Presentations
- Deliberate self-harm
- Overdose / Intentional poisoning
- Psychiatric disorders, acute
- Suicide attempts, or risk of
- Undifferentiated acute behavioural disturbance
Conditions
- Anxiety
- Attention deficit hyperactivity disorder (ADHD)
- Autism spectrum disorder
- Behavioural and psychiatric:
- agitation
- confusion
- deliberate self-harm
- substance abuse
- Depression
- Eating disorders
- Intellectual disability and developmental delay with behavioural disturbance
- Organic disorders causing behavioural disturbance, including, but not limited to:
- brain tumours
- encephalitis
- epilepsy
- pain
- sepsis
- Psychosis
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Presentations and conditions
- Attachment disorder
- Cannabis hyperemesis syndrome
- Fabricated illness or induced illness by proxy
- Functional disorder
- Personality disorder
- Psychosis, acute
- Somatisation disorder
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Toxicology:
- ADHD epidemiology and medications
- antipsychotics and use in acute behavioural concerns
- chemical sedation and:
- appropriate patient populations
- benefits
- minimum standards of monitoring throughout
- risks
- common overdoses, including their antidotes, pathophysiological effects, and presentation, including, but not limited to:
- alcohol
- antidepressants
- aspirin
- ecstasy
- methamphetamines
- paracetamol
- life-threatening overdoses
- unclear toxin
- toxidromes
Investigations
- Blood results related to behaviourally disturbed or toxicology patients:
- blood gas results
- for assessing risk in patients with eating disorders
- specific drug levels, such as paracetamol and iron
- ECG:
- patient groups:
- behaviourally disturbed
- eating disorders
- toxicology patients
- to assess for organic cause
- Specific investigations for:
- aggressive / scared or heightened patients
- excluding underlying organic cause for presentation
- overdose patients, to determine type and severity of overdose
Procedures
- Chemical restraint:
- intramuscular
- intravenous
- oral
- De-escalation of disturbance in individuals across the age ranges
- Intravenous / Venepuncture cannulation
- Lumbar puncture for patients with possible organic cause for behavioural disturbance
- Nasogastric (NG) insertion for:
- decontamination
- NG feeding
- NG medication administration
- Non-chemical restraint
- Urinary catheterisation for enhanced elimination
Clinical assessment
- Acute suicide risk
- Assessments to exclude underlying organic cause for presentation
- Medical stability in eating disorder patients
- Mental state examination
- Physical examination to assess for organic cause for behavioural disturbance
- Acute mental health impacts of other diseases, such as chronic disease or life-limiting disease
- Addiction:
- drugs of addiction
- in eating disorders
- management of addiction
- First presentation at emergency department of acute psychiatric disorders
- Local referral pathways for young children with behavioural concerns
- Medicolegal:
- legal framework regarding ADHD medications
- legal status of duty of care, mental health acts, and restraint
- Possible contributors to behaviour:
- bullying
- family dynamics
- exposure to parental use of drugs and alcohol
- role of social media
- peer group interactions
- Recognition of maternal / parental mental health crisis as factors in child presentations to health services
- Recreational substance abuse
- Treatment:
- antipsychotic and anti-anxiety medications, and administration with psychiatric specialist support
- restraint versus sedation, especially in the uncooperative child
- treatment pathways for acute mental health paediatric patients, including:
- legal implications
- safe transfer (if required)
- units suitable for admission
- treatment pathways for long-term increasing disturbance, behavioural outbursts, and self-harm in neurodiverse patients
