Mzantsi Medics

Contents

1. Mental Health Definitions
2. Mental Health Act
3. Mental Status Examination
4. Organic Mood Disorders
5. Definitions
6. Drugs List
7. Important Basic Work-up for GMC
8. Substances
9. Psychiatric Emergencies
10. …

ADMISSION OF MHCU

1	PATIENT DEMOGRAPHICS	– Name and Surname – Race – Gender
2	PREVIOUS ADMISSIONS	– Index admission – 2 x previous admissions – Previous rx trials – lengths of hospitalisation
3	PRESENTING COMPLAINT	– Disorderly behaviours. – Endangerment of private property.
4	SYSTEMIC ENQUIRY	– Attention, memory and concentration – MOOD (stability) – VEGETATIVE SYMPTOMS – PSYCHOSIS
5	PAST PSYCHIATRIC HX	Indications for relapse
6	FAMILY HX OF MENTAL ILLNESS	Genetic predisposition
7	SUBSTANCE ABUSE HX	Alcohol (utywala) Amphetamine (Ritalin/lisdexamfetamine) Benzodiazepine Cannabis (intsango) Methamphetamine (Tik/Ecstasy/) Methaqualone (Mandrax) Narcotic (Cocaine) Nicotine (icuba) Opioid (nyaope /heroin)
8	FORENSIC HX	– Previous court appearances – Convictions
9	MEDICAL HX	– Asthma – Delirium – Epilepsy – TBI –
10	DEVELOPMENTAL HX	M
11	MENTAL STATUS EXAMINATION	1. Appearance 2. Behaviour 3. Speech 4. Neurocognitive assessment 5. Mood assessment 6. Thought Processes 7. Perception 8. Hypothalamic 9. Autonomic Symptoms 10. Insight 11. Judgement
12	RISK ASSESSMENT	– Adherence poor – Sex – Substances – Suicide – Violence – Vulnerable
13	DDX	– SUD – SIPD – BPD
14	PROBLEM LIST	– Social support – Reintegration plan – Grants / pays
15	MANAGEMNT PLAN	Plan including all MPT approach
16	PHYSICAL EXAMINATION

Mental Health Care Act [ No. 17 of 2002]

