SAQ 221 – Mental Health – psychosis, violence risk, and chemical restraint
Model Answer
Question 1. psychosis, violence risk, and chemical restraint.
a. Psychosis
- Distortion or loss of contact with reality without clouding of consciousness.
b. Schizophrenia criteria
- At least two characteristic symptoms: delusions, hallucinations, disorganised speech, grossly disorganised or catatonic behaviour, or negative symptoms.
- Social or occupational dysfunction.
- Duration longer than six months.
- Exclusion of schizoaffective and mood disorders.
- Exclusion of substance-related or medical causes.
c. Situation
- Code Black or armed threat.
d. Immediate violence risk
- Motor agitation.
- Verbal agitation.
- Intoxication.
- Pressure of speech suggesting mental illness.
- Possession of a knife.
- Explicit threat to use the knife.
- Hostile attitude to assistance.
e. Initial pharmacological treatment
| Situation | Drug | Route | Initial dose |
|---|---|---|---|
| Compliant | Olanzapine or diazepam. | Oral. | Olanzapine 5-10 mg or diazepam 5-10 mg. |
| Non-compliant | Midazolam, lorazepam, haloperidol, droperidol, or ziprasidone. | IM or IV. | Midazolam 5-10 mg; lorazepam 1-2 mg; haloperidol or droperidol 5-10 mg; ziprasidone 10-20 mg. |
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