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SBAs and EMQs In Psychiatry for Medical Students

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SBAs and EMQs In Psychiatry for Medical Students

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SBAs and EMQs in Psychiatry for Medical Students by Neel Sharma (Author) (z-lib.org)

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Prescribing Safety Assessment Psychiatry

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Presentation Description

Prescribing Skills Assessment

Presentation Transcript

Prescribing Safety Assessment - Psychiatry:

Prescribing Safety Assessment - Psychiatry Dr Marija Axiak Consultant Psychiatrist

Some facts..:

Some facts.. EQUIP Study Dornan et al, 2009 11,077 errors were detected in 124,260 medication orders checked on seven 'census days' in 19 acute hospital trusts FY1 and FY2 doctors write most hospital prescriptions FY1 doctors write 40% of hospital prescriptions (50k) FY2: write 28% Consultants: write just 3%

Some facts..:

Some facts.. Prescribing is risky : Errors in 8%-11% of FY1 & FY2 prescriptions Error rates - admission (13.4%), during stay (7.6%), rewriting (3.9%), discharge (6.4%)

Back to Psychiatry:

Back to Psychiatry Anti-depressants - monitoring, SE, interactions, Serotonin Syndrome Anti-psychotics - monitoring, SE, Acute Dystonia Mood Stabilizer - Lithium monitoring Management of alcohol withdrawals in-patient

Anti-depressants:

Anti-depressants The three main neurotransmitters of depression are: Serotonin , the prominent calming and inhibiting neurotransmitter Dopamine regulates the sense of pleasure, satisfaction and reward. Norepinephrine affects motivation, ability to focus and energy. 5HT DA NA

Classes of AD:

Classes of AD SSRIs - inhibit reuptake of serotonin eg Sertraline, Citalopram SARIs - prevent reuptake of serotonin as well as stopping it binding to cell receptors eg Trazodone TeCAs - inhibit serotonin and norepinephrine reuptake eg Mirtazapine TCAs - inhibit reuptake of mostly epinephrine and serotonin eg Amitriptylene

SSRIs :

SSRIs Sertraline and Escitalopram are considered as the best tolerated SSRIs with the fewest drug interactions (Cipriani studies) Adverse effects worth noting - GI, akathisia, sexual dysfunction, platelet dysfunction SSRIs interact with Warfarin/Aspirin - increased risk of bleeding SSRIs do not interact with most OCPs SSRIs interact with Tramadol - increased seizure potential and for Serotonin Syndrome

SARIs:

SARIs Trazodone is a serotonin antagonist and reuptake inhibitor Mostly useful as a hypnotic due to sedative effects May be intolerable due to same sedation Rare but dramatic side-effect of priapism due to antagonism of alpha-adrenergic receptors

TeCAs:

TeCAs Mirtazapine increases quality of sleep BUT in some cases can cause restless leg syndrome and REM sleep behaviour disorder Most likely to cause increased appetite and weight gain Less likely to cause sexual dysfunction Does NOT cause serotonin syndrome as it does NOT have serotonergic activity

TCAs:

TCAs Major limitation is not their efficacy but their side effect profile Anti-histaminic (sedation, weight gain) Anti-cholinergic (dry mouth, blurred vision, urinary retention, constipation) Cardiac arrythmias Avoid in patients with history of glaucoma

Serotonin Syndrome:

Serotonin Syndrome Excessive increase in serotonin levels in brain Commonly misdiagnosed as a psychiatric disorder Can be fatal if the drug causing it, is not discontinued Can be caused from a single therapeutic dose of an SSRI Can be caused by Overdose of one or more serotonergic agents or combination therapy (SSRI + TCA or SSRI + Lithium or SSRI + Tramadol)

Monitoring during anti-depressant Rx:

Monitoring during anti-depressant Rx Bleeding risk (CBC) and hyponatremia (Na) with SSRIs LFTs, TFTs, ECG for QTc interval with TCAs CBC (agranulocytosis) Lipid Profile, FBG, LFTs with TeCAs