No.	MHCA FORM NAME	FORM NAME AND INDICATION	COMPLETED BY	SECTION NO OF ACT 17
1	MHCA 01 Ungeniswa ngaphandle kwemvume okanye ukungeniswa ngokunxama	Report to Mental Health Review Board on provision of care, treatment and rehabilitation without consent or emergency admission.		Section 9(2)
2	MHCA 02 Ukuhlukunyezwa komsebenzisi weenkonzo	Report on exploitation, physical or other abuse, neglect or degrading treatment of a mental health care user		Section 11(2)
3	MHCA 03 Ingxelo xa ekhululwa/egoduswa	Discharge report from the mental health establishment	– Ward MO	Sections: – 16 – 37(6) – 56
4	MHCA 04 Cela imvume kumphathi wesiseko.	Application to the head of health establishment concerned for assisted or involuntary care, treatment and rehabilitation	– Admitting MO –	– Section 27(1) + 27(2) – Section 33(1) + 33(2)
5	MHCA 05	Report on completion of examination and findings by mental health care practitioner following an application for assisted or involuntary care treatment and rehabilitation	– Ward MO	Sections: – 27(5) – 33(5)
6	MHCA 06 Imvume ifumanekile kumphathi wesiseko emva kweyure ezi 72	72-hour assessment and findings of medical practitioner and another mental health care practitioner after head of health establishment has approved involuntary care, treatment and rehabilitation services	– Ward MO [Section 34(1)
7	MHCA 07 Isaziso esivela kumphathi wesiseko ngesigqibo sakhe.	Notice by head of health establishment on his/her decision whether to provide assisted- or involuntary inpatient care, treatment and rehabilitation services		Sections: – 27(9) – 28(1) – 33(7) and 33(8)
8	MHCA 08	Notice by head of health establishment to review board requesting approval for further involuntary care, treatment and rehabilitation on an inpatient basis		Section 34(3)(c)
9	MHCA 09	Notice by head of health establishment after 72-hour assessment period informing review board that mental health care user warrants further involuntary care, treatment and rehabilitation on an outpatient basis		Section 34(3)(b)
10	MHCA 10	Transfer of involuntary mental health care user – schedule of conditions relating to his or her involuntary outpatient care, treatment and rehabilitation services		Section 34(3)(b) or (5)
11	MHCA 11	Transfer of assisted / involuntary mental health care user on inpatient basis to another health establishment		Sections – 27(10) – 34(4)
12	MHCA 12	Discharge of involuntary mental health care user from inpatient to outpatient care or cancellation of the discharge		Section 34(3) and 34(6)
13	MHCA 13A	Periodical report on mental health care user (assisted/involuntary user/mentally ill prisoner)		Sections – 30(2) – 37(2) – 55(1)
14	MHCA 13B	Periodical report on state patient		Section 46(2)
15	MHCA 14 Isigqibo sebhodi	Decision by review board concerning		l
16	MHCA 15	Appeal to review board against decision of head of health establishment on assisted- or involuntary mental health care, treatment and rehabilitation		Sections – 29(1) – 35(1)
17	MHCA 16	Order by the high court for further hospitalisation/immediate discharge of an involuntary mental health care user		Section 36(c)
18	MHCA 17	Decision/recommendation by review board following periodic reviews/ reports on assisted or involuntary mental health care users or mentally ill prisoners		Sections – 30(4) – 37(4) – 55(4)
19	MHCA 18	Summons to appear before a review board		Section – 11(2) – 29(2)(a) – 35(2)(c)
20	MHCA 19	Request by head of health establishment to review board to transfer mental health care user/state/mentally ill prisoner		–
21	MHCA 20	Order by review board to transfer mental health care user/state patient/mentally ill prisoner		–
22	MHCA 21	Notice of transfer of state patient or mentally ill prisoner		Sections – 43(8) – 54(6)
23	MHCA 22 Amapolisa anikezela ngomntu okrokreleka ukuba uphazamisekile engqondweni	Handing over custody by the South African Police Services (SAPS) of a person suspected of being mentally ill and likely to inflict serious harm to him/herself or others		Section 40(1)
24	MHCA 23	Transfer of state patients from detention centre to a designated health establishment OR Transfer of mentally ill prisoners from prison to designated health establishment		Section 42(3) Section 53(2)
25	MHCA 24	Transfer of state patients and mentally ill prisoners between designated health establishments		g
26	MHCA 25	Notice of abscondment to South African Police Service (SAPS) and request for assistance to locate, apprehend and return user		Sections: – 40(4) – 44(1) – 57(1)
27	MHCA 26	Notice of the return of an absconded assisted user/involuntary user/state patient/mentally ill prisoner		Section s: – 40(4) – 44(1) – 57(1)
28	MHCA 27	Granting of leave of absence to a state patient, assisted or involuntary mental health care users		Section – 45 – 66(1)(j)
29	MHCA 28	Cancellation of leave of absence of a state patient or an assisted or involuntary mental health care user		Section: – 45(3) – 66(1)(j)
30	MHCA 29	Application for discharge of state patient to judge in chambers (where applicant is not an official curator ad litem or administrator)		Section 47(2)(e)
31	MHCA 30	Application for discharge of state patient to judge in chambers (where applicant is an official curator ad litem or administrator)		Section 47(2)(c)
32	MHCA 32	Six-monthly report on conditionally discharged state patient		Section 48(3)
33	MHCA 33	Unconditional discharge by head of health establishment of state patient previously discharged conditionally		Section 48(4)(a)
34	MHCA 34	Application to registrar of the high court for an order amending the conditions/revoking the conditional discharge of a state patient		Section 48(5)
35	MHCA 35	Application by state patient to judge in chambers for amendment to any condition applicable to discharge requesting unconditional discharge		Section – 48(6) – (7)
36	MHCA 36	Assessment of mental health status of prisoner following request from head of a prison and/or magistrate		Sections – 50(2) – 52
37	MHCA 37	Magisterial order to head of prison to – (a) Transfer prisoner to health establishment OR (b) Take necessary steps to ensure that the required levels of care and treatment are provided to the prisoner concerned		Sections 52(3)(a) or (b)
38	MHCA 38	Application to magistrate for continued detention of a mentally ill prisoner		-Sections 58(3)
39	MHCA 39	Application to master of high court for the appointment of administrator		Sections 60(1) and (2)
40	MHCA 40	Decision by master of the high court on appointment of an administrator		Section 60(8) of the Act]
41	MHCA 41	Notice of appeal to high court judge in chambers regarding the decision of the master of the high court to appoint or not to appoint an administrator		Sections 60(10)
42	MHCA 42	Notice of decision of high court to appoint an administrator or to terminate the appointment of an administrator		Sections – 61(3) – 64(3)
43	MHCA 43	Notice of appointment of administrator		Section 62
44	MHCA 44	Application for termination of term of office of an administrator and the decision of the master of the high court		Section 64
45	MHCA 45	Notice of appeal to high court judge in chambers regarding the application for the termination of the term of office of an administrator		Section 64(5)
46	MHCA 46	Notice of appeal to high court judge in chambers regarding the application for the termination of the term of office of an administrator		Section 64(5) of the Act]

