Thursday, 6 September 2012

section 136-part two

Staffing issues
1 The psychiatric Section 136 facility should ideally have dedicated staffing, or at the very least, a supernumerary post attached to the team responsible for the place of safety.
2 Staffing levels should be sufficient 24 hours a day to ensure that the police can leave promptly after a handover period, even when the patient is disturbed. There should be no expectation that the police will remain until the assessment is completed, as currently happens in some places. In many areas this will require additional resources.
3 There should be a clearly identified person in charge of the psychiatric assessment facility at all times. A member of staff should be present to receive the patient on their arrival.
4 The local implementation group must ensure that there are adequate approved mental health professionals and doctors approved under Section 12 of the Mental Health Act to enable joint assessments to begin within 3 hours currently, with an expectation that, in the longer term, the target will become 2 hours.
5 The description of staff roles, from which competences can be derived, as outlined in this report should be available to assist in commissioning services, the development of local policies and procedures and the provision of appropriate training.
6 Consideration should be given to multi-professional training and the involvement of users and carers in this.

source-Royal College of Psychiatrists

section 136-place of safety

Report of the multi-agency group led by the Royal College of Psychiatrists
College Report CR149
September 2008
Royal College

Recommendations have been grouped by theme. The key recommendations relate to staffing of psychiatric places of safety and monitoring of the process, both at the local and the national level.
Place of safety
1 There should be sufficient places of safety in psychiatric facilities to meet foreseeable local need without recourse to police stations as a convenient local option or because the place of safety is regularly full. Further capital funding may be required to achieve this.
2 Police stations should only be used as the place of safety on an exceptional basis. The local monitoring group should check that this is the case and take appropriate action where necessary.
3 Emergency departments should be used as places of safety for those who need urgent physical health assessment and management but they may then be transferred to a psychiatric facility for further mental health assessment, provided that this does not result in undue delay.
4 Local policy should specify the range of places of safety which can be used and offer guidance as to when this would be appropriate. This should allow for example the young, the elderly and the disturbed to be assessed in an environment more appropriate for their needs.
5 When the place of safety is not the preferred psychiatric facility, emergency department or custody suite, the use of such a place must involve the prior agreement of the person in charge of the psychiatric facility before the patient begins their journey. This staff member must assure themselves that the place in question (which may include day hospitals, day centres and the home of a friend or family member) agrees to be used in this way and has sufficient staff or support at that time to be able to safely manage the situation, given the information on the patient’s behaviour received, before agreeing to the patient being assessed there.
8 http://www.rcpsych.ac.uk
College Report CR149
6 Defined standards for the physical environment should be applied to the place of safety in mental health units. They may be used to inform the development of alternative places of safety,

Section 136 of the Mental Health Act -part 1

Section 136 of the Mental Health Act 1983 states that:

1 ‘If a constable finds in a place to which the public have access a person

who appears to him to be suffering from mental disorder and to be in immediate need of care or control, the constable may, if he thinks it necessary to do so in the interests of that person or for the protection of other persons, remove that person to a place of safety within the meaning of Section 135 above.

2 A person removed to a place of safety under this Section may be detained there for a period not exceeding 72 hours to enable him to be examined by a registered medical practitioner and interviewed by an approved mental health professional and of making any necessary arrangements for his treatment or care.’

Friday, 3 August 2012

two for one-fibromyalgia-shellyandm

another one of shelly,s causes and because i consider myself to be reasonably aware of both physical and mental health disorders i was stunned when shelly and i talked about fibromyalgia because im ashamed to admit i had not heard about it at all.
so we will try and explain it although this really is shellys area-
it is a medical condition of unknown cause.it affects about 4% of the population and research has shown it causes abnormalities in thier nerves and become more sensitive to normal pain signals,it also causes a difficulty in deep sleeping.
it is a syndrome caused by a possible number of factors including physical or mental trauma,viral infections,disorders of immune system functions and anxiety.
treatment of fibromyalgia according to the AMERICAN COLLEGE OF RHEUMATOLOGY which is where i checked these facts out is painkillers,anti inflammatory medication,muscle relaxents and possible physiotherapy.
please never self diagnose and always get proffessional expert advice before taking any medication,as i said earlier i had not heard of it and had to research it by the AMERICAN COLLEGE OF RHEUMATOLOGY.

just me-about

i thought that i should just give a few facts about me so people know who i am.
i have two biological daughters,3 stepdaughters.
1995 lost a child through etopic pregnancy and myself and my then partner where told we could never have children-but in 1998 we had a daughter born with a club foot and in later life after my self and her mam split up she was diagnosed with celebral palsy-
then in may 2009 one of my step daughters was after fighting since october 2007 was diagnosed with borderline personality disorder and remains in a mental health hospital.
BUT i consider myself to be very lucky because despite two children with disabilities thay are living and loving and that to me is a great gift

