Compiled by Linda English

Cambridge University Press 978-1-909-72630-7 — Emergency Psychiatry Edited by Kevin Nicholls Index More Information

Index

ABCDE model 188–190, 203 relationship with psychiatric symptoms acute stress disorder (ASD) 252–253, 254 53–59 adjustment disorders 253 ‘responsible’ and ‘irresponsible’ drinkers 51 adrenaline 203 safeguarding 159 advance decision or statement 172, 278, 300, snoring 59 309 suicide 8, 52–53, 54, 63, 64 aggression see violence and aggression thiamine deiciency 56–57, 66, 74 agranulocytosis 106 tolerance 55 akathisia 95–96 units of alcohol 60–61 alcohol misuse 51–68, 86 Wernicke’s encephalopathy 56–57, 62, 66, acute intoxication 54, 63–64 74, 233 after assessment 64–66 withdrawal 55–56, 61, 65–66, 73–74, 208, alcohol diary 65 233, 274, 316 alcoholic hallucinosis 58 Alzheimer’s disease 231, 232 Alcoholics Anonymous (AA) 66 AM v South London & Maudsley NHS alcohol-induced symptoms 53–55 Foundation Trust & Secretary of State for anaphylaxis 57, 66 Health [2013] 304, 311 anxiolytic effect 53–55 anaphylaxis 57, 66, 189, 190, 202, 203 assessment and management 59–66, 233 anorexia nervosa 113, 116, 185, 240, 309 attitudes 67 anticholinergic side-effects 100–101 behavioural disturbance in general hospital anticonvulsants 102 266, 273–275 antidepressants breathalysers 62 ECT 168, 176 delirium tremens (DTs) 55, 58, 73–74, 233 elderly 229 depressed mood 53–54 self-poisoning 313, 316, 317, 324–326 detoxiication 65–66 side-effects 89, 92, 95, 97, 100, 103 elderly 232–233 tricyclics 316, 317, 324–325 ethanol 55, 60 see also individual drugs itness for assessment 62–63 antipsychotics 86, 87 gamma-glutamyl transferase 62 acute dystonic reactions 92, 94–95, 235 glucose administration 74 akathisia 95–96 hepatitis C 62 alcohol misuse 64, 66, 74 history-taking 59–62 anticholinergic side-effects 100 Korsakoff syndrome 56–57, 74 child and adolescent psychiatry 27, 121, 125 management of non-dependent drinking 65 dementia 232, 272 and other substances 58–59 elderly 232, 235, 272 pathoplastic effects and relapse of mental hyperglycaemia 101–102 illness 57–58 intellectual disability 222–223 physical disorder due to severe misuse neuroleptic malignant syndrome 97, 235 56–57 pregnancy 243 post-traumatic stress disorder 256 pseudo-Parkinsonism 96

