MHA
Antipsychotics
Important to know (medications)
Assessments
100

Your patient has been certified x1 under the mental health act. What forms need to be completed? 

Form 4, 5, 13, 15, 16

100

What is the difference between typical and atypical antipsychotics? 

The main difference between the two types of antipsychotics is that the first generation drugs block dopamine and the second generation drugs block dopamine and also affect serotonin levels.

2nd generation have less side effects (EPS) 

100

Name one medication per class of antidepressants

SSRI: citalopram, escitalopram, fluoxetine, fluvoxmine, paroxetine, sertraline

TCA: amitriptyline, clomipramine, imipramine, nortriptyline

SNRI: duloxetine, venlafaxine

MAOI: phenelzine, tranylcypromine, isocarboxazid

Atypical: wellbutrin

100

Define SBAR

Situation

Background

Assessment 

Recommendation

Used for reports/handover

200

Your patient was admitted under the MHA on April 1/21. It is now April 28/21 and they are being discharged on extended leave. What forms will you send to their mental health outpatient team?

Form 4s, 5, newly done 6, and 20 (13, 15, 16)

You will NOT do a discharge certificate as the client is being discharged from the hospital NOT from extended leave 



200

Name 3 1st generation 

Name 3 2nd generation 

First: Chlorpromazine, Droperidol, Fluphenazine, Haloperidol, Loxapine, Perphenazine, clopixol

Second:Aripiprazole, Asenapine, Clozapine, lurasidone, Olanzapine, Paliperidone, Quetiapine, Ziprasidone, risperidone 

200

Considerations with Lithium

- Do blood work - Lithium toxicity: nausea, vomiting, hand tremors, confusion, vision changes

- Do not just stop taking it abruptly

- Side effects: polyuria, polydipsia, polyphagia, headache, N/V, diarrhea, dizziness, changes in appetite, hand tremors, dry mouth 

200

What is SOAP charting? Provide 3 examples of subjective versus objective data with regards to a respiratory assessment

Subjective - denied difficulty breathing. Denied discomfort with exertion. Denied use of cigarettes, cannabis, or inhalation of illicit substances. Reported having a non-productive cough x2 days. 

Objective - vital signs stable (with vitals here), Good air entry noted to all lung quadrants. Crackles evident to lower left lobe. 

Assessment

Plan

300

Your patient is under 16 and is not suitable for admission. Can they be certified? What is the process? 

Legal decision-making rests with legal guardian (unless “mature minor” under Infants Act). If the guardian wants admission but child DOES NOT, it’s technically “voluntary” (though child is going involuntarily)

- Recommend these admissions are under Mental Health Act to protect patient’s rights (e.g. regular

reviews, access to Review Panel, etc)

- Need:

o Form 1 (Request for Voluntary Admission), filled by guardian

o Form 2 (Consent for Voluntary Treatment), filled by guardian

o Form 3 (Medical Report, Exam for < 16), filled by MD

300

Clozapine: 

- how to start

- side effects

- ongoing tests and how often

Titration: reduce the risks of adverse events such as seizures, hypotension, agranulocytosis, and myocarditis.

side effects: weight gain; dizziness, tremor; fast heart rate; headache, drowsiness; nausea, constipation; dry mouth, or increased salivation; AGRANULOCYTOSIS/NEUTROPENIA; NMS (neuroleptic malignant syndrome); vision problems; fever, increased sweating

- blood work q1 week x26weeks; q2 week x26weeks; q4weeks ongoing 

300
3 "S" side effects associated with antidepressants (SSRIs). What is the one very concerning syndrome associated with antidepressants that also started with S - explain what it is and signs/symptoms

Sexual dysfunction, stomach upset, suicidal ideation

Serotonin Syndrome: Too much serotonin causes signs and symptoms that can range from mild (shivering and diarrhea) to severe (muscle rigidity, fever, and seizures). Severe serotonin syndrome can cause death if not treated.

Signs and symptoms include:

  • Agitation or restlessness
  • Confusion
  • Rapid heart rate and high blood pressure
  • Dilated pupils
  • Loss of muscle coordination or twitching muscles
  • Muscle rigidity
  • Heavy sweating
  • Diarrhea
  • Headache
  • Shivering
  • Goose bumps
  • High fever
  • Seizures
  • Irregular heartbeat
  • Unconsciousness
300

Name all components of MSE

ABC STAMP LICKER
Appearance
Behaviour
Cooperation
Speech
Thought content & form
Affect
Mood
Perceptions
LOC / Orientation
Insight & Judgement
Cognitive function & Sensorium
Knowledge
Ends (suicide/homicide)
Reliability

400

Name the 4 criteria of involuntary admission

Criteria: Information must be based on exam, but can include collateral

1. is suffering from a MENTAL DISORDER that seriously IMPAIRS the person’s ABILITY TO REACT appropriately to his or her environment or to ASSOCIATE with others;

2. requires psychiatric treatment in or through a designated facility;

3. requires care, supervision, and control in or through a designated facility to prevent the person’s substantial mental or physical deterioration or for the person’s own protection or the protection of others

4. is not suitable as a voluntary patient

400

S/S of NMS and nursing considerations if you believe your pt has this condition in the community

HOSPITALIZE. Treat fever and fluids. Antiparkinsonianism drugs and stop the medication  


NMS symptoms usually last for 7 to 10 days. They may include:

  • High fever (102 to 104 F)
  • Muscle stiffness
  • Sweating a lot
  • Anxiety or other changes in mental state
  • Fast or abnormal heartbeat
  • More saliva than usual
400

Nutrition education with MAOIs

NO tyramine - wine, strong cheeses, cured/processed meats, soy, chocolate
400

Main components of a suicide assessment

Ideation

Substance abuse

Purposelessness

Anxiety

Trapped

Hopelessness

Withdrawal

Anger

Recklessness

Mood changes

(Psychosis)

- ideation, plan, means, intent protective factors

500

Your client was discharged from hospital on august 21, 2020 on extended leave. They are recalled from leave due to decompensation on sep 2, 2021. What form was filled out for recall? Who does this form get sent to? Upon admission to hospital what happens to your clients extended leave documentation? 

Form 21, police and pes, resets form 6 with new admission date 

500

What is EPS? What are types of EPS?

Movement disorder caused by dopamine blockade or depletion in the basal ganglia

acute dystonias, akathisia, Parkinsonism, and tardive dyskinesia (TD)

500

Importance of metabolic monitoring...

antipsychotics are associated with weight gain, lipid disturbance, and glucose dysregulation, thereby contributing to the development of metabolic syndrome.

500

COWS assessment (components) and what score is needed for a suboxone start?

Heart Rate

Sweating

Restlessness

Pupil size

Bone/joint aches

Runny nose/tearing

GI upset (over last 30 mins)

Tremor

Yawning

Anxiety/Irritability

Gooseflesh

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