Chronic fatigue syndrome-what it is-Two For One

definition from-From Wikipedia, the free encyclopedia

A new onset (not lifelong) of severe fatigue for six consecutive months or greater duration which is unrelated to exertion, is not substantially relieved by rest, and is not a result of other medical conditions.
The fatigue causes a significant reduction of previous activity levels.
Four or more of the following symptoms that last six months or longer:
- Impaired memory or concentration
- Post-exertional malaise, where physical or mental exertions bring on "extreme, prolonged exhaustion and sickness"
- Unrefreshing sleep
- Muscle pain (myalgia)
- Pain in multiple joints (arthralgia)
- Headaches of a new kind or greater severity
- Sore throat, frequent or recurring
- Tender lymph nodes (cervical or axillary)

Other common symptoms include:

Irritable bowel, abdominal pain, nausea, diarrhea or bloating
Chills and night sweats
Brain fog
Chest pain
Shortness of breath
Chronic cough
Visual disturbances (blurring, sensitivity to light, eye pain or dry eyes)
Allergies or sensitivities to foods, alcohol, odors, chemicals, medications or noise
Difficulty maintaining upright position (orthostatic instability, irregular heartbeat, dizziness, balance problems or fainting)
Psychological problems (depression, irritability, mood swings, anxiety, panic attacks)^[39]

The CDC proposes that persons with symptoms resembling those of CFS consult a physician to rule out several treatable illnesses: Lyme disease,^[38] "sleep disorders, depression,alcohol/substance abuse, diabetes, hypothyroidism, mononucleosis (mono), lupus, multiple sclerosis (MS), chronic hepatitis and various malignancies."^[40] Medications can also cause side effects that mimic symptoms of CFS.^[38]

Two For One

I want to start a blog radio, I haven’t signed up yet, but my ideas are to get the unseen diagnoses recognized, ie: Chronic Fatigue Syndrome, Fibromyalgia, Complex Regional Pain syndrome, pain management that gives quality of life and dignity, also of course depression. I have well about 20 doctors who follow me and want to get them in on this, such there is power in prayer in numbers applies to this as well.

this is shelly,s fabulous idea and i think it is brilliant.if anyone would like to tell shelly or myself about your experiences,we would love to hear from you please.

shelly is working tirelessly to get the publicity to get some unseen or ignored diagnoses highlighted and to help everyone in this type of position.

shelly and i have had considersble discussions on this issue and i am 100% committed with shelly to obtain the desired and most importantly correct conclusion

Friday, 20 July 2012

elderly in my words-poem by me

being elderly does not feel so good
i dont feel the way i thought i would
served my country,worked all my life
some years ago i lost my wife
i do not need or ask for a lot
but not all happy with what ive got
someoe to talk to for an hour a day
we still love you to hear anyone say
to my sons and daughters im just a pest
please dear lord lay me down to rest

memories of a child-a true account

20/07/2012 16:25

sometimes it is strange how you think about the past,but recently i have-so i thought i would blog some memories.

as a child i had a loving but very strong mother and an alcoholic father but i have no regrets apart from maybe the odd cuts and bruises.

my parents eventually split which i guess was inevitable in so many ways and i remember one xmas day my dad came to visit us,but as usual he was drunk and he started his idiotic behavior and he ended up fighting with mam and a xmas present of mine got broken.

it was something that most of you would not even remember a reel to reel tape recorder-it was not new and mam saved to buy it from a second hand shop but to me it was the best ever xmas present and he broke it through alcohol.i dont think it was just my present that was broken on that xmas day but a piece of my heart too.

memories of a child-a true account

sometimes it is strange how you think about the past,but recently i have-so i thought i would blog some memories.

as a child i had a loving but very strong mother and an alcoholic father but i have no regrets apart from maybe the odd cuts and bruises.

20/07/2012 16:25

Thursday, 19 July 2012

THE TWIITER LYNCH MOB

twitter sometimes reminds me of the old wild west with its lynch mobs and always a person who runs the town(twiitertown) if you like westerns you will hve seen it loads of time,get everyone worked up into a frenzy against someone who has the cheek and nerve to challange them,they think they can post what they want about who or what the want.
one out of this bunch i believe to be professional and then in my oppinion the others are wannabe,s-they all like to hear how great they are and have huge egos but little substance and some do suffer from mental issues but that should not be held against them because in fairness a lot on twitter have disorders and should be admired for thier bravery of talking about it.
i am not asking anyone else to become involved that is thier sneaky way,i am not the only one who as been singled out by this group of people who seem to get a real buzz out of basically trying to regulate twitter in thier lynch mob rule.
me could not give a stuff about these morons but i thought i would warn the rest of you to be carefull because they will turn on you.i would happily leave twitter but at the moment i would not give the mindless word thugs the satisfaction

Claire OT @claireOT I'm an occupational therapist. I talk about health, mental health recovery, disability, social justice, busy organising

@BPDFFS Campaigning and Training for People with Borderline Personality Disorder
　
　
The Care Guy @StuartSorensen British trainer & speaker. Interested in mental health, social care, human rights. I work throughout UK
Workington, UK ·
　Gill_Sorensen @Gill_Sorensen mum, wiccan, wife, some times silly, some times serious but most of the time a complete flake. I live with 1 bloke 2 boys and 5 cats.
Cumbria
　Amanda O @Trying to do my bit to make a difference in mental health matters. My blog can be found at
　
　
　and then the followers of these morons who are more like sheep than people who will do as they are told by idiots-if you want to reply please use my blog .amanda_stand BPD FFS sue sibbald

questions and answers-just for fun

earlier today i asked two questions
the first one got no answers the second one was what is all bran and below is a very good if somewhat not very informative reply-but i liked it though.
it's a breakfast cereal made only out of bran ;)

this was just an execise in how difficult it can be to answer a question without cutting and pasting if you want it to be evidence based.

below is a more indepth answer using a source which is shown,this was just in the sense of fun but i think it proves to an extent how difficult answering questions can be without using sources.