Case Example:

Case Example An 81 year old woman presents feeling generally unwell, lethargic and nauseated. Past medical history includes hypertension, atrial fibrillation and TIA. Her blood results were: Na+ 121 mmol /L (137- 144), K+ 3.4 mmol /L (3.5-4.9), U 17.7 mmol /L (2.5-7.0), Cr 203 μmol /L (60-110), eGFR 27. Select the medication which is the most likely cause of the hyponatraemia

Case Example:

Case Example Perindopril 4mg orally daily Rivaroxaban 20mg orally twice a day Sodium Valproate 500mg orally daily Citalopram 10mg orally daily Lorazepam 2mg orally twice a day

Anti-psychotics:

Anti-psychotics

Anti-psychotics:

Anti-psychotics Typical agents - Haloperidol, Chlorpromazine Atypical agents - Olanzapine, Quetiapine , Risperidone Various preparations including Intramuscular (short acting and long acting depot injections) and Orodispersible tablets

Side Effects:

Side Effects Sedation - initially considerable, tolerance usually develops after a few weeks Postural hypotension - due to blockade of Adrenergic receptors, tolerance may develop Anticholinergic effects - blurred vision, constipation, dry mouth, urinary retention Endocrine effects - increase prolactin secretion can cause galactorrhea , results from anti-dopamine effect Weight gain

Monitoring:

Monitoring HBA1c, FBG, Lipid Profile (metabolic syndrome) Prolactin (high levels may cause amenorrhea) Weight ECG (for QTc interval, baseline and post-dose changes) CBC (Febrile Neutropenia with Clozapine and in rare cases with Olanzapine)

Interactions:

Interactions Antipsychotics lower seizure threshold ; Anti-epileptics reduce antipsychotics plasma conc Antipsychotics in combination with anti- hypertensives increase risk of postural hypotension Antipsychotics in combination with amiodarone increase risk of ventricular arrhytmia Antipsychotics in combination with lithium increase risk of NMS

Neuroleptic Malignant Syndrome:

Neuroleptic Malignant Syndrome NMS is a potentially lethal process related to the use of neuroleptic agents that block Dopamine NMS can occur in ANY patient taking an anti-psychotic drug, REGARDLESS of the duration of use 10-20% mortality rate Elevated Serum CK levels

Acute Dystonic Reaction:

Acute Dystonic Reaction Frightening syndrome that involves uncontrollable and repetitive muscle contractions that may be painful May be caused by ALL antipsychotics and antiemetics such as Metoclopramide May present with a subjective feeling of enlarged tongue with difficulty in swallowing Respiratory compromise may occur if larynx is involved

Acute dystonic reaction:

Acute dystonic reaction TREAT WITH PROCYCLIDINE HYDROCHLORIDE 10mg I.M

Lithium - the classic mood stabiliser:

Lithium - the classic mood stabiliser Bipolar disorder has been treated with Lithium for more than 50 years Effective mostly in manic episodes (acute and maintenance) Helps to prevent suicide in patients with mood disorders Used also as an augmenting agent to anti-depressants for depression

Lithium - how to use it:

Lithium - how to use it Before starting check CBC, renal function tests, creatinine clearance test (or DTPA scan) and thyroid function tests ECG as may cause sick sinus syndrome In women, pregnancy test Monitor Lithium levels and routine blood tests every 6 months

Lithium - side effects :

Lithium - side effects Most common tremors and GI problems, which often disappear after 4 weeks Less common increased thirst, worsening of acne/psoriasis/eczema, weight gain and somnolence Advise to increase fluid intake and to avoid caffeine Advise regarding symptoms of toxicity and the increased risk of this, due to interactions of medications

Factors affecting Lithium levels:

Factors affecting Lithium levels Impaired renal function Dehydration Pregnancy Medications such as diuretics (Bumetanide), ACE inhibitors (Enalapril) and NSAIDS increase Lithium concentration Caffeine decreases Lithium levels