333

INDEX

QTc interval prolongation 326 CAGE questionnaire 233 self-poisoning 326–327 cannabinoids 32, 34, 35, 42–43, 52 substance misuse 45, 75, 273–274 capacity see Mental Capacity Act 2005 suicide 7 cardiac arrest 186, 192–199, 315, 316 upper airway obstruction 199, 200 cardiopulmonary resuscitation (CPR) 186, violence and aggression 23, 26, 27, 28, 187, 188–190, 192–199, 209 82–83, 222–223 advance decision 198 weight gain 101–102 automated external deibrillation (AED) see also individual drugs devices 195–197, 199 Asperger syndrome 18 chest compressions 195 asphyxiation 209–210 drugs for 197 aspirin 202 equipment 193 self-poisoning 314, 317, 322 nasopharyngeal airway 193–194 asthma attack, life-threatening 203–205 oropharyngeal airway 193 AVPU scale 190 paediatric life support 193, 194 resuscitation team 192–193 self-poisoning 315 termination or non-commencement 197–198 ‘Baby P’ 156 tracheal intubation 194 behavioural disturbance in general hospital training 193, 199 265–275 cardiovascular shock 190, 202–203 aetiology 266 Care Quality Commission 162–163 assessment and management 266–275 catatonia 116, 170, 171 delirium 266, 267–270, 272–273 chemical burns 211 dementia 266, 270–272 child and adolescent psychiatry 110–126 not result of mental disorder 266, 274–275 aggression 27, 111, 113, 115–116, 121, 124 presentation 266 assessment process 116–118 psychotic patient 272–273 biological domain 120–121 security staff 266, 267, 273 CAMHS emergency 111–114 staff 270, 275 CAMHS in-patient units 116 substance intoxication 266, 273–274 case studies 122–125 violence or aggression 267, 268–270 classiication of emergencies 112–113, 124 Behavioural Pathology in Alzheimer’s Disease clinical symptoms 113 rating scale 231 Common Assessment Framework (CAF) benzodiazepines 98, 100, 315 123–124 alcohol misuse 64, 66, 74 emergency department referrals 115–116 delirium 207 factors extraneous to CYP 113–114 dementia 272 four-by-three psychiatric formulation grid 118 discontinuation symptoms 92 management 119–122 elderly 236 medication 121 itting patient 208–209, 315 out-patient department 114–115 misuse of 43–44, 48 police station assessments 116 pregnancy 243 ‘pseudo-emergencies’ 112 psychological trauma 261 psychological domain 121–122 self-poisoning 316, 322–324 risks 113 side-effects 107, 236 role to contain anxiety of others 118 for substance misuse 45, 46, 75, 273 social domain 122 violence 23, 27, 28, 121 see also safeguarding see also individual drugs Children Act 1989: 152–153, 155–156, 306–307 beta-blockers 96 chlordiazepoxide 65–66, 74, 274 β2 agonist bronchodilator 205 choking 186–187, 199–200 bipolar disorder 52, 75, 103, 171, 240, 244 Chronological Assessment of Suicide Events see also mania 229 Bournewood case 298 Climbié, Victoria 155–156 Bröset Violence Checklist 135 clozapine 8, 23, 89, 309 buprenorphine 40, 47–48 breast feeding 246 burns 211–213 ECT 170, 171, 174 B v Croydon Health Authority [1995] 309, 311 side-effects 101–102, 105–106

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cocaine 32, 34, 35, 44–45, 92, 94, 200, 273, nihilistic 87 316, 317 paranoid 74, 77, 171 Cohen–Mansield Agitation Inventory 231 perinatal psychiatry 245 Commissioner of the Police for the Metropolis schizophrenia 75 v ZH [2013] 303, 311 dementia 185, 199, 231–232 Confusion Assessment Method 231 ABC assessment framework 271 consciousness 71, 190, 317–318 aggression 19, 22, 27, 28, 232 contraception, emergency 241 assessment and diagnosis 231 conversion disorders, acute 283 behavioural disturbance in general hospital coronary syndrome, acute 201–202 266, 268, 270–273 cyber abuse 160–161 behavioural or psychological symptom of cytochrome P450 enzymes 89, 90–91, 320, dementia (BPSD) 231 321, 327 delirium 71, 206, 268 Lewy body 272 medication 232, 272 deaf people 286–296 ‘three Ts’ approach 272 British Sign Language (BSL) 287, 288, treatment 232 292–293, 294 unmet needs model for agitation 271–272 communication preferences 287–289 depression congenital deafness 286 child and adolescent psychiatry 112, 113, deaf advocates 293 115, 122–123 deaf children born to deaf parents 287 deaf people 291 differences between sign languages 288 ECT 166, 167–168, 169, 171, 179 disability 289 intellectual disability 219 hard of hearing 286–287 late-onset 228–229 homicides 292–293 postpartum 244, 245 lip-reading 288 psychological trauma 254, 255, 256, 258, 261 mental health 289–292 with psychotic symptoms 77, 80–81, 87–88 partial deafness 286 suicide 6–7, 158, 228–229 pre-lingually deaf 286, 287–288 Wilson’s disease 75 prisoners 294 Deprivation of Liberty Safeguards (DoLS) profound deafness 286 224–225, 302–304 psychiatric emergencies 292–294 diabetes 77–78, 101–102 specialist education 288 diazepam 44, 74, 92, 208, 220 Usher syndrome 289 dissociative disorders, acute 283 work with interpreters 293 Domestic Crime and Violence Act 2003: 161 de-escalation techniques 23, 28, 83, 107, 136, domestic violence 151, 161–162, 242 268, 274 dopamine blockade 97 delirium (acute confusional state) 206–207 DRESS (drug reaction with eosinophilia and assessment and diagnosis 230–231 systemic symptoms) acronym 102 behavioural disturbance in general hospital drug hypersensitivity syndrome 102 266, 267–270, 272–273 dystonic reactions, acute 92–95, 96, 235 elderly 230–231 hyperactive 206, 230 hypoactive 206, 230 ecstasy (MDMA) 44, 45–46, 261 intellectual disability 221–222 elderly see older persons’ psychiatry investigations 268 electrical burns 211 management 206–207 electroconvulsive therapy (ECT) 166–184, 186 mixed 206, 230 advance directive or decision 172, 309 psychosis 70–74 amnesia 167, 168, 177, 178, 179 treatment 231 bilateral 174, 178 violence 19, 28 brain damage 177 delirium tremens (DTs) 55, 58, 73–74, 233 changes in brain structure 169 delusions 70, 71 contemporary practice 169–172 delusional disorder 76, 85, 158–159 counter-kindling effect 168 grandiose 70, 76–77 ECT Accreditation Service 180 of inidelity 85 The ECT Handbook (3rd edn) 170, 172, 174 mood-congruent 77, 87 effects on neurotransmitters 169

