Psychiatry

Contributors, xi Foreword, xv Acknowledgements, xvii Abbreviations, xix About the companion website, xxi Part I: Introduction 1 Welcome, 3 Sarah Stringer 2 Mental health services overview, 5 Christina Barras, Rory Conn, Laurine Hanna, Abigail G Crutchlow, and Juliet Hurn 3 Your team, 9 Christina Barras, Rory Conn, Laurine Hanna, and Abigail G Crutchlow 4 Your role, 13 Christina Barras, Rory Conn, Laurine Hanna, and Abigail G Crutchlow 5 Getting started, 16 Mujtaba Husain, Christina Barras, Rory Conn, and Laurine Hanna 6 Safety and verbal de-escalation, 19 Sarah Stringer 7 Boundaries, time management and burnout, 25 Sarah Stringer, Christina Barras, Rory Conn, and Laurine Hanna 8 Psychiatric assessment, 31 Sarah Stringer, Mujtaba Husain, Penelope Brown, and Sean Cross 9 Management: General principles, 45 Sarah Stringer 10 Physical healthcare, 48 Katherine Beck, Stephanie Young, and Juliet Hurn 11 Medications, 53 Noreen Jakeman and Sarah Stringer 12 Psychological interventions, 65 Jane Bunclark, Natasha Liu-Thwaites, Cheryl Kipping, Juliet Hurn, and Sarah Stringer 13 Social interventions, 83 Christina Barras, Rory Conn, Laurine Hanna, Abigail G Crutchlow, Juliet Hurn, Rachel Thomasson, and Anna M Burnside 14 Handovers, 96 Rachel Thomasson 15 Mental health legislation, 97 Penelope Brown, Peter Hindley, and Anna M Burnside 16 Compliments, complaints and serious incidents, 107 Anna M Burnside and Sarah Stringer 17 Training in psychiatry, 110 Mujtaba Husain, Juliet Hurn, Rachel Thomasson, Christina Barras, Rory Conn, Laurine Hanna, and Sarah Stringer Part II: Common tasks COMMUNITY MENTAL HEALTH TEAM (CMHT) 18 Outpatient clinics, 123 Christina Barras, Rory Conn, and Laurine Hanna 19 Care programme approach (CPA) meetings, 127 Abigail G Crutchlow, Christina Barras, Rory Conn, and Laurine Hanna 20 Home visits, 130 Laurine Hanna 21 Depression, 133 Rory Conn and Rachel Thomasson 22 Generalised anxiety disorder (GAD), 141 Laurine Hanna 23 First episode psychosis (FEP), 147 Christina Barras and Juliet Hurn 24 Psychosis - longer term, 154 Stephanie Young 25 Bipolar affective disorder (BPAD), 159 Rory Conn and Juliet Hurn 26 Emotionally unstable personality disorder (EUPD), 165 Jane Bunclark and Juliet Hurn 27 Non-engagement or disengagement, 174 Rory Conn 28 Patients with forensic histories, 179 Penelope Brown 29 Pregnancy, 183 Anna M Burnside and Noreen Jakeman 30 Older adults, 189 Vivienne Mak and Sean Lubbe 31 Trauma and asylum, 196 Laurine Hanna and Juliet Hurn 32 Driving, 203 Christina Barras 33 Discharge, 208 Laurine Hanna WARD 34 From admission to discharge, 212 Katherine Beck and Abigail G Crutchlow 35 Ward rounds, 221 Katherine Beck 36 Common side effect management, 225 Katherine Beck, Noreen Jakeman, and Sarah Stringer 37 Clozapine, 235 Stephanie Young and Noreen Jakeman 38 Self-discharge and section 5(2), 242 Abigail G Crutchlow 39 Seclusion reviews, 246 Katherine Beck 40 Alcohol misuse, 251 Lisa Conlan, Isabel McMullen, and Cheryl Kipping 41 Illicit drugs, 259 Isabel McMullen, Lisa Conlan, and Cheryl Kipping 42 Pregnant patients, 265 Anna M Burnside 43 Inpatients with forensic histories, 269 Penelope Brown 44 People with learning disabilities (LD), 274 Rory Sheehan 45 Emotionally unstable personality disorder (EUPD), 281 Jane Bunclark and Juliet Hurn 46 Older adults, 287 Vivienne Mak and Sean Lubbe 47 Electroconvulsive therapy (ECT), 293 Sean Lubbe and Vivienne Mak 48 Section 136 assessments, 298 Anna M Burnside 49 Tribunals, 303 Sarah Stringer ON-CALL 50 Your first on-call shift, 307 Rachel Thomasson, Sean Cross, and Anna M Burnside 51 Self-harm, 318 Rachel Thomasson, Jane Bunclark, Sean Cross, Rory Conn, and Christina Barras 52 Self-harm in young people, 330 Peter Hindley and Matthew Fernando 53 First episode psychosis (FEP), 336 Rachel Thomasson 54 Mania, 341 Rachel Thomasson 55 Delirium, 345 Vivienne