Applied Science for Medicine Anatomy of the brain Pathophysiology of delirium and dementia Microbiology of herpes simplex virus Role of drug intoxication and withdrawal in altered mental states Awareness of nutritional deficiencies and how this may compound certain presentations e.g. delirium tremens Pharmacology of haloperidol, olanzapine, rispiridone, benzodiazepines
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Clinical and Communication Skills History from an agitated patient; elicit a collateral history; assess risk factors for delirium Perform a general examination, as complete as is possible; recognise drug withdrawal and intoxication Differential diagnosis of the aggressive patient, delirium Indications for CT head, MRI brain, lumbar puncture Perform capillary glucose level, measurement of blood pressure, lumbar puncture Interpret full blood count, electrolytes, liver function tests, blood glucose level, calcium, thyroid function tests, vitamin B12/ B12 (NZF link) folate, toxicology screen, pathology report on cerebrospinal fluid (CSF), chest X-ray, syphilis serology, short synthacen test Management of the challenging patient: pharmacological and non-pharmacological Awareness of high mortality rates with delirium tremens and the medical treatments required for this Role of security staff, levels of observation and de-escalation measures Role of liaison psychiatry, social worker, nurse Understand how medically unexplained physical symptoms can present
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Personal and Professional Skills Deescalating an aggressive situation Self-care: personal safety Decision-making capacity Best interests principle Assent and consent Legal aspects of compulsory assessment and treatment, Mental Health Act, Right 7(4) of the Health and Disability Commissioner’s Code of Rights
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Population Health Epidemiology of delirium/acute confusion state, schizophrenia, substance abuse, substance withdrawal, herpes simplex virus, meningitis Homelessness: reasons, support programmes, discrimination
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