All Bran Cereal
All bran cereal is cereal which features the benefit of maximizing the grams of fiber per each serving. This is a benefit because of how it affects your sense of feeling sated. Eating all bran cereal will make you feel more full, not only in the short term, but also extending to a couple of hours thereafter. This longer state of feeling sated may just have something to do with all bran cereal's lower glycemic index. The benefits of all bran cereal don't end just at making you feel more full. All bran cereal has also been found to reduce the likelihood of weight gain for both men over 40 as well as women in the age range of 38 to 63. The aforementioned cereal that contains refined-grain has the tendency of causing weight gain in people who eat it regularly.
Comparison
The choice of whole grain cereal versus all bran cereal largely comes down to what your priorities and preferences are. If you value a cereal that puts an emphasis on reducing your risk for noxious diseases like diabetes and heart disease, you should choose whole grain cereal. If, on the other hand, you mainly value the possibility of weight loss or reducing the likelihood that you will gain weight, you should opt to eat all bran cereal. You must remember that both kinds of cereals are a lot healthier than refined-grain cereal, which you ought to avoid.

http://www.fitday.com/

final answer-please read and decide for yourself

this really is my last response to this issue-best interest is for people without capacity-
i do hope that this will clear this up once and for all-the mental capacity act is clearSory @MikeGargett but this is misleading. Part 5 MCA is clear: decision-makers are expected to be reasonable, not expert. -for a person who lacks capacityView conversation Hide conversation Reply RetweetedRetweet Delete FavoritedFavorite 3h The Care Guy ?@StuartSorensen
@MikeGargett @claireOT @SocialWorkKent Not particularly but if you want to go ahead.
on Reply RetweetedRetweet Delete FavoritedFavorite 19h The Care Guy ?@StuartSorensen
@MikeGargett @nicolejade6 @dementia_tch1 If you mean me thst's unfair. I commented on the MCA, not you.
The Care Guy ?@StuartSorensen
@cal_ann @lavinialady Thankyou. Problem is it's too wasy to look like a bulky when all I realky want to do is challenge misleading myths -there are no misleading myths just the factsThe Care Guy ?@StuartSorensen
@dementia_tch @lavinialady I spend too much time dispelling these dangerous myths to let such go unchallenged on
The Care Guy ?@StuartSorensen
@dementia_tch @lavinialady And there are those who object to dangerous misrepresentation by psuedo experts. That affects practice -no misrepresentation only what is stated by the mca clearlyThe Care Guy ?@StuartSorensen
@MikeGargett Including A&E Dr
23h The Care Guy ?@StuartSorensen
@MikeGargett @stuartsanderso2 @maggsy2000 @MentalHealthCop @Ermintrude2
　 Read chapter 6 CoP. Clearly states NOT just medical. Principles of the ActThe Act is underpinned by five key principles:without capacity must be in their best interests. Home > Professional Reference > Mental Capacity ActPrint this page Send to a friend Mental Capacity Act This PatientPlus article is written for healthcare professionals so the language may be more technical than the
See separate articles condition leaflets. You may find the abbreviations list helpful.Consent To Treatment (Mental Capacity and Mental Health Legislation), Consent To Treatment In Children (Mental Capacity and Mental Health Legislation) and Compulsory Hospitalisation.

The Mental Capacity Act (2005) provides a statutory framework to empower and protect vulnerable people who are not able to make their own decisions. It makes it clear who can take decisions, in which situations, and how they should go about this. It enables people to plan ahead for a time when they may lose capacity. The Act replaces previous statutory schemes for Enduring Powers of Attorney and Court of Protection Receivers with reformed and updated schemes. The Mental Capacity Act applies to people aged 16 and over.On this page
Principles of the Act Purposes of the Act Deprivation of liberty safeguards Document references Internet and further reading

A presumption of capacity
The right for individuals to be supported to make their own decisions
That individuals must retain the right to make what might be seen as eccentric or unwise decisions.
Best interests
Least restrictive intervention: anything done for or on behalf of people without capacity should be the least restrictive of their basic rights and freedoms.: anything done for or on behalf of people : people must be given all appropriate help before anyone concludes that they cannot make their own decisions. : every adult has the right to make his or her own decisions and must be assumed to have capacity to do so unless it is proved otherwise. Assessment of mental capacity is specific for each individual decision at any particular time. People are considered to lack capacity if they have an impairment that causes them to be unable to make a specific decision. The person should be able to understand, retain and weigh the information provided and communicate their decision.

Independent mental capacity advocates should be appointed to represent people who lack capacity and face serious decisions with no one to be an advocate for them. The possible causes of incapacity are wide ranging and include dementia, acute confusion, depression, psychotic illness, distress or emotional disturbance. No specific diagnosis should be assumed to imply incapacity.
　

