types of detention order you need to know about?

Answer 14

Emergency detention order

Short term detention order

Compulsory treatment order

Question 15

Who can fill out an emergency detention order?

Answer 15

FY2+

with the consent of a Mental Health Officer

Question 16

Why would you file an emergency detention order?

Answer 16

Patient requires a full mental state examination

AND you think they are a risk to themselves or others

Question 17

Who needs to give their permission before an FY2+ doctor can file an emergency detention order?

Answer 17

Mental health officer

Question 18

How long does an emergency detention order last?

Can it be appealed?

Answer 18

72h

No

Question 19

Who can approve a short term detention order?

How long does it last?

Answer 19

ST4+ psychiatrist

28 days

Question 20

Apart from doctors, who else can use the MHA?

Answer 20

Nurses

Police

Judges

Question 21

In general, emergency detention orders are filled out for patients with mental disorders who lack ___.

Answer 21

lack capacity

Question 22

Does the MHA authorise treatment?

Answer 22

Emergency treatment only

Question 23

Where do patients need to be taken once an emergency detention certificate has been filled out?

Answer 23

Hospital

Psychiatric unit

Question 24

Under which act can you give a patient emergency treatment while they are under an emergency detention order?

Answer 24

Adults with Incapacity Act

Question 25

Which detention order allows you to detain a patient for **28 days?** Is **treatment** allowed under this act?

Answer 25

**Short term detention order** **Yes**

Question 26

Can patients **appeal** against a) **emergency detention** b) **short term detention?**

Answer 26

**a) No** **b) Yes**

Question 27

In general, **short term detention** orders are for patients who cannot make ____ for themselves.

Answer 27

**decisions** i.e they don't have capacity due to their mental disorder **AND they pose a risk to themselves or others**

Question 28

What is meant by **significant risk to a patient or others**?

Answer 28

**Obviously homicide and suicide** but also loss of possessions, disruption to family life, finances...

Question 29

Which **detention** **order** allows a patient to be treated in hospital or in the community **long-term**?

Answer 29

**Compulsory treatment order**

Question 30

How long does a **compulsory treatment order** last?

Answer 30

**6 months**

Question 31

Who is responsible for filing a **compulsory treatment order**?

Answer 31

**Mental health officer** with support from senior doctor and/or GP

Question 32

A ___ must hear a patient's case before a **compulsory treatment order** can be filed.

Answer 32

**tribunal**

Question 33

What is a last ditch method of **calming** an aggressive patient who poses a risk to themselves or others?

Answer 33

**Rapid tranquilisation** using drugs

Question 34

Which **oral drug** is used first line to **rapidly tranquilise** a patient?

Answer 34

**Lorazepam**

Question 35

If **oral tranquilisation** isn't effective, how can drugs be administered to calm an aggressive patient?

Answer 35

**IM**

Question 36

Which **oral drugs** are used to rapidly tranquilise patients if they have a psychiatric history?

Answer 36

**Lorazepam** **AND/OR** **Haloperidol**

Question 37

If a patient does not respond to rapid tranquilisation, what would you do?

Answer 37

**Wait 30 mins and try again** If still no response, get help

Question 38

Which **class** of antipsychotic is usually **first-line** for treating psychosis?

Answer 38

**Atypical / 2nd generation** except clozapine

Question 39

Which antipsychotic drug is used **third-line** for **treatment resistant illness?**

Answer 39

**Clozapine** Due to risk of agranulocytosis

Question 40

What is a **depot**?

Answer 40

**Formulation injected into arm / buttock which releases drug slowly over weeks - months**

Question 41

What does **formal admission** mean in the context of psychiatric illness?

Answer 41

**Admission under detention**

Question 42

What are the **three risk factors** you need to know to assess a patient's risk of becoming **aggressive?**

Answer 42

**Mental illness** **Alcohol / substance abuse** **History of violent behaviour**

Question 43

Which **class** of drug can cause **psychotic symptoms** as a side effect?

Answer 43

**Steroids**