Limbic System

No	Area	Function
1	Thalamus	– Sleep regulation – Alertness – Consciousness
2	Hypothalamus	– Sleep – Hunger – fatigue – Body Temperature
3	Basal ganglia	– Control of emotions – Movement control – learning – habits – Emotions
4	Hippocampus	– Memory – Navigation
5	Amygdala	– Memory – Decision making – Emotions

MENTAL STATUS EXAMINATION
The mental status examination (MSE) is the psychiatric and neurologic equivalent of the physical examination, combining objective observation with subjective patient reporting to document an individual’s mental state at the time of evaluation (Hall, 2015).

NO	ASPECT	NOTES
1	APPEARANCE (inkangeleko)	– Young patient / middle age – Well groomed – Neatly dressed – no body markings/no tattoos – No self-inflicted injuries
2	BEHAVIOUR (ukuziphatha)	1. Psychomotor level 2. Attitude towards the interviewer. 3. Facial expressions. 4. Eye contact.
3	MOOD	Dysphoric / Elevated / Euthymic / Expansive / Irritable
4	AFFECT	1. State 2. Range 3. Appropriateness 4. Congruence
5	SPEECH (ukuthetha)	– Flow Rate (isantya): Normal / Pressure of speech/ rapid / slow / lacking content. – Quantity (ubungakanani): Expansile / Talkative / Poor / paucity – Tone/Prosody (ukutshintsha-tshintsha kwesandi): Noram/Loud/ soft/ shaking/ tremulous/ dull. – Fluency Rhythm (ubuciko nobuchule): clear / well-articulated / aphasic / hesitant. – Route: Linear / Circumstantial / Tangential.
6	THOUGHT PROCESS (inkqubo yengcingo)	Associations Rate or Flow
7	THOUGHT CONTENT (ubuzaza bengcingo)	– Suicidal ideation – Homicidal ideation – Delusions – Hallucinations – Obsessions & Compulsions – Feelings of derealization & depersonalization
8	COGNITION	Oriented (4): Person / Place / Time / Situation Concentration & Attention Memory
9	JUDGEMENT	Ability to interpret situations correctly in relation to actions taken
10	INSIGHT	Understanding of current situation.

DSM-5 bipolar and related disorders

1. Bipolar I disorder
2. Bipolar II disorder
3. Cyclothymic disorder
4. Substance/medication-induced bipolar and related disorder
5. Bipolar and related disorder due to another medical condition
6. Other specified bipolar and related disorder
7. Unspecified bipolar and related disorder