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elderly 176, 229 intellectual disability 217–227 endocrine effects 169 acute dystonic reactions 94 enhanced dendritic function 167 aggressive behaviour 220, 222, 223, 225 hippocampus 169, 177 arrange follow-up 223–224 history 166–167 assessment 221–224 laryngospasm 200 autistic disorders 219, 221, 222, 224, 225, mechanism of action 167–169 289 Mental Health Act 1983: 309 capacity to consent to treatment 218–219 NICE guidelines 170–171, 172, 179 communication dificulties 218 procedure 172–173 co-morbid conditions 219 safety 175–177 conception rate 240 Scottish ECT Accreditation Network deaf people 289 (SEAN) 180 ‘four Cs’ 217 seizure duration 167–168, 174 in general hospital 275 seizure threshold 168, 173–174 medical emergencies 185, 186, 199, 203 side-effects 178–179 Mental Health Act 2007: 224–226 standards of practice in UK 179–180 non-verbal communication 218, 221 stimulus 173–174 off-label prescribing 222–223 Emson, Daksha 158 optimise clinical encounter 221 epilepsy 19, 185, 208–209, 220 pathoplastic effects 219 ethnicity 91, 129–130 prolonged tonic–clonic seizure 220 European Convention on Human Rights 298, provisional diagnosis 222 302–303 safeguarding 151, 153–154, 157–158, 163 triage 224–225 types of emergency 219–220 factitious disorder 283–284 Ishaq, Kyra 156–157 falls 185, 236 itting patient 208–209, 316–317 see also epilepsy Kayser–Flesicher ring 75 lumazenil 43–44, 107, 324 Korsakoff syndrome 56–57, 74, 85 fugue states 283

laryngospasm 200–201 Geriatric Depression Scale 229 lasting power of attorney (LPA) 300–301 learning disability see intellectual disability haemorrhage 202–203 liaison psychiatry 265–285 hallucinations 70, 75, 77 behavioural disturbance in general hospital alcoholic hallucinosis 58 265–275 deaf people 291 case studies 265, 267–268, 270, 274, 276 intellectual disability 219 medically unexplained symptoms 279–284 organic causes 71, 73, 74, 120 refusal of treatment 275–279 hallucinogens 35, 46, 274 ligatures 5, 9, 188 haloperidol lithium 89, 90, 97–98 acute psychosis 82, 83 breast feeding 246 delirium 207, 231, 268–270 delirium 206 side-effects 96, 200, 235 ECT 171, 172 violence 22, 28 self-poisoning 317, 319, 327–328 hanging 209–210 side-effects 103–105 heroin 34, 40, 42, 328 suicide risk 8 Hoskin, Steven 157–158 withdrawal 92 Hunter’s criteria 99 lorazepam 73, 74 hyperglycaemia 101–102 dementia 272 hyponatraemia 103 itting patient 209, 315 intellectual disability 220, 221, 222 violence 22, 23, 28 Idiots Act 1886: 297 Lunatics Asylums Act 1845: 297 independent mental capacity advocate (IMCA) Lunatics (Consolidation) Act 1890: 297 301–302 lysergic acid diethylamide (LSD) 274