Principles of the ActThe Act is underpinned by five key principles:
A presumption of capacity
The right for individuals to be supported to make their own decisions
That individuals must retain the right to make what might be seen as eccentric or unwise decisions.
Best interests: : people must be given all appropriate help before anyone concludes that they cannot make their own decisions. : every adult has the right to make his or her own decisions and must be assumed to have capacity to do so unless it is proved otherwise. Assessment of mental capacity is specific for each individual decision at any particular time. People are considered to lack capacity if they have an impairment that causes them to be unable to make a specific decision. The person should be able to understand, retain and weigh the information provided and communicate their decision.

Independent mental capacity advocates should be appointed to represent people who lack capacity and face serious decisions with no one to be an advocate for them. The possible causes of incapacity are wide ranging and include dementia, acute confusion, depression, psychotic illness, distress or emotional disturbance. No specific diagnosis should be assumed to imply incapacity.anything done for or on behalf of people without capacity must be in their best interests. Least restrictive interventionPurposes of the ActThe Act deals with the assessment of a person's capacity and
Assessing lack of capacity
acts by carers of those who lack capacity.The Act sets out a single clear test for assessing whether a person lacks capacity to take a particular decision at a particular time.
It is a 'decision-specific' test. No one can be labelled 'incapable' as a result of a particular medical condition or diagnosis. A lack of capacity cannot be established merely by reference to a person's age, appearance, or any condition or aspect of a person's behaviour which might lead others to make unjustified assumptions about capacity.
To test if the person has capacity:
Does the person have an impairment of the mind or brain, or a disturbance of mental function?
If so, does that impairment or disturbance mean that the person is unable to make the decision in question at the time it needs to be made?To have capacity to make a decision, someone must be able to:
Understand the information relevant to the decision.
Retain the information.
Use that information as part of the process of making the decision.
Communicate his/her decision either by talking, signing, or any other means.Best interests
Everything that is done for or on behalf of a person
The Act provides a checklist of factors that decision-makers must work through in deciding what is in a person's best interests.
A person can put his/her wishes and feelings into a written statement if they so wish, which the person making the determination must consider.
Carers and family members have a right to be consulted.
All decisions must be made in the best interest of that person:
Involve the person who lacks capacity.
Be aware of the person's wishes and feelings.
Consult with others who are involved in the care of the person.
Do not make assumptions based solely on the person's age, appearance, condition or behaviour.
Consider whether the person is likely to regain capacity to make the decision in the future.who lacks capacity must be in that person's best interests. Acts in connection with care or treatment
Section 5 of the Act clarifies that where a person is providing care or treatment for someone
This covers actions that would otherwise result in a civil wrong or crime if someone has to interfere with the person's body or property in the ordinary course of caring. For example, by giving an injection or by using the person's money to buy items for them.
The Bill introduces a new criminal offence of ill treatment or neglect of a person who lacks capacity. A person found guilty of such an offence may be liable to imprisonment for a term of up to five years. who lacks capacity then the person can provide the care without incurring legal liability. The key will be proper assessment of capacity and best interests. Restraint or deprivation of liberty
Section 6 of the Act defines restraint as the use or threat of force where an incapacitated person resists, and any restriction of liberty or movement whether or not the person resists.
Restraint is only permitted if the person using it reasonably believes it is necessary to prevent harm to the incapacitated person, and if the restraint used is proportionate to the likelihood and seriousness of the harm.
Section 6(5) makes it clear that an act depriving a person of his or her liberty cannot be an act to which section 5 provides any protection.Advance decisions
The Mental Capacity Act introduces
Advance decisions replace 'advance directives', which were made prior to the Mental Capacity Act. Advance directives may still be valid and applicable under the Mental Capacity Act but no new advance directives can now be made.
Advance decisions can only be made by people 18 years old or older and considered to have mental capacity.
Under advance decisions, any treatment can be refused, except for those actions needed to keep a person comfortable, eg. warmth, shelter, and offering food or water by mouth.
Wishes to have certain treatments may be expressed in advance which must be taken into account, but do not have to be followed.
An advance decision carries the same weight as decisions made by a person with capacity and must be followed. Therefore best interests do not apply.
Advance decisions may be verbal, except those about life-sustaining treatment which must be in writing and signed by the patient and a witness, and include a statement that the decision is to apply even if life is at risk.
The advance decision becomes invalid if the decision is withdrawn or amended when the person still had capacity (or even if there have been any actions suggesting they changed their mind after making the advance decision), or if there are 'lasting powers of attorney' with powers to make the same decision after the advance decision was made.
The advance decision must apply to the specific circumstance in question.
Going against a valid and applicable advance decision can result in claims for battery or criminal charges of assault.advance decisions giving a person the right to make a decision to refuse healthcare treatment in advance, even if it results in their death. Lasting powers of attorney
The Act allows a person to appoint an attorney to act on their behalf if they should lose capacity in the future.
The Act allows people to let an attorney make financial, property, health and welfare decisions.
The designated attorney must be aged 18 years or older.
The lasting powers of attorney only come into force once the person has lost capacity and the lasting powers of attorney must be registered with the Office of the Public Guardian (see link at end of article).
The person making the lasting powers of attorney must have capacity when they sign a written document confirming the powers and limitations of the powers of attorney.Independent Mental Capacity Advocate (IMCA)
