1. Essential Skills For mental health care Dr Jim Crabb 13 th September 2007

2. Introduction Introductions Housekeeping Our aims, your aims Agenda Quiz Questions

3. Assessing someone Important questions to ask Personal details Presenting complaint History of the presenting complaint Golden questions Medical history Physical illness & allergies Safety questions

4. The mental state examination Appearance Behaviour Speech Mood Thoughts Perception Cognition Insight

5. The physical health check Pulse Temperature Blood pressure Capillary refill test Breathing rate Physical examination Urine tests Blood tests Alcohol tests

6. Get the whole story Ask permission Speak to their family Speak to the person on their own

7. Bio-psycho-social treatment model 1. Medicines 2. Talking cures (psychological treatments) 3. Building the best life possible (social treatment)

8. 1) Medicine Use medicine when: You know exactly what the mental illness is It is a serious mental illness It is a common mental illness that has not improved despite psychological / social treatment Do not use medicine: Just because the family expect it Because you do not know what else to do

9. 1) Medicines: golden rules Stick to the lowest dose and the right dose Use one medicine Be patient Do not stop taking the medicine suddenly Managing side effects Use the right medicine Some medicines should not be mixed Medicines and pregnancy / breast feeding Medicines and children Medicines and the physically weak Medicine and alcohol Medicine and food

10. 2) Talking cures a) Problem solving b) Relaxation c) Crisis planning d) Counselling e) Coping strategies f) Looking at a situation differently The therapeutic alliance Showing warmth Showing empathy Showing positive regard

11. a) Problem solving work Derry’s story Not enough money to buy food Owes his friends money Does not have a girlfriend The plan Wash and shave at a friends house Borrow clothes Work for free / work for food The plan worked! Derry was offered a job!

12. a) Problem solving Activity!! Get into 4 groups Read your case study Make a plan Present your ideas

13. b) Relaxation: Activity!!

14. 2) Talking cures c) Crisis planning d) Counselling e) Coping strategies f) Looking at a situation differently The therapeutic alliance Showing warmth Showing empathy Showing positive regard

15. 3) Building the best life possible Getting the right balance Daily routine Sleep hygiene Diet Exercise Pleasant activities Work Working with a persons family Managing stress Relapse prevention

16. Break time

17. The types of mental illness Mental illness due to a physical illness. This is called organic mental illness. Mental illness due to the use of alcohol or illicit drugs. This is called substance misuse. Where a person loses touch with reality. This is called psychosis. Where a person is too sad or too happy. The mood disorders. Where a person is worried or afraid The anxiety disorders.

18. Organic mental illness: Delirium What are the key features Partial loss consciousness Disorientated Not able to sleep Strange / odd behaviour Restless, aggressive, suspicious, fearful Forgetful Lack concentration Visual auditory hallucinations Sudden onset over days or hours

19. Organic mental illness: Delirium Who gets delirium Anybody with a physical illness Very old, young What causes delirium Dehydration Fever, infection Abnormal levels sugar / salt Head injury Substance misuse Medicine

20. Delirium activity!! If you suspect delirium Group 1: What questions would you ask? Group 2: What would the mental state examination show? Group 3: What would the physical observations show? Group 4: Once diagnosed, what would you do with this person? Present ideas

21. Delirium treatment Treat the physical illness Monitor physical observations Give fluids Treat infection Lower dose medicines for mental illness At the same time Keep away from noise Reassure and remind Care for by one person

22. Lunch time

23. Organic mental illness: Epilepsy What are the key features? Generalised seizures Becomes unconscious Fall down Bite tongue Become stiff and shake Eyeballs roll upwards Froth at the mouth Pass urine Lips become blue Feel drowsy afterwards

24. Organic mental illness: Epilepsy What are the key features? Partial seizures Awake but not aware Aura Jerky movements in one part of their body Smack lips Repeated movements Hysterical seizures Fall to the ground and shake Will not become unconscious Bite tongue Pass urine

25. Organic mental illness: Epilepsy Who gets epilepsy 1 / 100 people Under 30 years More common in men and people with mental retardation What causes epilepsy Withdrawal from alcohol Infection Abnormal levels of salt / sugar Bleeding / tumour in the head Delirium

26. Assessing someone when you suspect epilepsy Questions to ask: Brainstorm!! Things to do Test for confusion Physical health check Check blood sugar – give sugary drink Make sure it was a seizure not a faint

27. What to do if someone has a seizure Make the area safe Recovery position Remove objects in their mouth Loosen belts / ties Do not restrain Do not give medicine Protect the head Wait 5 minutes If not recovering….

28. What to do if someone has a seizure Give medicines 1. Insert airway 2. 100mg thiamine plus 50% dextrose soln 3. 10mg diazepam (wait 5 min) 4. 5mg diazepam (wait 5 min) 5. Repeat 5mg diazepam until Seizure stops You have given 20mg diazepam

29. What to do if someone has a seizure Check physical observations Move with a sheet

30. Long term treatment Medicines 2+ generalised or partial seizures Best medicines to use Sodium valproate Carbamazepine Side effects Hysterical seizures Do not give anti-psychotics or anti-depressents Talking cures

31. Long term treatment Building the best life possible Sleep and wake at regular times Avoid alcohol Avoid extreme physical exercise Avoid stress Avoid triggers: flashing lights What next? Take medicines Do not swim alone, drive, operate heavy machines Tell doctor if planning children

32. Organic mental illness: Dementia The key features of dementia Forgetful Wander Angry and irritable Strange behaviour Make little sense Sexually inappropriate Who gets dementia? Over 65 Younger people with HIV

33. Dementia Cause Disease of the brain Stroke Infection Alzheimer's disease Under active thyroid gland Drinking too much alcohol Low vitamin levels (folate, B12)

34. Assessing when you suspect dementia What questions should you ask? Activity! What should you look for and do? Test for confusion Check sight and hearing Check to see if a physical illness is causing it Depression or dementia?

35. Treating dementia Medicines Treat the physical illness If no physical illness present: avoid medicines Haloperidol can be used to calm (short term) Talking cures Counselling Warmth and empathy Speak slowly, use simple words

36. Treating dementia Building the best life possible Work out a daily time table Keep tasks simple Give regular sight / hearing tests Identity bracelet Signs around the home Lock doors to prevent wandering Medicine What next Talk to the family - be honest.

37. Quiz ?

38. See you tomorrow