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Madhouses Act 1774: 297 best interests 219, 226, 241, 278, 301, 318 mania 103, 244 court-appointed deputy 300–301 ECT 170, 171, 175 Court of Protection 301, 303 with psychotic symptoms 70, 76–77 decision-makers 299, 303 medical emergencies in mental health units Deprivation of Liberty Safeguards (DoLS) 185–216 224–225, 302–304 ABCDE model 188–190, 203 independent mental capacity advocate acute coronary syndrome 201–202 (IMCA) 301–302 acute upper airway obstruction 199–201 intellectual disability 218–219, 222, anaphylaxis 189, 190, 202, 203 224–225, 226 assessment and management 187–188 lasting power of attorney (LPA) 300–301 asthma attack 203–205 least restrictive alternative 218, 303 AVPU scale 190 life-sustaining treatment 300, 301, 318 burns 211–213 maximise potential for decision making 219 cardiac arrest 186, 192–199 PLUMB acronym 218 cardiovascular shock 202–203 presumption of capacity 218 cervical spine immobilisation 188, 210 refusal of treatment in general hospital children 189, 193, 194, 205, 208 276–279 communication and handover 191 restraint and deprivation of liberty 302– Competencies for Recognising and Responding 304 to Acutely Ill Patients in Hospital 186 safeguarding 155 itting patient 208–209 self-poisoning 318–319 major trauma 209–210 serious medical treatment 301, 302 National Early Warning Score (NEWS) 189 unwise decisions 218 paediatric early warning score (PEWS) 189 Mental Deiciency Act 1913: 297 poisoning 210–211 Mental Health Act 1959: 297–298 primary medical assessment (primary Mental Health Act 1983: 298–300 survey) 188–190 applications for detention under 304–307 pulse oximeter 189, 202 approved mental health professional rapid history and secondary survey 190–191 (AMHP) 304–306, 308 respiratory arrest 186, 192–199 assessment 304 SAFE response 187–188 medical treatment deined 309 SBAR tool 191 Part IV 308–309 self-inlicted injuries 209–213 PICU 137, 139, 140 training 193 registered medical practitioner 306, see also cardiopulmonary resuscitation 309–310 (CPR); delirium responsible clinician 308 medically unexplained symptoms second-opinion appointed doctor (SOAD) abreaction 283 309 ambulance crews 281–282 Section 2: 225, 303, 306, 307, 308, 309–310 assessment and management 281–282 Section 3: 225, 306, 307–308, 309–310 classiication and terminology 279 Section 4: 308 collaborative approach 282 Section 5(2): 225–226, 309–310 fugue states 283 Section 5(4): 310 illness representation 281 Section 136: 310 liaison psychiatry 279–284 self-harm 279, 309 management of somatoform and which Section to use 307–311 dissociative disorders 282–284 Mental Health Act 2007: 293, 298, 299 psychological trauma 262 elderly 234, 236 role of general hospital staff 281–282 intellectual disability 224–226 role of mental health specialist 282 self-poisoning 319 secondary complications 283 mental health law 297–311 melatonin 121 Mental Health Review Tribunals 298 Memorial Delirium Assessment Scale 231 mental health units, medical emergencies in Mental Capacity Act 2005: 234, 293, see medical emergencies in mental health 298–304, 309, 310 units advance decision or statement 278, 300 Mental Treatment Act 1930: 297 assessing capacity 277–278, 299–300, 318 methadone 40, 42, 328