Lithium Toxicity:

Lithium Toxicity Mild (levels 1.5-2.0) vomiting, diarrhoea , unsteady gait, dizziness, slurred speech Moderate (levels 2.0-2.5) nausea, vomiting, blurred vision, clonic limb movements, convulsions, delirium , syncope Severe (levels >2.5) generalized convulsions, renal failure, oliguria

Alcohol withdrawals:

Alcohol withdrawals MINOR SEIZURE HALLUCINATIONS DELIRIUM 6-36 hrs from last drink 6-48hrs 12-48hrs 48-96hrs Normal mental state Generalized Tonic- Clonic Usually visual Disorientation Tremor Usually singular Resolves in <48hrs before DTs start Agitation Mild anxiety Treat with Benzodiazepines Increase d Autonomic activity Headache If untreated, 1/3 go into DT 5% Mortality Sweating Insomnia

Benzodiazepines:

Benzodiazepines Sedation and CNS depression is common but worse if combined with alcohol and antihistamines Behavioural disinhibition - irritability, excitement, aggression (<1%) Psychomotor and cognitive impairment - coordination and attention impaired (driving!) Overdose - rare fatalities if BZD alone but worse when combined with TCAs, alcohols, and narcotics

Benzodiazepine Toxicity:

Benzodiazepine Toxicity Effects include excessive sedation, respiratory depression and coma Flumazenil is the antedote For overdose, 0.1-0.2mg boluses very 15-60 secs up to a maximum of 1-2mg

Presentation Description

Prescribing Skills Assessment

Presentation Transcript

Prescribing Safety Assessment - Psychiatry:

Prescribing Safety Assessment - Psychiatry Dr Marija Axiak Consultant Psychiatrist

Some facts..:

Some facts.. EQUIP Study Dornan et al, 2009 11,077 errors were detected in 124,260 medication orders checked on seven 'census days' in 19 acute hospital trusts FY1 and FY2 doctors write most hospital prescriptions FY1 doctors write 40% of hospital prescriptions (50k) FY2: write 28% Consultants: write just 3%

Some facts..:

Some facts.. Prescribing is risky : Errors in 8%-11% of FY1 & FY2 prescriptions Error rates - admission (13.4%), during stay (7.6%), rewriting (3.9%), discharge (6.4%)

Back to Psychiatry:

Back to Psychiatry Anti-depressants - monitoring, SE, interactions, Serotonin Syndrome Anti-psychotics - monitoring, SE, Acute Dystonia Mood Stabilizer - Lithium monitoring Management of alcohol withdrawals in-patient

Anti-depressants:

Anti-depressants The three main neurotransmitters of depression are: Serotonin , the prominent calming and inhibiting neurotransmitter Dopamine regulates the sense of pleasure, satisfaction and reward. Norepinephrine affects motivation, ability to focus and energy. 5HT DA NA

Classes of AD:

Classes of AD SSRIs - inhibit reuptake of serotonin eg Sertraline, Citalopram SARIs - prevent reuptake of serotonin as well as stopping it binding to cell receptors eg Trazodone TeCAs - inhibit serotonin and norepinephrine reuptake eg Mirtazapine TCAs - inhibit reuptake of mostly epinephrine and serotonin eg Amitriptylene

SSRIs :

SSRIs Sertraline and Escitalopram are considered as the best tolerated SSRIs with the fewest drug interactions (Cipriani studies) Adverse effects worth noting - GI, akathisia, sexual dysfunction, platelet dysfunction SSRIs interact with Warfarin/Aspirin - increased risk of bleeding SSRIs do not interact with most OCPs SSRIs interact with Tramadol - increased seizure potential and for Serotonin Syndrome

SARIs:

SARIs Trazodone is a serotonin antagonist and reuptake inhibitor Mostly useful as a hypnotic due to sedative effects May be intolerable due to same sedation Rare but dramatic side-effect of priapism due to antagonism of alpha-adrenergic receptors