An IMCA is someone appointed to support a person who lacks capacity but has no one to speak for them. The IMCA makes representations about the person's wishes, feelings, beliefs and values at the same time as bringing to the attention of the decision-maker all factors that are relevant to the decision. The IMCA can challenge the decision-maker on behalf of the person lacking capacity if necessary.
An IMCA must be involved in the following situations and where the person lacks capacity and has no relative, friend or unpaid carer:
An NHS body is proposing:
Serious medical treatment.
A stay of more than 28 days in hospital or eight weeks in a care home.
Change to a person's accommodation to another hospital for more than 28 days or more than eight weeks in a care home.A local authority is proposing:
To change or to provide residential or supported accommodation for more than eight weeks.An IMCA may also be involved in:
Accommodation reviews where there are concerns about the suitability of the placement, where the Local Authority or NHS has arranged the original accommodation, the person lacks capacity, and there is no other person appropriate to consult. Involvement of an IMCA is not necessary:
If any treatment needs to be provided as a matter of urgency.
If the person lacking capacity would be made homeless unless they were admitted to a care home.
In accommodation reviews or adult protection cases where there is already appropriate family support or where an advocate is currently involved.Adult protection cases where protective measures are being put in place in relation to the protection of a vulnerable adult from abuse, and where the person lacks capacity. Where the person who lacks capacity is abusing another person.Parameters for research
Research involving, or in relation to, a person lacking capacity may be lawfully carried out if an 'appropriate body' (normally a Research Ethics Committee) agrees that the research is safe, relates to the person's condition and cannot be done as effectively using people who have mental capacity. The research must produce a benefit to the person that outweighs any risk or burden.
Alternatively, if it is to derive new scientific knowledge, it must be of minimal risk to the person and be carried out with minimal intrusion or interference with their rights.
Carers or nominated third parties must be consulted and agree that the person would want to join an approved research project. If the person shows any signs of resistance or indicates in any way that he or she does not wish to take part, the person must be withdrawn from the project immediately.
Transitional regulations will cover research started before the Act where the person originally had capacity to consent, but later lost capacity before the end of the project.Court appointed deputies
The Act provides for a system of court appointed deputies to replace the previous system of receivership in the Court of Protection.
Deputies will be able to take decisions on welfare, healthcare and financial matters as authorised by the Court but will not be able to refuse consent to life-sustaining treatment. They will only be appointed if the Court cannot make a one-off decision to resolve the issues.
The Act creates two new public bodies to support the statutory framework, both of which will be designed around the needs of those who lack capacity.A new Court of Protection
The new Court will have jurisdiction relating to the whole Act and will be the final arbiter for capacity matters. It will have its own procedures and nominated judges.
A new Public Guardian: the Public Guardian and his/her staff supervise deputies appointed by the Court and provide information to help the Court make decisions. They also work together with other agencies, such as the police and social services, to respond to any concerns raised about the way in which an attorney or deputy is operating.
A Public Guardian Board scrutinises and reviews the way in which the Public Guardian discharges his/her functions. The Public Guardian is required to produce an Annual Report about the discharge of his/her functions.Deprivation of liberty safeguards
^{The aim of the deprivation of liberty safeguards is to provide legal protection for those vulnerable adults who are not detained under the amended Mental Health Act 1983, but are restricted in their freedom due to their inability to consent to care or accept treatment.
The deprivation of liberty safeguards (an amendment of the Mental Capacity Act 2005) came into effect on 1 April 2009 and cover mentally incapacitated adults in hospitals, as well as those in care homes registered under the Care Standards Act 2000. The safeguards apply to anyone aged 18 and over:
who suffers from a mental disorder or disability of the mind, e.g. dementia or a profound learning disability,
who lacks the capacity to give informed consent to the arrangements made for their care and/or treatment, and
for whom deprivation of liberty is considered after an independent assessment to be necessary in their best interests to protect them from harm.Whenever a hospital or care home identifies that a person
When a person is in a care home, the supervisory body will be the relevant Local Authority.
When the person is in a hospital, this will be the relevant Primary Care Trust (PCT).The Mental Capacity Act 2005who lacks capacity is being, or risks being, deprived of their liberty, they must apply to a 'supervisory body' for authorisation of deprivation of liberty: will not permit someone being deprived of their liberty without such an authorisation (unless it is a consequence of following a decision of the Court of Protection on a personal welfare question). Doctors are eligible to undertake a mental health assessment as part of these procedures provided they are three years post-registration and they must have undertaken the deprivation of liberty safeguards Mental Health Assessors training programme made available by the Royal College of Psychiatrists.
This work is not part of Essential Services for GPs and the British Medical Association's (BMA) Professional Fees Committee advises doctors to undertake this work only if they have agreed the level and payment arrangements for the work in advance.
Responsibility for payment lies with the PCT or Local Social Services Authority (LSSA) according to whether the person is in hospital or a Registered Home at the time of the assessment.
　Document references

　^{The Mental Capacity Act Deprivation of Liberty Safeguards}^{, Dept of HealthInternet and further reading

^{Mental Capacity Act 2005 Code of Practice}^{, Ministry of Justice ^{Consent guidance: patients and doctors making decisions together}^{, General Medical Council, 2008 ^{The Mental Capacity Act 2005}^{, Dept of Health ^{The Mental Capacity Act 2005: Guidance for health professionals}^{, British Medical Association ^{Mental Capacity Act Tool Kit}^{, British Medical Association, September 2008 ^{Consent tool kit - fifth edition}^{, British Medical Association, December 2009 ^{Advance decisions and proxy decision-making in medical treatment and research}^{, British Medical Association, November 2007 ^{The Office of the Public Guardian}}}}}}}}}}¹: anything done for or on behalf of people without capacity should be the least restrictive of their basic rights and freedoms.