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Michigan Alcoholism Screening Test – P (by his litigation friend the Oficial Solicitor) Geriatric Version 233 (Appellant) v Cheshire West & Chester midazolam 208, 220 Council and another (Respondents) 303, 311 military trauma 262–263 PC v City of York Council [2013] 299, 311 monoamine oxidase inhibitors (MAOIs) peak expiratory low rate 205 106–107, 235–236, 319, 326 perinatal psychiatry 240–248 morphine 40, 201, 328 admission of pregnant woman 242 breast feeding and medication 246 care plan 241 naloxone 42, 328–329 domestic abuse in pregnancy 242–243 National Assistance Act 1948: 234 perinatal psychiatry service 241, 246 neuroleptic malignant syndrome (NMS) physical illness misattributed to mental 97–98, 116, 142–143, 191, 235, 316 disorder 245 neuroleptics see antipsychotics postpartum 244–246 Neuropsychiatric Inventory 231 pregnancy 190, 203, 240–243 non-steroidal anti-inlammatory drugs, self- rapid tranquillisation during pregnancy 243 poisoning with 322 risk of complications 243 Nursing Observed Illness Intensity Scale 135 safeguarding 158, 159, 242, 245–246 self-harm during pregnancy 241–242 personality disorder 18, 156, 256–257 olanzapine pesticides, self-poisoning with 329 delirium 207, 268–270 PICU see psychiatric intensive care unit self-poisoning 327 polypharmacy 89–90 side-effects 101–102, 235 porphyrias, acute 75, 81 violence and aggression 22, 23, 27, 83 post-traumatic stress disorder (PTSD) 249, older persons’ psychiatry 228–239 251, 253–257 comorbid medical conditions 237 audiotape desensitisation 261 delirium 71–73, 206, 230–231 biology 255 depression and suicide 228–229 borderline personality disorder (BPD) ECT 176, 229 256–257 elder abuse and neglect 162–163, 233–234 deaf people 291 falls 185, 236 DSM-III 253–254 iatrogenically induced conditions 235–236 DSM-IV 256, 257 stupor 236 enduring personality change after substance abuse 232–233 catastrophic experience 256–257 violence 27 epidemiology of comorbid disorders 256 see also dementia eye movement desensitisation 261 opiates 32, 35, 40–42, 47–48, 58–59 gender differences 254 self-poisoning 316, 317, 328–329 mechanisms of comorbidity 258–259 organophosphates, self-poisoning with 316, military service 262–263 317, 319, 329 over-diagnosis 262 overdose see self-poisoning pharmacological treatment 261 Overt Aggression Scale 135 post-traumatic disorders 258 oxygen 189, 202, 205, 208 psychological therapies 261 substance misuse 254, 256 treatment of established 260–261 P & Q (by their litigation friend: the Oficial pregnancy see perinatal psychiatry Solicitor (Appellants) v Surrey County pregnancy test 241 Council (Respondent) [2014] 303, 311 procyclidine 95, 96 paracetamol, self-poisoning with 312, 314, pseudo-Parkinsonism 96 316, 318, 319, 320–322, 328 psychiatric intensive care unit (PICU) acetylcysteine 320, 321–322 127–150 glutathione 320, 321 ACT model 136 N-acetyl-p-benzoquinone imine (NAPQI) acute psychological interventions 144–145 320 admission criteria 129–132 paraquat, self-poisoning with 329 comfort rooms 141 Parkinson’s disease, idiopathic 96 de-escalation 136 paroxetine 92 engagement 135–136

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extra care area 139–140 violence 13, 17, 18, 23, 28 interventions 135–147 see also psychotic disorders, acute length of stay 130–131 psychotic disorders, acute 69–88 management of acute medications 143–144 assertive-outreach teams 81 National Association of Psychiatric assessment 77–81, 84–88 Intensive Care Units (NAPICU) 127 biological component of management 82–83 observation 135–136 carers 81 occupational therapy interventions 145–147 case studies 73, 76, 77 patient typing 129–132 cerebral causation 70, 71, 82, 87 physical restraint 137 early-intervention teams 81 physical security 132–133 functional 71, 75–77, 82 procedural security 133 guarded patients 84 prone position 137 home assessments 78 rapid tranquillisation 141–143 hyponatraemia 103 relational security 133 information gathering 78–80 remotivation 146–147 interview 80–81 risk assessment and management 134–135 level of consciousness 71 seclusion 140–141 management 81–88 staff 128–129, 145 medication 82–83 time-out 138–139 neuroimaging 82 treatment model security 133 non-cerebral causation 70–71 zoning 138–139 organic 70, 71–74 psychological trauma 249–264 presentation 69–70 acute stress disorder 252–253, 254 psychological component of management 83 adjustment disorders 253 relationship between symptoms and anxiety disorders 257 behaviour 70 ‘battle shock’ 252 risk assessment 78, 80, 84, 85 emergency departments 259–260 safety 78 emergency service workers 249, 263 self tests 85–88 emotional reactions 250–251 social component of management 83–84 general practitioner 260 types 70–77 medicalisation 250, 251, 253 see also bipolar disorder; delusions; medically unexplained symptoms 262 hallucinations; schizophrenia military service 262–263 psychotropic medication NHS staff 252, 263 acute dystonic reactions 92–95 PIES 253 acute side-effects 89–109, 186–187 primary prevention 259 akathisia 95–96 psychotic disorders 257–258 anticholinergic side-effects 100–101 road trafic accidents 249 chemical restraint 20, 22–23 secondary prevention 259–260 cytochrome P450 enzymes 89, 90–91 sexual abuse 249, 254, 257, 263 discontinuation symptoms 92 somatoform disorders 257 drug hypersensitivity 102 stress-inoculation programmes 259 drug interactions 90–91 Trauma Risk Management (TRiM) 251 and ECT 174 traumatic events 249–250 good-practice guidelines 89–90 see also post-traumatic stress disorder (PTSD) hyperglycaemia 101–102 psychotic disorders 129 hyponatraemia 103 alcohol misuse 56, 57–58, 66 intellectual disability 222–223 behavioural disturbance in general hospital neuroleptic malignant syndrome 97–98, 116 266, 272–273 off-label prescribing 90, 222–223 child and adolescent psychiatry 113, 114, perinatal psychiatry 243, 244, 246 116, 118, 121 PICU 143–144 dementia 231 polypharmacy 89–90, 206 intellectual disability 219–220, 221–222 psychological trauma 253, 261 perinatal psychiatry 240, 244–245 receptor types 92 psychological trauma 257–258 schedules for side-effects 90 stimulant psychosis 45, 273–274 self-poisoning with 322–328 suicide 2, 3, 7 speciic drug issues 103–107

