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   May 26

Management of a Mental Patient (VIVA)

Management Considerations of a patient with a mental illness (considered after performing a Psychiatric History and after having formulated answers to the Mental State Examination.

  • Immediate Risk / Grounds for admission
  • Does the patient show signs that they may be a risk to themselves or to others around them?

    Is the patient in such a state that there is grounds for admission – are they medically unwell? (consider Wernicke’s encephalopathy, acute psychosis etc).

    Look at the past psychiatric history, is there something there that may assist you with your decision making?

    If the patient is not to be admitted is there support surrounding the patient that will provide for the patient (ie a supportive family that understands the situation).

    Is there a need to consider an Involuntary Treatment Order (ITO)?

  • Investigations to perform on the patient

We want to rule out Organic causes of the illness. As such it is wise to perform various tests. These include but are not limited to:

  • FBC/U&E
  • – There could be a delerium from an electrolyte abnormality, the FBC may show things such as alchol abuse or an infection that could be causing the symptoms presented.

  • LFT
  • – Presence of a substance abuse (e.g. Alcoholic liver disease)

  • CT/MRI
  • – After a recent change in behaviour always consider the possibility of a Space Occupying Lesion. There may have been a fall in the elderly or a tumour. This will also show cerebral atrohpy which may assist with diagnosis of Alzheimer’s dementia or other forms of dementia.

  • Urine Drug Screen
  • – This may be useful in picking up illicit substances in the urine.

  • TFTs
  • – In the instance of depression etc, always consider the possibility of hypothyroidism.

  • Specific Treatments
  • Buzz Word City!!

    Three Words: Bio – Psycho – Social.

    BIO

    • AWS
    • – if the patient is a known alcohol abuser, it may be worth implementing the alcohol withdrawal scale treatment protocol. Consider also involving ATODS and initiate treatment with Thiamine (remember Wernicke’s encephalopathy).

    • Antidepressants/Antipsychotics
    • – Consider initiating doses, side effects, when to increase, patient compliance, which one to use, contraindications etc.

    • Anxiolytics
    • – Always consider the risk of addiction. Patient might need sleep, calming etc but particularly where there is substance abuse etc there is the risk of dependence with benzodiazepines. Consider perhaps using quetiapine (sedative effect but also atypical antipsychotic). Involve ATODS if not sure.

    PSYCHO

    • CBT/Psychoeducation
    • – Patient may benefit from sessions with a psychologist doing cognitive behavioral therapy. This will allow identify distant antecedents and allow the patient to learn coping skills and skills to resolve some issues.

      Psychoeducation of the patient is very important as well. They need to understand that they have an illness, the issues surrounding their illness and what they can do to help with the treatment of their illness. This will assist with concordance and treatment.

      Consider with this also ongoing management of the client. Do they have a regular GP? Should they be linked in with the community mental health service? Should ATODS be involved.

    SOCIAL

    • Family and Friends
    • – Do they have a support network of people who understand their illness and are available to help out.

    • ADLs and Financial Support
    • – Do they have an income? Do they require someone to help them with things such as shopping, housework, managing bills etc. Should the public trustee or a financial power of attorney be considered.

    • Employment
    • – Will they be able to work? Is their work affecting their illness? Do they need time of work? Is there an issue of workcover? Should they consider alternative forms of work?

    • Followup and Ongoing Management
    • – Have the got a GP? Do they need to be treated at community mental health? Do they need a case-manager? Should ATODS be involved?

    • Community Support Organisations
    • – Does the patient or their family need to be referred to a community support group (eg Alzheimers Disease Support, Schizophrenia, Beyond Blue etc)

    So that about sums up management. At least in the short to medium term.

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    One Comment

    1. tracey j says:

      Thanks for submitting “a mental health management plan”. It helps with my studies at the moment and in the future. Excellent journal writing by the way!
      Cheers Tracey

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