TeCAs:

TeCAs Mirtazapine increases quality of sleep BUT in some cases can cause restless leg syndrome and REM sleep behaviour disorder Most likely to cause increased appetite and weight gain Less likely to cause sexual dysfunction Does NOT cause serotonin syndrome as it does NOT have serotonergic activity

TCAs:

TCAs Major limitation is not their efficacy but their side effect profile Anti-histaminic (sedation, weight gain) Anti-cholinergic (dry mouth, blurred vision, urinary retention, constipation) Cardiac arrythmias Avoid in patients with history of glaucoma

Serotonin Syndrome:

Serotonin Syndrome Excessive increase in serotonin levels in brain Commonly misdiagnosed as a psychiatric disorder Can be fatal if the drug causing it, is not discontinued Can be caused from a single therapeutic dose of an SSRI Can be caused by Overdose of one or more serotonergic agents or combination therapy (SSRI + TCA or SSRI + Lithium or SSRI + Tramadol)

Monitoring during anti-depressant Rx:

Monitoring during anti-depressant Rx Bleeding risk (CBC) and hyponatremia (Na) with SSRIs LFTs, TFTs, ECG for QTc interval with TCAs CBC (agranulocytosis) Lipid Profile, FBG, LFTs with TeCAs

Case Example:

Case Example An 81 year old woman presents feeling generally unwell, lethargic and nauseated. Past medical history includes hypertension, atrial fibrillation and TIA. Her blood results were: Na+ 121 mmol /L (137- 144), K+ 3.4 mmol /L (3.5-4.9), U 17.7 mmol /L (2.5-7.0), Cr 203 μmol /L (60-110), eGFR 27. Select the medication which is the most likely cause of the hyponatraemia

Case Example:

Case Example Perindopril 4mg orally daily Rivaroxaban 20mg orally twice a day Sodium Valproate 500mg orally daily Citalopram 10mg orally daily Lorazepam 2mg orally twice a day

Anti-psychotics:

Anti-psychotics

Anti-psychotics:

Anti-psychotics Typical agents - Haloperidol, Chlorpromazine Atypical agents - Olanzapine, Quetiapine , Risperidone Various preparations including Intramuscular (short acting and long acting depot injections) and Orodispersible tablets

Side Effects:

Side Effects Sedation - initially considerable, tolerance usually develops after a few weeks Postural hypotension - due to blockade of Adrenergic receptors, tolerance may develop Anticholinergic effects - blurred vision, constipation, dry mouth, urinary retention Endocrine effects - increase prolactin secretion can cause galactorrhea , results from anti-dopamine effect Weight gain

Monitoring:

Monitoring HBA1c, FBG, Lipid Profile (metabolic syndrome) Prolactin (high levels may cause amenorrhea) Weight ECG (for QTc interval, baseline and post-dose changes) CBC (Febrile Neutropenia with Clozapine and in rare cases with Olanzapine)

Interactions:

Interactions Antipsychotics lower seizure threshold ; Anti-epileptics reduce antipsychotics plasma conc Antipsychotics in combination with anti- hypertensives increase risk of postural hypotension Antipsychotics in combination with amiodarone increase risk of ventricular arrhytmia Antipsychotics in combination with lithium increase risk of NMS

Neuroleptic Malignant Syndrome:

Neuroleptic Malignant Syndrome NMS is a potentially lethal process related to the use of neuroleptic agents that block Dopamine NMS can occur in ANY patient taking an anti-psychotic drug, REGARDLESS of the duration of use 10-20% mortality rate Elevated Serum CK levels

Acute Dystonic Reaction:

Acute Dystonic Reaction Frightening syndrome that involves uncontrollable and repetitive muscle contractions that may be painful May be caused by ALL antipsychotics and antiemetics such as Metoclopramide May present with a subjective feeling of enlarged tongue with difficulty in swallowing Respiratory compromise may occur if larynx is involved