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treatment-resistant illness 90 salicylates (aspirin), self-poisoning with 314, weight gain 101–102 317, 322 see also individual drugs and drug types SBAR tool (Situation Background Assessment Recommendation) 191 schizophrenia 75–76 QTc interval prolongation 316, 326, 327 alcohol misuse 52, 57 catatonic symptoms 75–76 deaf people 291 rapid tranquillisation 22, 82–83, 141–142, developing countries 76 186, 243, 273 ECT 170, 171 respiratory arrest 186, 192–199 intellectual disability 219 restraint 12, 15, 28, 186 metabolic syndrome 101 chemical 20, 22–23 negative symptoms 75, 84–85 deprivation of liberty 302–304 perinatal psychiatry 244 environmental 20–21 physical illness 77–78, 82, 101–102 intellectual disability 222 positive symptoms 75 international differences 21–27 psychological therapy 83 mechanical 20, 22, 26–27 psychological trauma 257–258 net beds 22 substance misuse 74 physical 20, 21–22, 137 suicide 7, 8 pregnancy 243 violence 13, 17–18, 23 resuscitation see cardiopulmonary seclusion 12, 14–15, 26–27 resuscitation (CPR) environmental restraint 20–21 risperidone 222–223, 232, 327 PICU 133, 137, 140–141 R (Sessay) v South London and Maudsley NHS sedative hypnotics 35, 43–44, 232 Foundation Trust and another [2011] 303, 311 seizures see itting patient; epilepsy ‘rule of nines’ for burns 211 selective serotonin reuptake inhibitors (SSRIs) 103, 229, 235–236, 253, 261, 324, 325 self-harm safeguarding 118, 151–165 child and adolescent psychiatry 113, abuse of vulnerable adult deined 153–154 114–115, 116, 118, 122 child abuse deined 152 deaf people 291–292 child protection 86, 118, 153, 159 intellectual disability 219, 220 Children Act 1989: 152–153, 155–156 Mental Health Act 1983: 279, 309 consent 154–155 in mental health units 202, 209–213 cyber abuse 160–161 perinatal psychiatry 241 domestic abuse and violence 161–162 refusal of treatment 275–276, 277, 279 elder abuse 162–163 suicide 5 emotional neglect 162 see also self-poisoning Human Rights Act 1998: 153 self-poisoning 312–331 information sharing 154 activated charcoal 315, 319, 322, 324, 325 institutional neglect and abuse 163–164 appearance 315 intellectual disability services 163 breathing pattern 317 key cases of national inluence 155–159 breath odours 316 legal framework and deinitions 152–154 capacity 318–319 Local Safeguarding Children Boards cardiovascular system 315, 316, 324–325, 155–156 326 long-term impact of abuse 155 central nervous system 316–317 neglect 151, 154, 162, 163–164 clinical consequences 313–314 No Secrets guidance 152, 153 coma management 317–318 sexual abuse 159–160, 164 deined 312 signiicant harm 153 epidemiology 312–313 substance misuse 151, 159 gastrointestinal tract 317 taking action 164–165 history-taking 314 ‘toxic triad’ of parental problems 151 immediate management 314–317 Working Together to Safeguard Children 164 in mental health units 210–211 SAFE response 187–188 National Poisons Information Service 211 St John’s Wort 91 observations 315–316