Bipolar 1 Disorder

	Criteria	Criteria explanation
A	Mood bloating	≥ 7 days of irritable or concerningly elevated mood
B	Mania ++ (Ukudlamka gqitha)	≥ 3 of mania symptoms: (1) self-esteem soaring or grandiosity (2) sleep not needed and decreased (3) talkative more than usual + pressure (4) ideas and thoughts fast (5) distracted easily (6) goal seeking or psychomotor agitation (7) Reckless pleasurable activities (Vs Hypomania: Not present in hypomaina)
C	Mood Mixing	Symptoms do not meet criteria for a mixed episode (Vs Hypomania: present)
D	Normal functioning	– mood disturbance interferes with normal functioning occupationally and socially – ±History of hospitalisation due to mood disturbance
E	Medical explanation	– Symptoms are not due to general medical condition – Symptoms are not due to substances

Bipolar recommendations by American Family Physicians 2021

No	Item	Recommendation
1	Depression screening	All patients ≥ 12 years and older for depression All pregnant patients in the perinatal period.
2	Acute mania 1 agent treatment	Lithium Valproic acid
3	Acute mania Combination treatment	Lithium + quetiapine / risperidone Valproic acid + quetiapine / risperidone
4	Acute bipolar depression 1 agent treatment	Quetiapine and cariprazine (Vraylar)
5	Acute bipolar depression Combination treatment	Lithium + Lurasidone Valproic acid + Lurasidone
6	Bipolar disorder maintenance	Lithium Quetiapine Quetiapine + Lithium Quetiapine + Valproic acid

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Schizophrenia Spectrum Psychotic Disorders

• Schizotypal (Personality) Disorder
• Delusional Disorder
• Brief Psychotic Disorder
• Schizophreniform Disorder
• Schizophrenia
• Schizoaffective Disorder
• Substance/Medication-Induced Psychotic Disorder
• Psychotic Disorder Due to Another Medical Condition
• Catatonia Associated With Another Mental Disorder (Catatonia
  Specifier)
• Catatonic Disorder Due to Another Medical Condition
• Unspecified Catatonia
• Other Specified Schizophrenia Spectrum and Other Psychotic
  Disorder
• Unspecified Schizophrenia Spectrum and Other Psychotic Disorder

No	Psychotic	Definition
1	Schizotypal (Personality) Disorder	“Psychiatric disorder characterized by deficits in social and interpersonal skills, highlighted by a reduced ability to form close relationships, occurring in the setting of eccentric behavior and cognitive or perceptual distortions.” Zachariah Francois; Tyler J. Torrico
2	Delusional Disorder	“A delusion is a fixed false belief based on an inaccurate interpretation of an external reality despite evidence to the contrary. The diagnosis of a delusional disorder is made when a person has one or more non-bizarre (situations that are not real but also not impossible) delusional thoughts for one month or more that cannot be explained by any other condition.” Shawn M. Joseph; Waquar Siddiqui.
3	Brief Psychotic Disorder	“Brief psychotic disorder (BPD) according to DSM-5 is the sudden onset of psychotic behavior that lasts less than 1 month followed by complete remission with possible future relapses. It is differentiated from schizophreniform disorder and schizophrenia by the duration of the psychosis.” Anu Stephen; Forshing Lui
4	Schizophreniform Disorder	Schizophreniform disorder is characterized by symptoms identical to those of schizophrenia but that last ≥ 1 month but < 6 months.” Carol Tamminga
5	Schizophrenia	1
6	Schizoaffective Disorder	1

THOUGHT ABNORMALITY
Abnormal thought process (formal thought disorder) and abnormal thought content represent distinct psychopathological domains: formal thought disorder (FTD) concerns the form, flow, and organization of thinking, while abnormal thought content concerns the themes and substance of what is though (Jerónimo et al., 2018; Chapman & Chapman, 1975).