Saturday, 7 July 2012

MENTAL HEALTH-NO BOUNDRIES: do not judge

Friday, 6 July 2012

Home > Professional Reference > Ehlers-Danlos Syndrome

Epidemiology

Ehlers-Danlos syndrome (EDS) affects approximately 1 in 5,000 live births.¹
Inheritance is usually autosomal dominant.

Presentation

Abnormalities of collagen production result in:

Bruising, bleeding from the gastrointestinal tract.
Dissecting aortic aneurysm at an early age.
Wide scars.
Laxity of joints.
Herniae.
Hyperelasticity of skin.

The first presentation may be premature rupture of the membranes.

Types of Ehlers-Danlos syndrome

There are many types of Ehlers-Danlos syndrome (EDS) based on different gene mutations affecting the structure or assembly of different collagens. All share common features of fragile skin and laxity of joints and ligaments. The Villefranche classification of EDS substituted descriptions for earlier types numbered with Roman numerals:²

Classic (formerly known as Type I and II):
- Classical features of EDS (soft, doughy, hyperelastic skin) with atrophic scars.
- Multiple bruises, especially on the legs.
- Easy skin-splitting shows in childhood over the forehead, elbows, knees and chin.
- Other features are epicanthic folds, blue sclerae, fibrous nodules over knees and ankles.
Hypermobile type (formally known as Type III):
- Most common and often not diagnosed.
- Characterised by tall stature, blue sclerae and ready bruising.
- Shows marked joint hypermobility but moderate skin elasticity and no scarring.
Vascular type (formally known as Type IV):³
- Appears as thin skin with venous patterns readily visible, ecchymoses over the knees and shins, premature ageing of the skin on the dorsum of the hands, feet and shins with a 'Madonna' face with large eyes, nasal thinning and small ear lobes.
- The main problem is spontaneous rupture of medium/large arteries at any age from mid-adolescence to late adult life. Arterial aneurysms are also common.
- Death results from arterial rupture but rupture of the sigmoid colon is also common.
- Recent studies showed that 15% of women who became pregnant died due to complications during pregnancy.
- Overall median lifespan is reduced to 48 years.
Kyphoscoliosis type (formally known as Type VI):
- Severe main features with early progressive fibrosis and severe motor delay.
Arthrochalasia type (formally known as Types VII A and B):
- Severe main features, short stature, hip dislocation, dentinogenesis imperfecta.
Dermatosparaxis type (formally known as Type VII C):
- Main features are variable, early tooth loss with severe periodontitis.

Differential diagnosis

Cutis laxa.
Pseudoxanthoma elasticum.
Other causes of joint hypermobility, e.g. benign joint hypermobility syndrome, Marfan's syndrome, osteogenesis imperfecta.⁴

Investigations

Diagnosis is normally made on the clinical presentation.
Subcutaneous calcified spherules can be confirmed on X-rays.

Management

There is no specific treatment.
Celiprolol, a beta1-adrenoceptor antagonist with a beta2-adrenoceptor agonist action, has been used to prevent arterial dissections and ruptures.⁵
Trauma should be minimised, and protective clothing and padding may help.
Genetic counselling should be provided.

Complications

Pregnancy may be very dangerous. Obstetric complications include risk of uterine rupture during labour, damage to the vagina and perineum, bleeding and rupture of blood vessels and the colon during the puerperium.⁶
Abnormal bleeding may cause extreme difficulty with any surgical operation.

Prognosis

Lifespan is usually normal unless there is marked vascular fragility.
A high prevalence of severe complications occurs in a minority of families

scizophrenia

scizophrenia Treatment

Because the causes of schizophrenia are still unknown, treatments focus on eliminating the symptoms of the disease. Treatments include antipsychotic medications and various psychosocial treatments.
Antipsychotic medications
Antipsychotic medications have been available since the mid-1950's. The older types are called conventional or "typical" antipsychotics. Some of the more commonly used typical medications include:

Chlorpromazine (Thorazine)
Haloperidol (Haldol)
Perphenazine (Etrafon, Trilafon)
Fluphenazine (Prolixin).