Acute dystonic reaction:

Acute dystonic reaction TREAT WITH PROCYCLIDINE HYDROCHLORIDE 10mg I.M

Lithium - the classic mood stabiliser:

Lithium - the classic mood stabiliser Bipolar disorder has been treated with Lithium for more than 50 years Effective mostly in manic episodes (acute and maintenance) Helps to prevent suicide in patients with mood disorders Used also as an augmenting agent to anti-depressants for depression

Lithium - how to use it:

Lithium - how to use it Before starting check CBC, renal function tests, creatinine clearance test (or DTPA scan) and thyroid function tests ECG as may cause sick sinus syndrome In women, pregnancy test Monitor Lithium levels and routine blood tests every 6 months

Lithium - side effects :

Lithium - side effects Most common tremors and GI problems, which often disappear after 4 weeks Less common increased thirst, worsening of acne/psoriasis/eczema, weight gain and somnolence Advise to increase fluid intake and to avoid caffeine Advise regarding symptoms of toxicity and the increased risk of this, due to interactions of medications

Factors affecting Lithium levels:

Factors affecting Lithium levels Impaired renal function Dehydration Pregnancy Medications such as diuretics (Bumetanide), ACE inhibitors (Enalapril) and NSAIDS increase Lithium concentration Caffeine decreases Lithium levels

Lithium Toxicity:

Lithium Toxicity Mild (levels 1.5-2.0) vomiting, diarrhoea , unsteady gait, dizziness, slurred speech Moderate (levels 2.0-2.5) nausea, vomiting, blurred vision, clonic limb movements, convulsions, delirium , syncope Severe (levels >2.5) generalized convulsions, renal failure, oliguria

Alcohol withdrawals:

Alcohol withdrawals MINOR SEIZURE HALLUCINATIONS DELIRIUM 6-36 hrs from last drink 6-48hrs 12-48hrs 48-96hrs Normal mental state Generalized Tonic- Clonic Usually visual Disorientation Tremor Usually singular Resolves in <48hrs before DTs start Agitation Mild anxiety Treat with Benzodiazepines Increase d Autonomic activity Headache If untreated, 1/3 go into DT 5% Mortality Sweating Insomnia

Benzodiazepines:

Benzodiazepines Sedation and CNS depression is common but worse if combined with alcohol and antihistamines Behavioural disinhibition - irritability, excitement, aggression (<1%) Psychomotor and cognitive impairment - coordination and attention impaired (driving!) Overdose - rare fatalities if BZD alone but worse when combined with TCAs, alcohols, and narcotics

Benzodiazepine Toxicity:

Benzodiazepine Toxicity Effects include excessive sedation, respiratory depression and coma Flumazenil is the antedote For overdose, 0.1-0.2mg boluses very 15-60 secs up to a maximum of 1-2mg

Have a question? Call us at
US 210-787-1860

Open Monday to Friday, 8 AM to 6 PM EST

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Prescribing Skills Assessment Prescribing Safety Assessment - Psychiatry Dr Marija Axiak Consultant Psychiatrist Some facts.. EQUIP Study Dornan et al, 2009 11,077 errors were detected in 124,260 medication orders checked on seven 'census days' in 19 acute hospital trusts FY1 and FY2 doctors write most hospital prescriptions FY1 doctors write 40% of hospital prescriptions (50k) FY2: write 28% Consultants: write just 3% Some facts..

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Mastering Psychiatry

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Doctors and Nurses: The Rules of Engagement | Journey of a Junior Doctor

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Dear Doctor's Diary: Certifying A Death For The First Time

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Dear Doctor's Diary: Working With Nurses!