Organic Mood Disorders (DIMTOP)

D	DRUGS	Cannabis Cortisone Levodopa Cocaine Amphetamine Methylphenidate TAD (Amitriptyline, Clomipramine, Imipramine, Dosulepin) MOAI (moclobemide, tranylcypromine) St John‟s Wort
I	INFECTION	– AIDS – Encephalitis – Syphilis tertiary
M	MEDICAL CONDITION	– Hyperthyroidism – Vitamin deficiency (812, folate, thiamine) – Cushing’s syndrome
T	TRAUMA	– Temporal lobe epilepsy – Inter-ictal psychosis – Frontal lobe lesions
O	OXYGEN
P	Psychological

Important Basic Work-up for GMC

No	Test	Notes
1	FBC	– Leucocytes – Infection
2	U + E, Creatinine, eGFR	– Renal impairment / failure
3	CRP	– Normal: < 10 mg/L
4	ESR	– Males 0–15 mm/1 hr – Females 0–25 mm/1 hr.
5	Folate	– Normal: 7.0 – 46.4 nmol/L
6	B12	– Normal: 138 – 652 pmol/L
7	TFT	– Normal TSH: 0.34 – 5.60 mIU/L – Normal Thyroxine (Free T4): 7.6 – 16.1 pmol/L
8	RPR	– Syphilis
9	HIV	– Rapid
10	Lumbar puncture	– Meningitis

Substances

No	Substances	Examples	Chemical	Pictures
1	Alcohol (F10)	Utywala	Ethanol
2	Amphetamine (F15)	Ritalin	methylphenidate hydrochloride	k
3	Benzodiazepine (Y11)	H	j	k
4	Cannabis (F12 1.Cannabis sativa 2.Cannabis indica 3.Cannabis ruderalis	intsango	Tetrahydrocannabinol (THC)
5	Methamphetamine (Y49.7)	Tik / Ecstasy /	N-methylamphetamine
6	Methaqualone (F13.2)	Mandrax	Methaqualone
7	Narcotic (F14)	Cocaine	cocaine hydrochloride	k
8	Nicotine (F17)	Icuba	Nicotine
9	Opioid (F11)	Nyaope / heroin	Diamorphine / diacetylmorphine

Psychiatry Emergencies

Aggressive Patient

Delirium
Delirium is an acute neuropsychiatric syndrome characterized by a disturbance in attention, awareness, and cognition that develops over a short period and fluctuates in severity (Wilson et al., 2020), (Fan et al., 2024). Delirium is caused by an underlying medical condition, substance intoxication or withdrawal, or toxin exposure, and cannot be better explained by a pre-existing neurocognitive disorder (Wilson et al., 2020), (Slooter et al., 2020).

1	Typical antipsychotics / 1st Gen	Haloperidol	– 0.5 – 5 mg PO/IM O.D. (or in divided doses) – 0.5 – 5 mg IV 8 hourly PRN	Antipsychotic of choice Start with lowest doses ECG and close monitoring with IV
2	Atypical antipsychotics / 2nd Gen	Risperidone	0.5 – 1 mg PO B.D.	If haloperidol is contraindicated
3	Benzodiazepine	Lorazepam Clonazepam Diazepam	1 – 4 mg PO/IM/slow IV 8 hourly PRN 0.5 – 2 mg PO/IM/slow IV 8 hourly PRN	Diazepam preferred for alcohol withdrawal

Psychosis
Psychosis is a set of clinical symptoms, primarily hallucinations, delusions, and disordered thinking, that results in a distorted sense of reality and is observed across multiple psychiatric disorders (Rawani et al., 2024), (Sheffield et al., 2018).

No	Drug Class	Drug Example	Dose	Notes
1	Typical antipsychotic	Haloperidol	2.5 – 5 mg IM	…
2	Atypical antipsychotic	Clotiapine	20 – 80 mg IMI	– If Haloperidol contraindicated.
3	Benzodiazepine	Lorazepam Clonazepam	2 – 4 mg IM/IV 1 – 2 mg IM/IV	Lorazepam or Clonazepam
4	Antihistamine	Promethazine	25 – 50 mg IM	– Phenothiazine derivative which is non-selective. – sedating antihistamine

Neuroleptic malignant Syndrome (NMS)
Neuroleptic malignant syndrome (NMS) is a rare, potentially fatal idiosyncratic reaction to dopamine receptor–blocking medications, primarily antipsychotics (Caroff & Mann, 2000); (Berman, 2011).