Schizophrenia facts

Schizophrenia is a chronic, severe, debilitating mental illness that affects about 1% of the population, more than 2 million people in the United States alone.
With the sudden onset of severe psychotic symptoms, the individual is said to be experiencing acute schizophrenia. Psychotic means out of touch with reality or unable to separate real from unreal experiences.
There is no known single cause of schizophrenia. As discussed later, it appears that genetic factors produce a vulnerability to schizophrenia, with environmental factors contributing to different degrees in different individuals.
There are a number of various treatments for schizophrenia. Given the complexity of schizophrenia, the major questions about this disorder (its cause or causes, prevention, and treatment) are unlikely to be resolved in the near future. The public should beware of those offering "the cure" for (or "the cause" of) schizophrenia.
Schizophrenia is one of the psychotic mental disorders and is characterized by symptoms of thought, behavior, and social problems.
Symptoms of schizophrenia may include delusions, hallucinations, catatonia, negative symptoms, and disorganized speech or behavior.
There are five types of schizophrenia based on the kind of symptoms the person has at the time of assessment: paranoid, disorganized, catatonic, undifferentiated, and residual.
Children as young as 6 years of age can be found to have all the symptoms of schizophrenia as their adult counterparts and to continue to have those symptoms into adulthood.
Although the term schizophrenia has only been in used since 1911, its symptoms have been described throughout written history.
Schizophrenia is considered to be the result of a complex group of genetic, psychological, and environmental factors.
Health-care practitioners diagnose schizophrenia by gathering comprehensive medical, family, mental-health, and social/cultural information.
The practitioner will also either perform a physical examination or request that the individual's primary-care doctor perform one. The medical examination will usually include lab tests.
In addition to providing treatment that is appropriate to the diagnosis, professionals attempt to determine the presence of mental illnesses that may co-occur.
People with schizophrenia are at increased risk of having a number of other mental-health conditions, committing suicide, and otherwise dying earlier than people without this disorder.
Medications that have been found to be most effective in treating the positive symptoms of schizophrenia are first- and second-generation antipsychotics.
Psychosocial interventions for schizophrenia include education of family members, assertive community treatment, substance-abuse treatment, social-skills training, supported employment, cognitive behavioral therapy, and weight management.
Cognitive remediation, peer-to-peer treatment, and weight-management interventions remain the focus topics for research.

What is schizophrenia?

Schizophrenia is a chronic, severe, debilitating mental illness that affects about 1% of the population, corresponding to more than 2 million people in the United States alone. Other statistics about schizophrenia include that it affects men about one and a half times more commonly than women. It is one of the psychotic mental disorders and is characterized by symptoms of thought, behavior, and social problems. The thought problems associated with schizophrenia are described as psychosis, in that the person's thinking is completely out of touch with reality at times. For example, the sufferer may hear voices or see people that are in no way present or feel like bugs are crawling on their skin when there are none. The individual with this disorder may also have disorganized speech, disorganized behavior, physically rigid or lax behavior (catatonia), significantly decreased behaviors or feelings, as well as delusions, which are ideas about themselves or others that have no basis in reality (for example, the individual might experience paranoia, in that he or she thinks others are plotting against them when they are not).

What are the different types of schizophrenia?

There are five types of schizophrenia, each based on the kind of symptoms the person has at the time of assessment.

Paranoid schizophrenia: The individual is preoccupied with one or more delusions or many auditory hallucinations but does not have symptoms of disorganized schizophrenia.

Disorganized schizophrenia: Prominent symptoms are disorganized speech and behavior, as well as flat or inappropriate affect. The person does not have enough symptoms to be characterized as suffering from catatonic schizophrenia.

Catatonic schizophrenia: The person with this type of schizophrenia primarily has at least two of the following symptoms: difficulty moving, resistance to moving, excessive movement, abnormal movements, and/or repeating what others say or do.

Undifferentiated schizophrenia: This is characterized by episodes of two or more of the following symptoms: delusions, hallucinations, disorganized speech or behavior, catatonic behavior or negative symptoms, but the individual does not qualify for a diagnosis of paranoid, disorganized, or catatonic type of schizophrenia.

Residual schizophrenia: While the full-blown characteristic positive symptoms of schizophrenia (those that involve an excess of normal behavior, such as delusions, paranoia, or heightened sensitivity) are absent, the sufferer has a less severe form of the disorder or has only negative symptoms (symptoms characterized by a decrease in function, such as withdrawal, disinterest, and not speaking).

BORDERLINE pd-nothing borderline about bpd

Psychological therapies for people with borderline personality disorder

People with borderline personality disorder, are often anxious, depressed, self‐harm, in crisis and are difficult to engage in treatment. In this review of the talking/behavioural therapies for people with borderline personality disorder, we identified seven studies involving 262 people, over five separate comparisons. Dialectical behaviour therapy (DBT) included treatment components such as prioritising a hierarchy of target behaviours, telephone coaching, groups skills training, behavioural skill training, contingency management, cognitive modification, exposure to emotional cues, reflection, empathy and acceptance. DBT seemed to be helpful on a wide range of outcomes, such as admission to hospital or incarceration in prison, but the small size of included studies limit confidence in their results.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Drug treatment for borderline personality disorder

