Flashcards in Psychiatry Deck (31):
What are the main conditions to detain someone under mental health act?
Person has a mental disorder
Treatment available to stop condition getting worse/treat symptoms
Without the treatment the person poses risk to self or others
Because of the mental disorder persons ability to make decisions is impaired
What are the three main uses of MHA and key features of each?
Emergency detention (sec 36): 72 hours in hospital, no right of appeal
Short term (sec 44): 28 days,consent from MHO, can be appealed
Compulsory treatment order (part 7): hospital or community based, 6 months, MHO consent, can be appealed
What are the 2 acts to be aware of?
The mental health (scotland) act 2003
Adults with incapacity (scotland) act 2000
Is capacity specific to a decision or an individual?
Decision (may have capacity to choose meals but not handle finances etc)
What does the AWI 2000 act assume?
That all >16s have capacity (do not presume incapacity based on illness/behaviour)
What are the main principles of having capacity?
Receive and understand the treatment, its benefits and risks, consequences of not having the treatment
Retain the information and process to make a decision
Communicate understanding and choice
Memory of these decisions
When is a certificate of incapacity completed and what does it mean?
If concerns that patient doesn't have capacity
Allows the doctor to treat in patients best interests
What is an advance statement?
Statement written when individual was well/had capacity sets out how they would prefer to be treated
What is a power of attorney?
Power given by patient to another individual before they lost capacity (if no power of attorney in place before loss of capacity it is appointed by courts as guardianship- this can be welfare or treatment etc)
What is needed for consent?
Understanding of procedure, risks and benefits, consequences of not having it, process info and communicate decision
(decisions are not binding)
When is written consent needed?
Major procedures with risks
Management of paracetamol OD if less than 1hr?
Give activated charcol and measure serum paracetamol at 4hrs
How much paracetamol is danger?
When do you start aceitylcysteine in paracetamol OD?
serum paracetamol level is on or above the treatment line (100mg at 4hrs to 15mg at 15hrs)
If taken staggered OD
Serum paracetamol level not available in first 8hrs
Why does N-aceitylcysteine help paractemol OD?
Replenishes glutathione stores allowing the safe detoxification of NAPQI
Management of patient presenting at 8hrs paracetamol OD?
Serum paracetamol level
Management of patient presenting after 8hr paracetamol OD?
Start n-acetylacsyteine straight away and measure serum paracetamol
Tests in paracetamol OD?
U&Es (kidney function)
When is liver transplant indicated?
pH <7.3 after 24 hrs, encepalopathy, PT >100, creatinine >300
Management of aspirin OD (salicylate)?
Activated charcoal, IV sodium bicarbonate, haemodialysis
Management of opioid OD?
CAGE alcohol screening?
Cut down, annoyed, guilt, eye opener
MSE overall structure?
S E (M, A) T
P C I
Appearance in MSE?
Evidence of self harm
Behaviour in MSE?
Speech in MSE?
Speed (pressure, slow)
Quantity (poverty, minimal, excessive)
Volume (loud, quiet)
Tone (monotonous, tremulous)
Emotion in MSE?
Mood: Depressed, euthymic, elevated, labile
Affect: Congruent, incongruent, restricted, reactive, blunted, heightened
Thought in MSE?
Form: accelerated, slow, linear, incoherent, circumstantial, tangential, flight of ideas, perseverance
Content: Delusions, obsessions, overvalued ideas, suicidal ideation
Possession: insertion, withdrawal, broadcasting
Perception in MSE?
Cognition in MSE?
Formal testing: MOCA, MMSE
AMT4: age, dofb, hospital, current year