1	Antipsychotic discontinuation	–	–
2	Supportive care (hydration, cooling)	–	–
3	Dopamine agonist (Moderate-to-severe cases)	Bromocriptine	2 – 5 mg PO
4	Weak Dopamine agonist	Amantadine	100 mg PO
5	Direct acting muscle relaxant	Dantrolene	1 mg/kg IV 6 hourly

Mental Health Definitions

Term	DEFINITION
Accountability	Forensic definition Ability to distinguish between right and wrong
Affective disorders	DSM 3 reference to conditions encountered during bipolar such as depression, and euphoria, irritability, decreased need for sleep, and hyperactivity. Replaced by “mood disorder” in DSM 3-R Affect is fluctuating and mood is more sustained and pervasive.
Assisted psychiatry care admission	Provision of mental healthcare to MHCU who is deemed not capable of making an informed decision about their care but is not refusing
Asyndesis	a though disorder resulting in the speech having no connection or link between ideas – Cameron
Catatonia	An abnormal mental state referring to immobility or abnormal movements. [kata = down, tonia = tone]
Circumstantiality	Indirect circular thinking or speaking that results in the MHCU deviating from the focal point of the topic or question before the MHCU returns to the focal point.
Cognition	Utilisation of higher cortical functions e.g. logic, thinking and reasoning, to communicate with others.
Delusions	– Bizarre delusions, Control delusions, Grandeur delusions, Nihilistic delusions, persecution delusions, reference delusions, somatic delusions, Systematised delusions
Derailment	Derailment is a sign of the disturbance of the thought form (Thought Form disorder) where the subjects off ramps and never returns to the topic probed by interviewer. – FTD (anatomy) – Schneider
Fault	Forensic definition Fault is a blameworthy and reprehensible state of mind. – Negligence – Intention
Formal Thought Disorder (FTD)	Loss of abstract thinking. Mainly associated with schizophrenia. – Positive FTD vs Negative FTD
Insight	depth of cognitive and emotional understanding of condition Part of MSE
Judgement	Part of MSE capacity to make appropriate decisions
Liability	Whether a person can be held responsible for his or her actions in criminal proceeding
Logoclonia	Perseveration type
Mania ukudlamka gqitha	An abnormal and concerning high energy mental state which clusters symptoms and signs that are indicating increased abnormal mental energy and poorly regulated brain activity.
Metonyms	Incorrect use of words – TD – Cameron
Mood	Mood is defined as a pervasive and sustained feeling tone that is endured internally and which impacts nearly all aspects of a person’s behaviour in the external world. (Sandeep Sekhon; Vikas Gupta) D – Depressed (hypothymic)/ I – Irritable / S – Suicidal / H – Hypomanic/ E – Euthymic / D – Depressed (hypothymic)
Omission	– TD – Schneider
Overinclusions	The poor understanding of conceptual boundaries resulting linking of mutlpile seperated thoughts – TD – Cameron
Palilalia	Perseveration type
Perseveration	The mental response is beyond the scope of the initial stimulus. The response is beyond the scope of relevancy. Ideation perseveration and verbal perseveration
Positive symptoms	– Delusions – Hallucinations
Psychomotor	Body movement that results from mental activity.
Substitution	– TD – Schneider
Tourette’s Syndrome	Tics

