Psychiatry Breaking the ICE Introductions, Common Tasks, Emergencies for Trainees

Psychiatry: Breaking the ICE contains everything psychiatry trainees need in order feel confident and competent in general adult inpatient and community placements.

• A practical and reassuring guide to life as a psychiatrist, structured around the tasks expected both in day-to-day practice and in out-of-hours work
• Key themes running throughout the book include ethical and legal issues, risk assessment and management, patient experience and safe prescribing
• The authors are closely involved in the training, mentoring and supervision of core trainees, and know the real-world challenges faced by junior psychiatrists

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

Foreword, xv

Acknowledgements, xvii

Abbreviations, xix

About the companion website, xxi

Part I: Introduction

1 Welcome, 3
Sarah Stringer

2 Mental health services overview, 5
Christina Barras, Rory Conn, Laurine Hanna, Abigail G Crutchlow, and Juliet Hurn

3 Your team, 9
Christina Barras, Rory Conn, Laurine Hanna, and Abigail G Crutchlow

4 Your role, 13
Christina Barras, Rory Conn, Laurine Hanna, and Abigail G Crutchlow

5 Getting started, 16
Mujtaba Husain, Christina Barras, Rory Conn, and Laurine Hanna

6 Safety and verbal de-escalation, 19
Sarah Stringer

7 Boundaries, time management and burnout, 25
Sarah Stringer, Christina Barras, Rory Conn, and Laurine Hanna

8 Psychiatric assessment, 31
Sarah Stringer, Mujtaba Husain, Penelope Brown, and Sean Cross

9 Management: General principles, 45
Sarah Stringer

10 Physical healthcare, 48
Katherine Beck, Stephanie Young, and Juliet Hurn

11 Medications, 53
Noreen Jakeman and Sarah Stringer

12 Psychological interventions, 65
Jane Bunclark, Natasha Liu-Thwaites, Cheryl Kipping, Juliet Hurn, and Sarah Stringer

13 Social interventions, 83
Christina Barras, Rory Conn, Laurine Hanna, Abigail G Crutchlow, Juliet Hurn, Rachel Thomasson, and Anna M Burnside

14 Handovers, 96
Rachel Thomasson

15 Mental health legislation, 97
Penelope Brown, Peter Hindley, and Anna M Burnside

16 Compliments, complaints and serious incidents, 107
Anna M Burnside and Sarah Stringer

17 Training in psychiatry, 110
Mujtaba Husain, Juliet Hurn, Rachel Thomasson, Christina Barras, Rory Conn, Laurine Hanna, and Sarah Stringer

Part II: Common tasks COMMUNITY MENTAL HEALTH TEAM (CMHT)

