Psychiatry

Sarah Stringer, Independent Section 12 Approved Doctor; Extreme Psychiatry Course Lead and Honorary Lecturer, King's College London, UK Juliet Hurn, Consultant Psychiatrist, Southwark North-West Support and Recovery Team, South London and Maudsley NHS Foundation Trust, UK Anna M Burnside, Consultant Liaison Psychiatrist and RAID Clinical Lead, East London NHS Foundation Trust, UK

• Contributors, xiForeword, xvAcknowledgements, xviiAbbreviations, xixAbout the companion website, xxiPart I: Introduction1 Welcome, 3Sarah Stringer2 Mental health services overview, 5Christina Barras, Rory Conn, Laurine Hanna, Abigail G Crutchlow, and Juliet Hurn3 Your team, 9Christina Barras, Rory Conn, Laurine Hanna, and Abigail G Crutchlow4 Your role, 13Christina Barras, Rory Conn, Laurine Hanna, and Abigail G Crutchlow5 Getting started, 16Mujtaba Husain, Christina Barras, Rory Conn, and Laurine Hanna6 Safety and verbal de-escalation, 19Sarah Stringer7 Boundaries, time management and burnout, 25Sarah Stringer, Christina Barras, Rory Conn, and Laurine Hanna8 Psychiatric assessment, 31Sarah Stringer, Mujtaba Husain, Penelope Brown, and Sean Cross9 Management: General principles, 45Sarah Stringer10 Physical healthcare, 48Katherine Beck, Stephanie Young, and Juliet Hurn11 Medications, 53Noreen Jakeman and Sarah Stringer12 Psychological interventions, 65Jane Bunclark, Natasha Liu-Thwaites, Cheryl Kipping, Juliet Hurn, and Sarah Stringer13 Social interventions, 83Christina Barras, Rory Conn, Laurine Hanna, Abigail G Crutchlow, Juliet Hurn, Rachel Thomasson, and Anna M Burnside14 Handovers, 96Rachel Thomasson15 Mental health legislation, 97Penelope Brown, Peter Hindley, and Anna M Burnside16 Compliments, complaints and serious incidents, 107Anna M Burnside and Sarah Stringer17 Training in psychiatry, 110Mujtaba Husain, Juliet Hurn, Rachel Thomasson, Christina Barras, Rory Conn, Laurine Hanna, and Sarah StringerPart II: Common tasksCommunity Mental Health Team (cmht)18 Outpatient clinics, 123Christina Barras, Rory Conn, and Laurine Hanna19 Care programme approach (CPA) meetings, 127Abigail G Crutchlow, Christina Barras, Rory Conn, and Laurine Hanna20 Home visits, 130Laurine Hanna21 Depression, 133Rory Conn and Rachel Thomasson22 Generalised anxiety disorder (GAD), 141Laurine Hanna23 First episode psychosis (FEP), 147Christina Barras and Juliet Hurn24 Psychosis – longer term, 154Stephanie Young25 Bipolar affective disorder (BPAD), 159Rory Conn and Juliet Hurn26 Emotionally unstable personality disorder (EUPD), 165Jane Bunclark and Juliet Hurn27 Non-engagement or disengagement, 174Rory Conn28 Patients with forensic histories, 179Penelope Brown29 Pregnancy, 183Anna M Burnside and Noreen Jakeman30 Older adults, 189Vivienne Mak and Sean Lubbe31 Trauma and asylum, 196Laurine Hanna and Juliet Hurn32 Driving, 203Christina Barras33 Discharge, 208Laurine HannaWard34 From admission to discharge, 212Katherine Beck and Abigail G Crutchlow35 Ward rounds, 221Katherine Beck36 Common side effect management, 225Katherine Beck, Noreen Jakeman, and Sarah Stringer37 Clozapine, 235Stephanie Young and Noreen Jakeman38 Self-discharge and section 5(2), 242Abigail G Crutchlow39 Seclusion reviews, 246Katherine Beck40 Alcohol misuse, 251Lisa Conlan, Isabel McMullen, and Cheryl Kipping41 Illicit drugs, 259Isabel McMullen, Lisa Conlan, and Cheryl Kipping42 Pregnant patients, 265Anna M Burnside43 Inpatients with forensic histories, 269Penelope Brown44 People with learning disabilities (LD), 274Rory Sheehan45 Emotionally unstable personality disorder (EUPD), 281Jane Bunclark and Juliet Hurn46 Older adults, 287Vivienne Mak and Sean Lubbe47 Electroconvulsive therapy (ECT), 293Sean Lubbe and Vivienne Mak48 Section 136 assessments, 298Anna M Burnside49 Tribunals, 303Sarah StringerOn-call50 Your first on-call shift, 307Rachel Thomasson, Sean Cross, and Anna M Burnside51 Self-harm, 318Rachel Thomasson, Jane Bunclark, Sean Cross, Rory Conn, and Christina Barras52 Self-harm