Chapter 2: Management of acutely disturbed behaviour What intramuscular treatment can be given as an alternative to lorazepam for benzodiazepine tolerant patients? Chlorpromazine Promethazine Zuclopenthixol acetate (Acuphase) Trifluoperazine Clozapine Which of the following are environmental factors that have been associated with an increased risk of inpatient violence? Overcrowding High staff morale Low stimulation Lack of privacy Authoritarian conditions Intramuscular lorazepam is associated with which of the following side effects? Respiratory depression Acute dystonic reaction Paresthesia Cardiac arrhythmia Neuroleptic malignant syndrome Following intramuscular rapid tranquillisation how often should a patient’s physical observations be monitored? 5-10 minutes for 1 hour, then every 30 minutes 5-10 minutes for 2 hours, then every hour 15-20 minutes for 1 hour, then every 30 minutes 15-20 minutes for 2 hours, then every hour Which of the following is an aim of rapid tranquillisation? To enforce boundaries To help manage low staffing numbers To treat psychosis To induce sleep To reduce suffering for the patient Shugar and Rehaulk (1990) showed that episodes of continuous observation lasting up to how many hours helped 67% of patients? 36 48 60 72 84 Which of the following are predictors of suicide in schizophrenia? Older patient Female patient Severe and relapsing course of illness Lack of insight Social isolation Unemployment How often should the levels of observation be reviewed? Every hour Every shift Once a day Twice a week Once a week Which of the following are primary characteristics identified as predicting the potential for immediate violence or aggression? Suspiciousness or paranoid ideation Anxiety or pain Inability to verbalise feelings Poor impulse control Refusal to communicate Previous substance misuse Zuclopenthixol acetate (Acuphase) may be administered? When oral medication is not strong enough To calm a patient who is physically resisting intramuscular medication As rapid tranquilisation After repeated injections of antipsychotic drugs have been required At the same time as other parenteral antipsychotics Signs of acute organic brain syndrome, also known as delirium, should be suspected if which of the following features are present? Command hallucinations Visual hallucinations Disorientation Social isolation Gradual onset Clouding of consciousness What did Banerjee et al (1995) note after reviewing eight cases of sudden deaths in detained patients? The high risk of physical restraint combined with high levels of physiological arousal Vigorous risk assessments and risk management must be conducted There is a need for newer approaches to safer physical restraint The high risk of antipsychotics used during high periods of physical arousal The risk of seclusion when a patient is heavily sedated After how many hours does the sedative effect of zuclopenthixol acetate (Acuphase) peak? 2 4 8 12 18 24 Which of the following things would you routinely do to reduce the risk when assessing an acutely disturbed patient? Inform colleagues of your location Inform the police Sit close to an exit Be confident and confrontational Wear body armour There is an informal patient who has been threatening violence towards the nursing team and is refusing any medication. Which of the following Sections of the Mental Health Act (1983) might be used in order to enforce intramuscular medication? 2 3 4 5(2) None of the above When using intramuscular haloperidol which of the following are recommended? Use of buccal midazolam Pre-treatment ECG Use of tetrabenazine Avoiding concomitant antipsychotics Ensuring intramuscular procyclidine is available Loading …