MEDICATION LIST

DRUG	DRUG CLASS	SAMF INDICATIONS	DOSING	NOTES
Amantadine	Weak Dopamine agonist	NMS	100 mg PO TDS or QID	Alternative to bromocriptine
Bromocriptine	Dopamine agonist	NMS	2.5 mg orally B.D. initially, gradually increasing to 5 mg 3-times a day	….
Chlorpromazine LARGACTIL	Typical antipsychotics / 1st Gen Phenothiazine	– Psychotic disorders – BPD Agitation and aggression – BPD Mania – Schizophrenia – Intractable hiccups pg 506	Oral 25 mg PO B.D. or T.D.S. IM 25 – 50 mg IM PRN T.D.S. or Q.I.D.	– Use lowest possible effective dose. – Oral preferred over IM.
Clozapine	– Atypical antipsychotics / 2nd Gen	– Psychotic disorders (Recurrent suicidal behaviour) – Schizophrenia (rx resistant) – akinetic rigidity syndrome – DIP	initiation 12.5 – 25 mg [200 – 450 mg/day]	– Consultants initiated – Gradually reach therapeutic doses over 2 – 3 weeks
Flupenthixol	Typical antipsychotics / 1st Gen	– Psychotic disorders – Schizophrenia	Oral 3 – 9 mg B.D. PO [max 18 mg/day] Deep IM 10 mg test dose 20 – 60 mg every 2 – 4 weeks	….
Haloperidol SERENACE	Typical antipsychotics / 1st Gen	– Psychotic disorders – Schizophrenia – Tourette’s Syndrome – Agitated / aggressive behaviour	Initially 0.5 – 5 mg B.D. or TDS (maximum of 20 mg/day) [2 – 10 mg/day]	….
Lithium	Mood Stabiliser	– Mania prophylaxis – Hypomania prophylaxis – Recurrent unipolar depression	20 mg/kg/day (750 – 1500 mg/day) divided doses	Plasma concentration: 0.8 – 1.2 (acute mania) Plasma concentration: 0.6 – 0.8 (mania prophylaxis) Plasma concentration: 0.4 – 0.8 (depression prophylaxis)
Olanzapine	– Atypical antipsychotics / 2nd Gen	– BPD Mania – BPD Depression	5 – 20 mg O.D. nocte	– Consultants initiated – Weight Gain / sdudla – DM
Quetiapine	– Atypical antipsychotics / 2nd Gen	– BPD mania – Schizophrenia	Immediate Release (B.D.) BPMD mania – Day 1: 100 mg/day – Day 2: 200 mg/day – Day 3: 300 mg/day – Day 4: 400 mg/day (400 – 800 mg/day) Schizophrenia – Day 1: 50 mg/day – Day 2: 100 mg/day – Day 3: 200 mg/day – Day 4: 300 mg/day [Max 750 mg/day] Slow-Release (O.D.) Schizophrenia – Day 1: 300 mg/day – Day 2: 600 mg/day – Day 3: max 800 mg/day [400 – 800 mg/day]	….
Risperidone	– Atypical antipsychotics / 2nd Gen	– BPMD mania – Schizophrenia – Dementia behavioural disturbances	BPMD mania – 2 – 3 mg O.D. (adjust by 1 mg/day) [1 – 6 mg/day] Schizophrenia – Day 1: 2mg/day – Day 2: 4mg/day – Day 3: max 6 mg/day [4 – 8 mg/day] Dementia – Day 1: 0.25 mg B.D. – Day 2: 0.50 mg B.D. – Day 1: 1 mg B.D. [max]	……..
Valproic acid Epilim	Mood Stabiliser Antiepileptic Fatty acid	BPD mania	400 – 900 mg divided (up 1500 in highly agitated pt) [1 – 2 g/day]	……..
Zuclopenthixol Clopixol	Typical antipsychotics / 1st Gen	– Psychotic disorders – Schizophrenia	Deep IM (Maintenance) Test dose 50 – 100 mg 200 – 400 mg 2-4 weekly. IM (Aute) 50 – 150 mg IM may be repeated after 2-3 days [max 400 mg per 14 days] Oral 10 – 50 mg/day	high risk of EPS Initiated with test doses

DRUG	YEAR	CLASS
Paliperidone	2006	Atypical Antipsychotic / 2nd GEN
Aripiprazole	2002	Atypical Antipsychotic / 2nd GEN
Quetiapine	1997	Atypical Antipsychotic / 2nd GEN
Olanzapine	1996	Atypical Antipsychotic / 2nd GEN
Risperidone	1994	Atypical Antipsychotic / 2nd GEN
Ziprasidone	1987	Atypical Antipsychotic / 2nd GEN
Clotiapine	1970	Atypical Antipsychotic / 2nd GEN
Amisulpride	1975	Atypical Antipsychotic / 2nd GEN
Sulpiride	1967	Typical Antipsychotic / 1st GEN
Valproic acid	1967	Mood Stabilizer
Flupentixol	1965	Typical Antipsychotic / 1st GEN
Pimozide	1963	Typical Antipsychotic / 1st GEN
Zuclopenthixol	1962	Typical Antipsychotic / 1st GEN
Clozapine	1959	Atypical Antipsychotic / 2nd GEN
Haloperidol	1958	Typical Antipsychotic / 1st GEN
Chlorpromazine	1952	Typical Antipsychotic / 1st GEN
Lithium	1949	Mood Stabilizer