in young people, 330Peter Hindley and Matthew Fernando53 First episode psychosis (FEP), 336Rachel Thomasson54 Mania, 341Rachel Thomasson55 Delirium, 345Vivienne Mak, Sean Lubbe, and Sean Cross56 Obsessive compulsive disorder (OCD), 353Natasha Liu-Thwaites and Rachel Thomasson57 Panic attacks, 357Natasha Liu-Thwaites58 Drug-seeking, 361Isabel McMullen and Lisa Conlan59 Learning disability (LD) and behavioural change, 365Rory Sheehan60 ‘Social’ presentations, 369Sean Cross and Rachel Thomasson61 Medically unexplained symptoms, 374John MoriartyPart III: EmergenciesCommunity Mental Health Team (cmht)62 Acute relapse, 383Laurine Hanna63 Adult safeguarding, 388Rory Conn, Vivienne Mak, and Sean LubbeWard64 Child protection concerns, 394Peter Hindley, Juliet Hurn, and Sarah Stringer65 Medical emergencies, 401Katherine Beck and Abigail Steenstra66 Opiate overdose, 405Isabel McMullen and Lisa Conlan67 Stiff, feverish patients, 408Anna M Burnside68 Catatonia, 414Anna M Burnside69 Lithium toxicity, 418Noreen Jakeman and Katherine Beck70 Alleged sexual assault, 422Anna M Burnside, Sarah Stringer, and Penelope Brown71 Self-harm on the ward, 428Jane Bunclark and Abigail Steenstra72 Hanging, 433Anna M Burnside73 Death, 436Katherine BeckOn-call74 Aggression, 440Abigail G Crutchlow, Christina Barras, Noreen Jakeman, Sean Lubbe, Vivienne Mak, Rachel Thomasson, and Abigail Steenstra75 Challenging behaviour in children, 451Peter Hindley and Matthew Fernando76 Refusal of urgent treatment, 455Vivienne Mak, Sean Cross, Sean Lubbe, and Rachel Thomasson77 Delirium tremens, 461Rachel Thomasson, Isabel McMullen, and Lisa Conlan78 Puerperal psychosis, 466Anna M Burnside79 Eating disorders, 470Christina Barras and Sean Cross80 Threats of violence, 477Penelope Brown and Rachel ThomassonAppendicesAppendix A Investigations/Monitoring, 485Juliet Hurn, Noreen Jakeman, Anna M Burnside, and Abigail SteenstraTable A. 1 Overview of physical health monitoring in Severe Mental Illness (smi), 485Table A. 2 Delirium investigations, 486Table A. 3 First episode psychosis investigations, 487Table A. 4 Baseline checks before starting psychotropics, 488Table A. 5 Ongoing monitoring - antipsychotics, 489Table A. 6 Ongoing monitoring - mood stabilisers, 490Table A. 7 Rapid tranquilisation (RT) cautions and contraindications, 490Table A. 8 Monitoring after RT, 491Appendix B Medications, 492Noreen Jakeman and Sarah StringerTable B.. 1 Oral antipsychotics–approximate relative side effects, 492Table B.1. 2 Depot antipsychotics–approximate relative side effects, 493Table B. 2 Common oral antipsychotics–key information, 494Table B. 3 Common depot antipsychotics–key information, 496Table B. 4 Selective Serotonin Reuptake Inhibitors (SSRIs)–key information, 498Table B. 5 Non-SSRI antidepressants–key information, 499Table B. 6 Mood Stabilisers–key information, 502Table B. 7 Sedatives–key information, 504Appendix C Alcohol and drugs, 505Table C. 1 Quick guide to alcohol units (Cheryl Kipping), 505Table C. 2 Alcohol Use Disorders Identification Test (AUDIT) questionnaire, 506Table C. 3 Severity of Alcohol Dependence Questionnaire (SADQ), 508Table C. 4 Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar), 509Table C. 5 Clinical Opiate Withdrawal Scale (COWS), 511Table C. 6 Common illicit drugs summary, 513Appendix D Cognitive testing, 515Appendix D. 1 The Montreal Cognitive Assessment (MOCA), 515Appendix D. 2 The Addenbrooke’s Cognitive Examination-III (ACE-III), 516Appendix D. 3 The Mini-Addenbrooke’s Cognitive Examination (M-ACE), 530Appendix E Mental health legislation, 532Anna M Burnside & Penelope Brown, with thanks to Daniel M Bennett and Edward NobleTable E.1 The Mental Health (Care and Treatment) (Scotland) Act 2003: common civil sections, 532Table E.2 The Mental Health (Northern Ireland) Order 1986: common sections (Part II), 534Table E.3 The Mental Health Act 1983, amended 2007 (England & Wales): forensic sections, 537Appendix F Useful contacts, 539Index, 541