Mak, Sean Lubbe, and Sean Cross 56 Obsessive compulsive disorder (OCD), 353 Natasha Liu-Thwaites and Rachel Thomasson 57 Panic attacks, 357 Natasha Liu-Thwaites 58 Drug-seeking, 361 Isabel McMullen and Lisa Conlan 59 Learning disability (LD) and behavioural change, 365 Rory Sheehan 60 'Social' presentations, 369 Sean Cross and Rachel Thomasson 61 Medically unexplained symptoms, 374 John Moriarty Part III: Emergencies COMMUNITY MENTAL HEALTH TEAM (CMHT) 62 Acute relapse, 383 Laurine Hanna 63 Adult safeguarding, 388 Rory Conn, Vivienne Mak, and Sean Lubbe WARD 64 Child protection concerns, 394 Peter Hindley, Juliet Hurn, and Sarah Stringer 65 Medical emergencies, 401 Katherine Beck and Abigail Steenstra 66 Opiate overdose, 405 Isabel McMullen and Lisa Conlan 67 Stiff, feverish patients, 408 Anna M Burnside 68 Catatonia, 414 Anna M Burnside 69 Lithium toxicity, 418 Noreen Jakeman and Katherine Beck 70 Alleged sexual assault, 422 Anna M Burnside, Sarah Stringer, and Penelope Brown 71 Self-harm on the ward, 428 Jane Bunclark and Abigail Steenstra 72 Hanging, 433 Anna M Burnside 73 Death, 436 Katherine Beck ON-CALL 74 Aggression, 440 Abigail G Crutchlow, Christina Barras, Noreen Jakeman, Sean Lubbe, Vivienne Mak, Rachel Thomasson, and Abigail Steenstra 75 Challenging behaviour in children, 451 Peter Hindley and Matthew Fernando 76 Refusal of urgent treatment, 455 Vivienne Mak, Sean Cross, Sean Lubbe, and Rachel Thomasson 77 Delirium tremens, 461 Rachel Thomasson, Isabel McMullen, and Lisa Conlan 78 Puerperal psychosis, 466 Anna M Burnside 79 Eating disorders, 470 Christina Barras and Sean Cross 80 Threats of violence, 477 Penelope Brown and Rachel Thomasson Appendices Appendix A Investigations/Monitoring, 485 Juliet Hurn, Noreen Jakeman, Anna M Burnside, and Abigail Steenstra Table A.1 Overview of physical health monitoring in Severe Mental Illness (SMI), 485 Table A.2 Delirium investigations, 486 Table A.3 First episode psychosis investigations, 487 Table A.4 Baseline checks before starting psychotropics, 488 Table A.5 Ongoing monitoring - antipsychotics, 489 Table A.6 Ongoing monitoring - mood stabilisers, 490 Table A.7 Rapid tranquilisation (RT) cautions and contraindications, 490 Table A.8 Monitoring after RT, 491 Appendix B Medications, 492 Noreen Jakeman and Sarah Stringer Table B.1.1 Oral antipsychotics-approximate relative side effects, 492 Table B.1.2 Depot antipsychotics-approximate relative side effects, 493 Table B.2 Common oral antipsychotics-key information, 494 Table B.3 Common depot antipsychotics-key information, 496 Table B.4 Selective Serotonin Reuptake Inhibitors (SSRIs)-key information, 498 Table B.5 Non-SSRI antidepressants-key information, 499 Table B.6 Mood Stabilisers-key information, 502 Table B.7 Sedatives-key information, 504 Appendix C Alcohol and drugs, 505 Table C.1 Quick guide to alcohol units (Cheryl Kipping), 505 Table C.2 Alcohol Use Disorders Identification Test (AUDIT) questionnaire, 506 Table C.3 Severity of Alcohol Dependence Questionnaire (SADQ), 508 Table C.4 Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar), 509 Table C.5 Clinical Opiate Withdrawal Scale (COWS), 511 Table C.6 Common illicit drugs summary, 513 Appendix D Cognitive testing, 515 Appendix D.1 The Montreal Cognitive Assessment (MOCA), 515 Appendix D.2 The Addenbrooke's Cognitive Examination-III (ACE-III), 516 Appendix D.3 The Mini-Addenbrooke's Cognitive Examination (M-ACE), 530 Appendix E Mental health legislation, 532 Anna M Burnside & Penelope Brown, with thanks to Daniel M Bennett and Edward Noble Table E.1 The Mental Health (Care and Treatment) (Scotland) Act 2003: common civil sections, 532 Table E.2 The Mental Health (Northern Ireland) Order 1986: common sections (Part II), 534 Table E.3 The Mental Health Act 1983, amended 2007 (England & Wales): forensic sections, 537 Appendix F Useful contacts, 539 Index, 541