Psychological interventions

Psychological interventions	Exp	Conditions
Acceptance and commitment therapy (ACT)	….	….
Cognitive behaviour therapy (CBT)	d	l
Dialectical behaviour therapy (DBT)	d	l
Emotion-focused therapy (EFT)	d	l
Eye movement desensitisation and reprocessing (EMDR)	d	j
Family therapy and family-based interventions	d	h
Hypnotherapy	d	g
Interpersonal psychotherapy (IPT)	d	j
Mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR)	d	l
Narrative therapy	d	f
Play therapy (children)	d	h
Psychodynamic psychotherapy	d	h
Psychoeducation	d	g
Schema-focused therapy	d	h
Self-help	d	i
Solution-focused brief therapy (SFBT)	d	h

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REFERENCES

Berman, B. D. (2011). Neuroleptic malignant syndrome: a review for neurohospitalists: A review for neurohospitalists. The Neurohospitalist, 1(1), 41–47. https://doi.org/10.1177/1941875210386491 Caroff, S. N., & Mann, S. C. (2000). Neuroleptic malignant syndrome. Psychiatric Annals, 30(5), 308–308. https://doi.org/10.3928/0048-5713-20000501-07 Chapman, L. J., & Chapman, J. P. (1975). How to test hypotheses about schizophrenic thought disorder. Schizophrenia Bulletin, 1(12), 42–59. https://doi.org/10.1093/schbul/1.12.42 Fan, Y.-Y., Luo, R.-Y., Wang, M.-T., Yuan, C.-Y., Sun, Y.-Y., & Jing, J.-Y. (2024). Mechanisms underlying delirium in patients with critical illness. Frontiers in Aging Neuroscience, 16, 1446523. https://doi.org/10.3389/fnagi.2024.1446523 Hall, R. C. W. (2015). Mental Status: Examination. In Wiley Encyclopedia of Forensic Science (pp. 1–8). John Wiley & Sons, Ltd. Jerónimo, J., Queirós, T., Cheniaux, E., & Telles-Correia, D. (2018). Formal Thought Disorders-historical roots. Frontiers in Psychiatry, 9, 572. https://doi.org/10.3389/fpsyt.2018.00572 Rawani, N. S., Chan, A. W., Dursun, S. M., & Baker, G. B. (2024). The underlying neurobiological mechanisms of psychosis: Focus on neurotransmission dysregulation, neuroinflammation, oxidative stress, and mitochondrial dysfunction. Antioxidants (Basel, Switzerland), 13(6), 709. https://doi.org/10.3390/antiox13060709 Sheffield, J. M., Karcher, N. R., & Barch, D. M. (2018). Cognitive deficits in psychotic disorders: A lifespan perspective. Neuropsychology Review, 28(4), 509–533. https://doi.org/10.1007/s11065-018-9388-2 Slooter, A. J. C., Otte, W. M., Devlin, J. W., Arora, R. C., Bleck, T. P., Claassen, J., Duprey, M. S., Ely, E. W., Kaplan, P. W., Latronico, N., Morandi, A., Neufeld, K. J., Sharshar, T., MacLullich, A. M. J., & Stevens, R. D. (2020). Updated nomenclature of delirium and acute encephalopathy: statement of ten Societies. Intensive Care Medicine, 46(5), 1020–1022. https://doi.org/10.1007/s00134-019-05907-4 Wilson, J. E., Mart, M. F., Cunningham, C., Shehabi, Y., Girard, T. D., MacLullich, A. M. J., Slooter, A. J. C., & Ely, E. W. (2020). Delirium. Nature Reviews. Disease Primers, 6(1), 90. https://doi.org/10.1038/s41572-020-00223-4