MH Act, Psych Emerg, ECT Flashcards

1
Q

What is the purpose of the mental health legislation?

A
  • Provides for assessment, detention and compulsory treatment for people with severe mental illness
  • Includes check and balances to ensure compulsory treatment only used where necessary
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2
Q

What are some principles of MH act?

A
  • Mx provided in least restrictive way possible
  • rights, dignity, autonomy and respect promoted
  • medical and other health needs recognised and responded to
  • individual needs recognised and responded to
  • person involved in all decisions
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3
Q

What is the role of the second psychiatrist opinion?

A
  • promote self determination for pts by providing information about Rx and possible alternatives
  • empower to make decisions
  • promote dialogue between stake holders
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4
Q

What is a nominated person?

A
  • person to receive information and to support pt for duration of treatment order
  • assist pt to exercise rights and represent their views
  • cannot make treatment decisions on their behalf
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5
Q

What is the role of an advocate?

A
  • not in the bill
  • visit MH services or provide telephone assistance to help pts participate in decisions about their assessment, treatment and recovery
  • discuss concerns re treatment
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6
Q

What is an AO?

A
  • person appears to have serious illness and needs Rx to prevent harm to themselves or others, or serious deterioration in MH
  • enables psych to assess and determine whether CTO required
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7
Q

Where can an inpatient AO be conducted?

A

inpatient MH facility.

If issued in community, 72h to transfer pt thereafter 24h for assessment (up to 72h in special circumstances)

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8
Q

Max duration of TTO?

A

28 days

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9
Q

Criteria TTO?

A

person has mental illness and needs immediate Rx to prevent
-serious deterioration in their mental or physical health
-or serious harm to the person
-or to another person.
No less restrictive means reasonably available, including treatment on a voluntary basis.

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10
Q

Why are criteria for TTO strict?

A

Serious limitation on personal liberty and autonomy. Cannot be placed on TTO simply due to Hx of mental illness.

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11
Q

Max duration TO for young people?

A

3 months. Ensures greater oversight of treatment of young persons.

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12
Q

Timeframe inpatient v community TO?

A

6 months max inpatient

12 months max community

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13
Q

Major components of evaluation of a suicidal patient?

A

CPR
C- urrent plan/intent
P- ast history
R- esources

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14
Q

What are impending violence red flags?

A
  • Speech loud and threatening
  • Increased muscle tension
  • Hyperactivity (e.g. pacing)
  • Slamming doors, knocking furniture
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15
Q

Pharm Mx of arousal?

A
  1. Benzo (loraz or diaz) OR OLZ
  2. Benzo + OLZ
  3. IM OLZ or Ziprasidone
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16
Q

What is NMS?

A

Life threatening complication of anti-psychotic treatment, includes:
-muscular rigidity
-autonomic symptoms (elevated temp, sweating, elevated / labile BP, tachycardia)
-akinesia
-mutism
-changed LOC
Ix: elevated CK, leukocytosis

17
Q

Rx NMS?

A
  • Supportive
  • Cease anti psychotic
  • Dantrolene or bromocriptine
  • ICU
18
Q

What is serotonin syndrome?

A

SSRIs (and other serotonergic agents) combines with MAOIs, lithium, tryptophan.

  • Neuro: myoclonus, nystagmus, HA, tremor, rigidity, seizures
  • MSE: irritability, confusion, agitation, coma
  • Other: increased temp, arrhythmias, death
19
Q

Rx serotonin syndrome?

A
  • Supportive
  • Stop all psychotropics
  • 5HT receptor antagonists (cyproheptadine) or propranolol
20
Q

Advances in ECT?

A
  • Improved anaesthesia, muscle relaxants
  • Hyperoxygenation, denitrogenation
  • Brief pulse stimulus
  • Electrode placement
  • Adequate seizure duration
  • EEG monitoring
  • Stimulus dose titration
21
Q

Indications for ECt?

A
  • Major depressive episode
  • Mania
  • Schizophrenia, schizoaffective
22
Q

ECT cognitive side effects?

A
  • Retrograde and anterograde amnesia
  • Confusion
  • Persistent memory disturbance
23
Q

ECT and pregnancy?

A
  • May be a safer Rx in 1st trim

- 2/3 trim when meds don’t control or when pt has had good response in earlier episode

24
Q

What determines seizure threshold?

A
  • Gender: M>F
  • Age
  • Electrode placement: BL>UL
  • Number of ECTs
  • Exogenous factors: eg. drugs- benzodiazepines raise; antidepressants and antipsychotics lower