Violence, aggression, legislation & psychosis management

Question 1

management of aggressive behaviour (3 steps)?

Answer 1

prediction
(body language)

Prevention
(De-escalation, observations, room layout)

intervention
(restraint, seclusion, rapid tranquillisation)

Question 2

Scottish mental health act:

-who can use it?

Answer 2

-Any registered practitioner for Emergency detention

Approved medical practitioner for short term detention and compulsory treatment order

Question 3

Emergency detention

• when used?
• by who?
• last for how long?
• what criteria must patient meet?
• right of appeal?
• is treatment authorised?

Answer 3

• where it is necessary as a matter of urgency to detain the patient in hospital for the purpose of permitting a full assessment of the person’s mental state; and where if the patient were not detained in hospital there would be a significant risk to either themselves or others”
• a registered medial practitioner, usually with consent of MHO (but can proceed without if urgent)
• 72 hours
• ability to make decisions for treatment of mental disorder must be significantly impaired
• No
• No, unless emergency

Question 4

Short term detention

• applied by who?
• requires who to consent?
• treatment authorised?
• lasts for how long?
• right to appeal?
• what criteria must patient meet? (4)

Answer 4

• an approved medical practitioner
• MHO
• yes
• max 28 days
• yes

-patient has mental disorder
patient’s ability to make decisions about provision of treatment is significantly impaired as a result
necessary to detain the patient in hospital for to determine treatment or to give treatment
would be a significant risk to the health/safety/welfare of patient or another person if the patient not detained

Question 5

Compulsory treatment order

• who makes the application?
• can they appeal?
• treatment authorised?
• what is required?
• lasts how long?

Answer 5

• MHO supported by 2 medical reports, one of whom must be an AMP
• yes
• yes
• a tribunal hearing
• up to 6 months

Question 6

Rapid tranquillisation policy

what are the stages? (6-6)

Answer 6

consider non-drug approaches:
distraction, seclusion, try talking to patient

IF confirmed hx of significant typical antipsychotic exposure then:
->Oral lorazepam (1-2mg) and/or haloperidol 5mg
-> oral unsuccessful
->injected Lorazepam 1-2mg IM
extreme= lorazepam and haloperidol 5mg IM
(monitor resp rate, pulse BP)
->wait 30 mins and repeat

OR Hx unknown, cardiac disease, no hx typical antipsychotics, current illicit drug use:

• > oral lorazepam -2mg
• > oral unsuccessful
• > consider injection lorazepam 1-2mg IM
• > wait 30 mins and repeat

Question 7

pharmacological management of psychosis?

• what might be used if compliance issue? resistant?
• if competed with mood disorder?

Answer 7

Use antipsychotics
-is there an advanced treatment order?
atypical usually first line

-depot
clozapine

-mood stabilisers, antidepressants, ECT