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Mental Health Act

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Presentation Description

A Review of the Mental Health Act in Malta

Presentation Transcript

The Mental Health Act 2012 cap. 525:

The Mental Health Act 2012 cap. 525 Dr Marija Axiak

Agenda:

Agenda MHA Schedules Common Terminology Patients ' rights Brief overview Types of Admissions/Hospital Stays Modes of detainment Brief explanation of modes of detainment Capacity

MHA Schedules:

MHA Schedules

Common Terminology :

Common Terminology Informed consent for treatment Responsible C arer Specialist in Mental Health Responsible Specialist Commissioner for Mental Health Multi Disciplinary Team (MDT) Mental Health Care facility Mental Welfare Officer

Definition of Mental Disorder:

Definition of Mental Disorder " Mental disorder " means a significant mental or behavioural dysfunction, exhibited by signs and, or symptoms indicating a disruption of mental functioning, including disturbance in one or more of the areas of thought, mood, volition, perception, cognition, orientation or memory which are present to such a degree as to be considered pathological in accordance with internationally accepted medical and diagnostic standards..

Patients' Rights:

Patients ' Rights Each patient has the right to: Exercise all civil, political, economic, social, religious, educational and cultural rights Receive treatment : same quality & standards, least restrictive environment, needs holistically addressed through a MDT and receive treatment in the community Informed regarding their codition Participate in MDT plan Given free and informed consent regarding their treatment

Patients' Rights:

Patients ' Rights Have a responsible carer Dignity & Confidentiality Access to clinical records Unrestricted communication, unless otherwise indicated Receive visitors

Overview:

Overview Two different types of Hospital stays in The Mental Health Facility: Voluntary & Involuntary Persons may be admitted to hospital as voluntary patients but are later detained under the MHA or may be admitted detained under the MHA (involuntary) however remains as voluntary patient

Types of Admission/Hospital Stay :

Types of Admission/Hospital Stay Voluntary patient Shall not be admitted unless consents in writing to accept required treatment: informed consent for treatment Shall not be secluded unless consents in writing Can request discharge any time unless criteria for involuntary admission is met Be informed that the medical personal may exercise authority to prevent discharge: The nurse in charge may prevent discharge for up to 4 hours

Grounds for Sectioning:

Grounds for Sectioning Involuntary patient A person can only be detained under the MHA if one fits the following criteria: Has a severe mental disorder, And Due to mental disorder, there is a serious risk of physical harm to that person or to other persons, And Failure to admit or detain that person is likely to lead to serious deterioration in condition or will prevent the administration of appropriate treatment that can not be given in the community

Modes of Detainment:

Modes of Detainment Involuntary admission for Observation (IAO), 10 days Involuntary admission for Treatment Order (IATO), 10 weeks, Extension of IATO, 5 weeks Continuing Detention Order, 6 months Community treatment order, 6 months

Involuntary Admission for Observation (IOA):

Involuntary Admission for Observation (IOA) An initial assessment is made by 2 doctors, one who is specialized in MH, to detain a patient under an IOA. May ask for a independent assessor if there are discrepancies. In cases of emergency such as the likelihood of physical harm, a single assessment shall suffice. In such cases, a second assessment by a specialist in MH must be carried out within 24 hours

IOA (cont.):

IOA (cont.) A medical doctor signs the first part of the IOA and later is reviewed by a Specialist in MH/Responsible Specialist IOA requires a 3 rd signature from the patient ' s Responsible carer or the Mental Welfare Officer. Once completed this has to be endorsed by the Commissioner of MH

Involuntary admission for treatment order (IATO):

Involuntary admission for treatment order (IATO) This is continuous from an IAO The application is completed by a Responsible Specialist The application includes a MDT plan Prior approved, the patient is reviewed by an independent responsible specialist who may also interview the responsible carer. Once this process is completed, the IATO is endorsed by Commissioner of MH

IATO (Cont.):

IATO (Cont.) An extension IATO may be used to extend a person ' s treatment for another 5 weeks and then may be converted to a Continuing Detention Order should the person require longer hospitalisation. Alternatively, the patient may be Released from an Involuntary Admission for Treatment Order (IATO) before the allocated period lapses or once it has lasped.