Many people with borderline personality disorder (BPD) receive medical treatment. However, there are no drugs available for BPD treatment specifically. A certain drug is most often chosen because of its known properties in the treatment of associated disorders, or BPD symptoms that are also known to be present in other conditions, such as depressive, psychotic, or anxious disorders. BPD itself is characterised by a pervasive pattern of instability in affect regulation (with symptoms such as inappropriate anger, chronic feelings of emptiness, and affective instability), impulse control (symptoms: self‐mutilating or suicidal behaviour, ideation, or suicidal threats to others), interpersonal problems (symptoms: frantic efforts to avoid abandonment, patterns of unstable relationships with idealization and depreciation of others), and cognitive‐perceptual problems (symptoms: identity disturbance in terms of self perception, transient paranoid thoughts or feelings of dissociation in stressful situations). This review aimed to summarise the current evidence of drug treatment effects in BPD from high‐quality randomised trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Crisis interventions for people with borderline personality disorder

Borderline personality disorder (BPD) is a complex and severe mental disorder that affects approximately 2% of the general population. Many people with BPD experience considerable instability in their interpersonal relationships and sense of who they are, leading to frequent crises and acts of self harm. To date, little is known about what might help people with BPD when they are experiencing an acute crisis. In this review, we wanted to examine how effective crisis interventions are for people with BPD by looking at evidence from randomised controlled trials (RCTs).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Psychosocial and pharmacological treatments for deliberate self harm

Deliberate self‐harm is a major health problem associated with considerable risk of subsequent self‐harm, including completed suicide. This systematic review evaluated the effectiveness of various treatments for deliberate self‐harm patients in terms of prevention of further suicidal behaviour. From the results of 23 randomized controlled trials the reviewers concluded that more evidence is required to indicate what the most effective care is for this large patient population. Promising results were found for problem‐solving therapy, provision of a card to allow emergency contact with services, depot flupenthixol for recurrent repeaters of self‐harm and long‐term psychological therapy for female patients with borderline personality disorder and recurrent self‐harm. However, insufficient numbers of patients in nearly all trials limit the conclusions that can be reached. More evidence is required to determine the most effective treatment for deliberate self‐harm patients and larger trials are badly needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Antiepileptic drugs for treating recurrent aggression

Various medicines, which are collectively termed 'antiepileptic drugs', have been used to treat persistent aggression. This review systematically examines the evidence supporting this practice. From the evidence available, we were unable to draw any firm conclusion about using these medicines to treat aggression. Four antiepileptic drugs (valproate/divalproex, carbamazepine, oxcarbazepine and phenytoin) helped to reduce aggression in at least one study. However, for three of these drugs (valproate, carbamazepine and phenytoin) we found at least one other study where there was no significant improvement. Further research is needed to clarify which antiepileptic drugs are effective for whom. Such research is best carried out using carefully designed clinical trials. Such trials need to take account of the type of aggression displayed, the severity of the aggression, and any other disorders experienced by the participants.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Alzheimers

What is Alzheimer's disease?

Alzheimer's disease is the most common cause of dementia, affecting around 496,000 people in the UK. The term 'dementia' describes a set of symptoms which can include loss of memory, mood changes, and problems with communication and reasoning. These symptoms occur when the brain is damaged by certain diseases and conditions, including Alzheimer's disease. This factsheet outlines the symptoms and risk factors for Alzheimer's disease, and describes what treatments are currently available.
Alzheimer's disease, first described by the German neurologist Alois Alzheimer, is a physical disease affecting the brain. During the course of the disease, protein 'plaques' and 'tangles' develop in the structure of the brain, leading to the death of brain cells. People with Alzheimer's also have a shortage of some important chemicals in their brain. These chemicals are involved with the transmission of messages within the brain.
Alzheimer's is a progressive disease, which means that gradually, over time, more parts of the brain are damaged. As this happens, the symptoms become more severe.

Symptoms

People in the early stages of Alzheimer's disease may experience lapses of memory and have problems finding the right words. As the disease progresses, they may:

become confused and frequently forget the names of people, places, appointments and recent events
experience mood swings, feel sad or angry, or scared and frustrated by their increasing memory loss
become more withdrawn, due either to a loss of confidence or to communication problems
have difficulty carrying out everyday activities - they may get muddled checking their change at the shops or become unsure how to work the TV remote.

As the disease progresses, people with Alzheimer's will need more support from those who care for them. Eventually, they will need help with all their daily activities.
While there are some common symptoms of Alzheimer's disease, it is important to remember that everyone is unique. No two people are likely to experience Alzheimer's disease in the same way.

chrones

Crohn's disease

Inflammatory bowel disease - Crohn's disease; Regional enteritis; Ileitis; Granulomatous ileocolitis; IBD- Crohn's disease

Last reviewed: April 16, 2012.

Crohn's disease is a form of inflammatory bowel disease (IBD). It usually affects the intestines, but may occur anywhere from the mouth to the end of the rectum (anus).

mindfull

just look

do not judge

what works

bbc thurs-dimentia care

when i grow old on thursday was showing 4 celebrities in 4 elderly care homes.
this is about the home where renowned news reporter john simpson stayed for the programme.

john in his war correspondance days

but he found dimentia even harder to report on

it can happen to any of us

initially i got angry with him over a reply of "im not one of your patients"when asked if he knew where his room was-then tears as john got to know the residents inparticular an elderly lady who only rememberd her grown up kids as only small children and visibly upset john with her emotions and the fact the residents had to be locked in.