Ethical Issues in Civil Report Writing

Ethical Issues in Report Writing - Civil

• Clarify your role as either a treating doctor focusing on patient welfare or as an independent psychiatrist aiding the court.
• Maintain patient confidentiality unless legally obligated to disclose information, consulting medico-legal insurance for guidance.
• Inform the patient about the report request and obtain informed consent after explaining the process and your role.
• Ensure any report provided serves the best interests of the patient while considering potential harm.
• Evaluate the risk of causing harm by writing a report or sharing the patient’s notes.

Management of Patient Suicide

• Attend the hospital ward to gather specific details surrounding the incident, including time, witnesses, and police involvement.
• Consider switching to alternative antipsychotic medications such as Olanzapine or Asenapine.
• If the patient struggles with medication compliance, consider depot medication options and legal frameworks like Community Treatment Orders (CTOs).
• Discuss the potential use of Clozapine for treatment after risk assessment, considering the patient's ethnic background.
• Implement Cognitive Behavioral Therapy (CBT) or culturally-tailored individual therapy, involving community liaison workers as needed.
• Explore augmentation strategies, such as combining mood stabilizers with antipsychotics.
• Utilize distraction techniques, such as music and headphones, to alleviate distress.
• Employ anxiety reduction strategies to support the patient's mental health.
• Note that Transcranial Magnetic Stimulation (TMS) has some evidence for efficacy but is not commonly used.

Stigma and Mental Health - Community Management

• Organize a family meeting to address concerns, involving an indigenous liaison worker if available.
• Clarify specific worries from the family and explore how best to support them and Stan.
• Provide psycho-education on schizophrenia, treatment options, and the need for a collaborative therapeutic alliance considering cultural factors.
• Communicate that traditional healing and western medical practices can exist together, engaging in a liaison model with traditional healers.
• Facilitate meetings with community elders to foster cooperation and family agreement.
• Reassure the family regarding the roles of mental health services and involve legal measures for patient safety if necessary, emphasizing patient-centered care.
• Involve media liaison officers if public relations become a concern.
• Address broader community issues like stigma reduction and support for Stan's employment.

Motivational Interviewing Principles

• Use Open-ended questions to gauge the patient's stage of change regarding diet and weight management.
• Make affirmations to recognize and encourage the patient’s efforts for change and validate their courage in discussing sensitive issues.
• Develop cognitive dissonance by highlighting the gap between the patient's current behavior and their health goals.

Tackling Non-Adherence in Medication

• Recommend the use of a dosette box for organized medication management.
• Suggest setting alarms through various devices, such as mobile phones, to remind the patient to take their medication.
• Utilize visual reminders like post-it notes to assist in medication adherence.
• Simplify medication regimens where possible, concentrating doses into fewer times per day.
• Involve a family member in administering medications to improve compliance.
• Consider adherence therapy incorporating motivational interviewing for patients lacking insight.
• Explore depot medications to ensure consistent intake.
• Assess and address any cognitive impairments that may affect medication adherence.

Eating Disorders - Risk Factors

• Female gender and exposure to societal “thin ideals,” particularly in developed nations, pose risk factors.
• Early menarche and genetic predispositions contribute to vulnerability.
• Urban living and participation in body image-focused activities increase risk.
• History of dieting or rapid weight loss, alongside family history of eating disorders, exacerbates risk.
• Psychological factors include a history of low self-esteem, perfectionism, and impulsivity.
• Multidisciplinary treatment teams, including psychologists and dieticians, are crucial for effective management.
• Family involvement is essential, with family therapy showing effectiveness for anorexia nervosa treatment.
• Medications like SSRIs and antipsychotics may assist with obsessive thoughts and associated anxiety.

Principles of Family-Based Treatment in Anorexia Nervosa

• Family involvement is crucial throughout treatment, supporting the adolescent's recovery.
• Phase 1 focuses on weight restoration, with therapists observing family interactions during meals to strengthen cooperation.
• Phase 2 transitions control of eating from parents back to the adolescent.
• Phase 3 addresses emerging adolescent issues and discharges, emphasizing continued support and health maintenance post-recovery.