Alternative option: Community Treatment Order (CTO):

Alternative option: Community Treatment Order (CTO) persons with a mental disorder who do not require treatment in a licensed facility but meet the criteria for compulsory treatment in the community, shall, following the granting of a Community Treatment Order, be compulsorily treated in the community under a care plan that helps the person to live and integrate in the community.

Criteria for CTO:

Criteria for CTO the person has a severe mental disorder that is amenable to treatment in the community; and the responsible specialist has previously authorized treatment for the illness but the person has refused or failed to consistently cooperate with the treatment to an extent that has resulted or may result in relapse of the mental disorder or inadequate response which has previously led or may lead to involuntary admission; and the person should be given treatment for the illness in the interest of own safety or for the protection of others; and the treatment required can be safely provided in the community.

CTO (cont.):

CTO (cont.) A person who is a voluntary or involuntary patient within a licensed facility or who is living in the community, may be placed on a CTO following a medical recommendation which shall be made by a specialist, preferably the responsible specialist where applicable, and a medical practitioner, preferably the medical practitioner who will be following the patient in the community As in a IATO, the responsible carer or Mental Welfare Officer are also to complete the form and a care plan is formulated

CTO (cont.):

CTO (cont.) In addition, an indicated HCP/ key worker will be assigned to the person under the CTO to co-ordinate and oversees the smooth running of the CTO. If treatment is refused or there is deterioration in one ' s mental health, the person may be admitted into hospital involuntary for a period of 10 days. After exceeding 10 days, the patient shall either be discharged on a CTO or remain in hospital as a voluntary or involuntary patient.

Conveyance order:

Conveyance order Persons on IATO, Extension of IATO, Continuing Detention Order and CTO who either does not comply with the care plan, can not be located and are deem to deteriorate if kept in a community setting may be brought to hospital against their will, by police assistance. The Conveyance Order is issued by the responsible specialist or his delegate

Capacity:

Capacity Mental capacity means being able to make your own decisions A lack of mental capacity could be due to A stroke or brain injury An active mental health problem Dementia Learning Disability Confusion, drowsiness or unconsciousness because of an illness or the treatment for it Substance or alcohol misuse

Capacity - the rules:

Capacity - the rules Patient has capacity until proven otherwise Capacity is decision-dependant and time-dependant If a patient lacks capacity, you must act in their best interests If a patient makes a strange or irrational decision, this does NOT mean they don ' t have capacity

First Step :

First Step Does the patient have impairment and/or disturbance of brain function? If NO, then then the patient has capacity If YES, does this mean they are unable to make a decision as a result?

Consent Test:

Consent Test

Have a question? Call us at
US 210-787-1860

Open Monday to Friday, 8 AM to 6 PM EST

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A Review of the Mental Health Act in Malta The Mental Health Act 2012 cap.

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Panic disorder - panic attacks, causes, symptoms, diagnosis, treatment & pathology

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Delirium - causes, symptoms, diagnosis, treatment & pathology

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Generalized anxiety disorder (GAD) - causes, symptoms & treatment

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Obsessive compulsive disorder (OCD) - causes, symptoms & pathology

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Alcoholism - causes, symptoms, diagnosis, treatment, pathology

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Posttraumatic stress disorder (PTSD) - causes, symptoms, treatment & pathology

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Phobias - specific phobias, agoraphobia, & social phobia

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Social Anxiety Disorder - causes, symptoms, diagnosis, treatment, pathology

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Dissociative disorders - causes, symptoms, diagnosis, treatment, pathology

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Clinical depression - major, post-partum, atypical, melancholic, persistent

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Bipolar disorder (depression & mania) - causes, symptoms, treatment & pathology

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Attention deficit hyperactivity disorder (ADHD/ADD) - causes, symptoms & pathology

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Hearing Voices - Observers Perspective

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Auditory Hallucinations

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Nihilistic Delusions

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Delusions

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Delusional Perception

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Thought Block

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Acute Organic Brain Syndrome

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Psych Notes

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Historical Dictionary of Psychiatry