340

INDEX

ocular indings 317 section 136 suites 34 physical examination 315–317 settings for emergency presentations 33–34 poly-drug ingestion 314 social factors 39 respiratory system 315, 317 suicide 3, 8, 32 role of psychiatrist 312 types of emergencies 35–48 speciic drugs used for 320–329 violence 18, 19 status epilepticus 315 see also alcohol misuse sweating 316 suicide temperature 315–316 child and adolescent psychiatry 113, 114, TOXBASE 211 115–116, 118, 122–123 treatment principles 319 deaf people 291–292 serotonin syndrome 91, 97–98, 99–100, 191, ECT 170 235–236, 316, 325, 326 elderly 228–229 sexual abuse intellectual disability 219 safeguarding 159–160, 164 in mental health unit 209 self-harm in pregnancy 242 perinatal psychiatry 241, 245, 246 trauma 249, 254, 257, 263 safeguarding 158 solvent abuse 35, 46 self-poisoning 312, 313, 323 somatoform disorders 282–283 see also suicide, assessment of risk Staff Observation Aggression Scale – Revised suicide, assessment of risk 1–11, 87–88 (SOAS-R) 14, 135 after hospital discharge 3 Stafford Hospital 163–164 alcohol and drug use 6–7, 8, 52–53, 63, 64 status epilepticus 208, 209, 220, 315 assessment 4–6 Sternbach criteria 99 background information 5 Stevens–Johnson syndrome 102 current presentation 5 stimulants 35, 44–46, 273–274 dynamic risk factors 2 Storck v Germany [2005] 302–303 intent 5 stupor 236 key features 1–4 substance misuse 32–50, 185, 203 ligature points 5, 9 assessment of motivation to change 39 mental illness 3, 4, 6–7 behavioural disturbance in general hospital mental state examination 6 266, 273–275 need for repeated/frequent risk assessments by injection 46–47 5 dependence syndrome 38 physical illness 3, 7 diversity of 34–35 prevention 8–9 drug-induced psychotic disorder 45, 71, previous contact with mental health 74–75 services 1 ‘drug mules’ 47 protective factors 5–6 drug-related deaths 32, 45 protocols 1 elderly 232–233 risk factors 2–4 harmful use 38 risk minimisation 8–9 intoxication and withdrawal 40–46, 274 self-harm 5 lack of engagement with services 47–48 static risk factors 2 mental health 38 sulpiride 273 model of change 36 needle and syringe programmes (NSPs) 46–47 toxic epidermal necrolysis 102 pain management 47 trauma, major 202, 209–210 perinatal psychiatry 243, 246 see also psychological trauma physical health 38 tricyclic antidepressants, self-poisoning with police custody 34 316, 317, 324–325 post-traumatic stress disorder 254, 256 tyramine 107 prescriptions 48 presentations in A&E 33 principles of assessment and treatment upper airway obstruction, acute 199–201 35–39 risk assessment 39 safeguarding 151, 156, 159 venlafaxine 324, 325–326

341

INDEX

violence and aggression 12–31 rapid tranquillisation 22, 82–83, 141–142, alcohol misuse 54–55, 58, 63 186, 243, 273 child and adolescent psychiatry 27, 111, risk factors in patients 17–19 113, 115–116, 121, 124 Staff Observation Aggression Scale – de-escalation 23, 28, 83, 107, 136, 268, 274 Revised (SOAS-R) 14, 135 dementia 19, 22, 27, 28, 232 zero tolerance 12–13, 274 domestic 151, 161–162 see also behavioural disturbance in general illness-related factors 28 hospital; restraint; safeguarding; seclusion; intellectual disability 220, 222, 223, 225 volatile solvents 35, 46 international comparisons and guidelines 19–27, 28 National Audit of Violence 15, 16, 19 Wernicke–Korsakoff syndrome 56–57, 74 NICE guidelines 19–20, 22–26, 82, 137, Wilson’s disease 75, 95 140, 142, 267, 268–270 PICU 130, 134, 136, 137, 139 prevalence 13–17 zuclopenthixol 22, 23

342