18 Outpatient clinics, 123
Christina Barras, Rory Conn, and Laurine Hanna

19 Care programme approach (CPA) meetings, 127
Abigail G Crutchlow, Christina Barras, Rory Conn, and Laurine Hanna

20 Home visits, 130
Laurine Hanna

21 Depression, 133
Rory Conn and Rachel Thomasson

22 Generalised anxiety disorder (GAD), 141
Laurine Hanna

23 First episode psychosis (FEP), 147
Christina Barras and Juliet Hurn

24 Psychosis – longer term, 154
Stephanie Young

25 Bipolar affective disorder (BPAD), 159
Rory Conn and Juliet Hurn

26 Emotionally unstable personality disorder (EUPD), 165
Jane Bunclark and Juliet Hurn

27 Non-engagement or disengagement, 174
Rory Conn

28 Patients with forensic histories, 179
Penelope Brown

29 Pregnancy, 183
Anna M Burnside and Noreen Jakeman

30 Older adults, 189
Vivienne Mak and Sean Lubbe

31 Trauma and asylum, 196
Laurine Hanna and Juliet Hurn

32 Driving, 203
Christina Barras

33 Discharge, 208
Laurine Hanna

WARD

34 From admission to discharge, 212
Katherine Beck and Abigail G Crutchlow

35 Ward rounds, 221
Katherine Beck

36 Common side effect management, 225
Katherine Beck, Noreen Jakeman, and Sarah Stringer

37 Clozapine, 235
Stephanie Young and Noreen Jakeman

38 Self-discharge and section 5(2), 242
Abigail G Crutchlow

39 Seclusion reviews, 246
Katherine Beck

40 Alcohol misuse, 251
Lisa Conlan, Isabel McMullen, and Cheryl Kipping

41 Illicit drugs, 259
Isabel McMullen, Lisa Conlan, and Cheryl Kipping

42 Pregnant patients, 265
Anna M Burnside

43 Inpatients with forensic histories, 269
Penelope Brown

44 People with learning disabilities (LD), 274
Rory Sheehan

45 Emotionally unstable personality disorder (EUPD), 281
Jane Bunclark and Juliet Hurn

46 Older adults, 287
Vivienne Mak and Sean Lubbe

47 Electroconvulsive therapy (ECT), 293
Sean Lubbe and Vivienne Mak

48 Section 136 assessments, 298
Anna M Burnside

49 Tribunals, 303
Sarah Stringer

ON-CALL

50 Your first on-call shift, 307
Rachel Thomasson, Sean Cross, and Anna M Burnside

51 Self-harm, 318
Rachel Thomasson, Jane Bunclark, Sean Cross, Rory Conn, and Christina Barras

52 Self-harm in young people, 330
Peter Hindley and Matthew Fernando

53 First episode psychosis (FEP), 336
Rachel Thomasson

54 Mania, 341
Rachel Thomasson

55 Delirium, 345
Vivienne Mak, Sean Lubbe, and Sean Cross

56 Obsessive compulsive disorder (OCD), 353
Natasha Liu-Thwaites and Rachel Thomasson

57 Panic attacks, 357
Natasha Liu-Thwaites

58 Drug-seeking, 361
Isabel McMullen and Lisa Conlan

59 Learning disability (LD) and behavioural change, 365
Rory Sheehan

60 ‘Social’ presentations, 369
Sean Cross and Rachel Thomasson

61 Medically unexplained symptoms, 374
John Moriarty

Part III: Emergencies

COMMUNITY MENTAL HEALTH TEAM (CMHT)

62 Acute relapse, 383
Laurine Hanna

63 Adult safeguarding, 388
Rory Conn, Vivienne Mak, and Sean Lubbe

WARD

64 Child protection concerns, 394
Peter Hindley, Juliet Hurn, and Sarah Stringer

65 Medical emergencies, 401
Katherine Beck and Abigail Steenstra

66 Opiate overdose, 405
Isabel McMullen and Lisa Conlan

67 Stiff, feverish patients, 408
Anna M Burnside

68 Catatonia, 414
Anna M Burnside

69 Lithium toxicity, 418
Noreen Jakeman and Katherine Beck

70 Alleged sexual assault, 422
Anna M Burnside, Sarah Stringer, and Penelope Brown

71 Self-harm on the ward, 428
Jane Bunclark and Abigail Steenstra

72 Hanging, 433
Anna M Burnside

73 Death, 436
Katherine Beck

ON-CALL

74 Aggression, 440
Abigail G Crutchlow, Christina Barras, Noreen Jakeman, Sean Lubbe, Vivienne Mak, Rachel Thomasson, and Abigail Steenstra

75 Challenging behaviour in children, 451
Peter Hindley and Matthew Fernando

76 Refusal of urgent treatment, 455
Vivienne Mak, Sean Cross, Sean Lubbe, and Rachel Thomasson

77 Delirium tremens, 461
Rachel Thomasson, Isabel McMullen, and Lisa Conlan

78 Puerperal psychosis, 466
Anna M Burnside

79 Eating disorders, 470
Christina Barras and Sean Cross

80 Threats of violence, 477
Penelope Brown and Rachel Thomasson

Appendices

Appendix A Investigations/Monitoring, 485

Juliet Hurn, Noreen Jakeman, Anna M Burnside, and Abigail Steenstra

Table A.1 Overview of physical health monitoring in Severe Mental Illness (SMI), 485

Table A.2 Delirium investigations, 486

Table A.3 First episode psychosis investigations, 487

Table A.4 Baseline checks before starting psychotropics, 488

Table A.5 Ongoing monitoring - antipsychotics, 489

Table A.6 Ongoing monitoring - mood stabilisers, 490

Table A.7 Rapid tranquilisation (RT) cautions and contraindications, 490

Table A.8 Monitoring after RT, 491

Appendix B Medications, 492
Noreen Jakeman and Sarah Stringer

Table B.1.1 Oral antipsychotics–approximate relative side effects, 492

Table B.1.2 Depot antipsychotics–approximate relative side effects, 493

Table B.2 Common oral antipsychotics–key information, 494

Table B.3 Common depot antipsychotics–key information, 496

Table B.4 Selective Serotonin Reuptake Inhibitors (SSRIs)–key information, 498

Table B.5 Non-SSRI antidepressants–key information, 499

Table B.6 Mood Stabilisers–key information, 502

Table B.7 Sedatives–key information, 504

Appendix C Alcohol and drugs, 505

Table C.1 Quick guide to alcohol units (Cheryl Kipping), 505

Table C.2 Alcohol Use Disorders Identification Test (AUDIT) questionnaire, 506

Table C.3 Severity of Alcohol Dependence Questionnaire (SADQ), 508

Table C.4 Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar), 509

Table C.5 Clinical Opiate Withdrawal Scale (COWS), 511

Table C.6 Common illicit drugs summary, 513

Appendix D Cognitive testing, 515

Appendix D.1 The Montreal Cognitive Assessment (MOCA), 515

Appendix D.2 The Addenbrooke’s Cognitive Examination-III (ACE-III), 516

Appendix D.3 The Mini-Addenbrooke’s Cognitive Examination (M-ACE), 530

Appendix E Mental health legislation, 532
Anna M Burnside & Penelope Brown, with thanks to Daniel M Bennett and Edward Noble

Table E.1 The Mental Health (Care and Treatment) (Scotland) Act 2003: common civil sections, 532

Table E.2 The Mental Health (Northern Ireland) Order 1986: common sections (Part II), 534

Table E.3 The Mental Health Act 1983, amended 2007 (England & Wales): forensic sections, 537

Appendix F Useful contacts, 539

Index, 541

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