Management of psychosis

Question 1

Under the terms of the Mental Health Act, what is any registered medical practitioner able to do?

Answer 1

Perform an emergency detention (usually with consent of a mental health officer, but can proceed without)

Question 2

How long does emergency detention last for?

Answer 2

maximum 72 hours

Question 3

What terms must be met for a short term detention to be granted? (5)

Answer 3

1. Patient has a mental disorder
2. Their ability to make decisions about care is likely impaired
3. Medical treatment is available
4. They are at risk of causing harm to themselves or others
5. Granting the order is necessary

Question 4

How long can a compulsory treatment order last for?

Answer 4

Up to 6 months

Question 5

What is the first-line option for tranquilising patients?

Answer 5

Try non drug approaches e.g. talking, seclusion, distraction

Question 6

What is the first-line drug option in tranquilisation?

Answer 6

Oral lorazapem 1-2mg

If patient has history of significant atypical antipsychotic therapy- consider adding haloperidol 5mg

Question 7

When should intramuscular injection be considered?

Answer 7

Oral is unsuccessful, or effect required within 30 minutes

Question 8

What formulation should the intramuscular injection be?

Answer 8

Lorazepam 1-2mg (Mixed 1:1 in water for injection or 0.9% sodium chloride)

Question 9

How should management with antipsychotic drugs be initiated? (2)

Answer 9

Lowest possible dose, 2 week trial

Question 10

First-line antipsychotics

Answer 10

Atypicals e.g. risperidone

Question 11

How should treatment-resistant illness be managed?

Answer 11

Clozapine

Question 12

What does the mental health act specifically preclude from being grounds for compulsory detention?

Answer 12

Under the influence of drugs/alcohol

Question 13

What happens after the 6 months of a compulsory treatment order expires?

Answer 13

Re-apply for another 6 months, then 12 months

Can be appealed and taken to tribunal