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  <head>
    <title>045-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Mental state, capacity, risk, and common syndromes">
      <outline text="Orientation and history">
        <outline text="Story, mental state, physical, collateral, course"/>
        <outline text="Causes include drugs, infection, neurology, endocrine, stress"/>
        <outline text="Distress does not remove autonomy">
          <outline text="A label does not determine capacity or risk"/>
        </outline>
        <outline text="Privacy, roles, confidentiality limits, interpreter"/>
        <outline text="Address instability, intoxication, violence, dependants"/>
        <outline text="Begin with what happened, why now, what is wanted"/>
        <outline text="Collateral when cognition, psychosis, or risk limits history">
          <outline text="Receive without disclosing confidential details"/>
        </outline>
      </outline>
      <outline text="Mental state examination">
        <outline text="Describes the current encounter"/>
        <outline text="Appearance and behaviour without moral judgement"/>
        <outline text="Mood is subjective, affect is observed">
          <outline text="Reported and observed emotion can differ"/>
        </outline>
        <outline text="Thought form: how ideas connect"/>
        <outline text="Thought content: guilt, delusions, self-harm">
          <outline text="Delusion: fixed false belief outside cultural context"/>
        </outline>
        <outline text="Visual hallucinations: neurological, substance, delirium causes"/>
        <outline text="Inattention and fluctuation suggest delirium"/>
        <outline text="Insight and judgement are not agreement"/>
      </outline>
      <outline text="Formulation and differential diagnosis">
        <outline text="Predisposing, precipitating, perpetuating, protective">
          <outline text="Across biological, psychological, social domains"/>
        </outline>
        <outline text="Explains this person, not a list of labels"/>
        <outline text="Exclude medical and substance causes by phenotype">
          <outline text="Sudden or late onset, fluctuating attention"/>
          <outline text="Focal neurology, fever, seizures, medication change"/>
        </outline>
        <outline text="Targeted tests; broad screening yields incidental findings"/>
      </outline>
      <outline text="Decision-making capacity">
        <outline text="Specific to the decision and time"/>
        <outline text="Understand, retain, weigh, communicate"/>
        <outline text="Support: interpreter, aids, pain relief, simple words"/>
        <outline text="An unwise choice does not prove incapacity"/>
        <outline text="Delusion matters only if it blocks weighing"/>
        <outline text="If absent: necessity, directives, substitutes, law">
          <outline text="Least restrictive alternative"/>
          <outline text="Document evidence, support, reasoning, review"/>
        </outline>
      </outline>
      <outline text="Suicide and self-harm risk">
        <outline text="Ask directly about thoughts, plans, intent, means">
          <outline text="Asking does not implant the idea"/>
        </outline>
        <outline text="Not a score or low-medium-high label">
          <outline text="Formulate dynamic and enduring factors, scenarios"/>
        </outline>
        <outline text="Urgency: discharge, intent, commands, intoxication"/>
        <outline text="Safety plan is collaborative and specific">
          <outline text="Warning signs, coping, contacts, means restriction"/>
          <outline text="Not a promise or no-suicide contract"/>
        </outline>
      </outline>
      <outline text="Violence, vulnerability, and neglect">
        <outline text="Threats, targets, weapons, persecutory beliefs"/>
        <outline text="Most people with mental illness are not violent">
          <outline text="Substances, past behaviour, access predict more"/>
        </outline>
        <outline text="Vulnerability: exploitation, abuse, dependants"/>
        <outline text="De-escalation: calm voice, space, choices, limits"/>
      </outline>
      <outline text="Depression and mania">
        <outline text="Low mood or loss of interest with change"/>
        <outline text="Grief does not exclude major depression"/>
        <outline text="Consider bipolar history, thyroid, anaemia, medicines"/>
        <outline text="Antidepressants take time and have side effects"/>
        <outline text="Electroconvulsive therapy for severe depression"/>
        <outline text="Mania: marked impairment or psychosis">
          <outline text="Hypomania is less severe"/>
        </outline>
        <outline text="Lithium toxicity from dehydration and interactions"/>
      </outline>
      <outline text="Anxiety, obsessive-compulsive, and trauma">
        <outline text="Panic mimics arrhythmia, asthma, seizure"/>
        <outline text="Cognitive behavioural and exposure therapy reduce avoidance"/>
        <outline text="Long-term benzodiazepines: dependence, falls"/>
        <outline text="Obsessions intrude, compulsions reduce distress"/>
        <outline text="Post-traumatic stress: re-experiencing, avoidance"/>
        <outline text="Trauma-informed care: choice and control">
          <outline text="No detailed retelling at every assessment"/>
        </outline>
      </outline>
      <outline text="Psychosis and catatonia">
        <outline text="Delusions, hallucinations, disorganisation"/>
        <outline text="First episode needs longitudinal exclusion"/>
        <outline text="Antipsychotics: metabolic, QT, movement harms"/>
        <outline text="Clozapine for resistant illness, needs monitoring"/>
        <outline text="Catatonia: immobility, mutism, posturing">
          <outline text="Dehydration, thrombosis, malignant deterioration"/>
          <outline text="Benzodiazepine challenge and electroconvulsive therapy"/>
          <outline text="Antipsychotics can worsen some cases"/>
        </outline>
      </outline>
      <outline text="Substance, eating, and personality">
        <outline text="Ask nonjudgmentally about use and goals"/>
        <outline text="Positive toxicology is not current impairment"/>
        <outline text="Alcohol and sedative withdrawal: seizure, delirium"/>
        <outline text="Eating disorders occur at any body size">
          <outline text="Refeeding shifts phosphate and fluid"/>
        </outline>
        <outline text="Personality diagnosis needs longitudinal context">
          <outline text="Not pejorative shorthand"/>
          <outline text="Consistent boundaries, avoid splitting teams"/>
        </outline>
      </outline>
    </outline>
  </body>
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