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  <head>
    <title>045-02 Phenomenology, dynamic risk, capacity, and psychiatric medical safety</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Phenomenology, risk, capacity, and medical safety">
      <outline text="Phenomenology and observation">
        <outline text="Describe experiences before naming a syndrome"/>
        <outline text="&quot;Hearing a voice&quot; has many origins">
          <outline text="Hallucination, intrusive thought, dissociation, delirium"/>
          <outline text="Clarify location, quality, control, commands"/>
        </outline>
        <outline text="The interview is itself an examination">
          <outline text="Movements are observations, not interpretations"/>
        </outline>
        <outline text="Affect: range, intensity, stability, congruence">
          <outline text="Flatness: negative symptoms, depression, parkinsonism"/>
        </outline>
      </outline>
      <outline text="Thought form and content">
        <outline text="Circumstantial reaches the point; tangential does not"/>
        <outline text="Flight of ideas: rapid understandable links">
          <outline text="Loosening makes links hard to follow"/>
        </outline>
        <outline text="Explore evidence and conviction without arguing"/>
        <outline text="Obsession recognised as one&#x27;s own thought"/>
        <outline text="Delusion: conviction despite counterevidence">
          <outline text="Overvalued ideas lie between"/>
        </outline>
        <outline text="Insight is dimensional"/>
      </outline>
      <outline text="Cognition and delirium">
        <outline text="Screen if acute, atypical, late, or fluctuating"/>
        <outline text="Arousal and attention before memory">
          <outline text="Months backward and digit span catch inattention"/>
        </outline>
        <outline text="Psychosis and delirium can coexist"/>
        <outline text="Visual hallucinations, abnormal vitals suggest medical cause"/>
      </outline>
      <outline text="Decision-making capacity">
        <outline text="Functional, not a global cognitive label">
          <outline text="Food yes, complex discharge perhaps not"/>
        </outline>
        <outline text="Understand, retain, weigh against values, choose"/>
        <outline text="Reasoning process, not agreement, decides">
          <outline text="Rational refusal of surgery is possible"/>
        </outline>
        <outline text="Delusion counts only if it blocks the decision"/>
        <outline text="Record own-words understanding and weighing">
          <outline text="Diagnosis or test score is not a conclusion"/>
        </outline>
        <outline text="Fluctuating: decide at the best time of day"/>
        <outline text="Substitute judges by the person&#x27;s values"/>
      </outline>
      <outline text="Suicide risk and discharge">
        <outline text="Formulate foreseeable pathways, not a score"/>
        <outline text="High lethality, concealment, escalating intent"/>
        <outline text="Test protective factors for reliability"/>
        <outline text="&quot;Low risk&quot; implies false certainty"/>
        <outline text="No-suicide promise does not prevent action"/>
        <outline text="Discharge: housing, time alone, access to means">
          <outline text="Family presence is not proven support"/>
          <outline text="Post-discharge period stays changeable"/>
        </outline>
        <outline text="Handover: what changed, what to do"/>
      </outline>
      <outline text="Violence and emergency intervention">
        <outline text="Dynamic and contextual, beyond diagnosis"/>
        <outline text="Most are not violent, more often victims"/>
        <outline text="De-escalate: distance, one calm speaker, choices"/>
        <outline text="Restraint and medication as last resort">
          <outline text="Check allergy, pregnancy, QT before drugs"/>
          <outline text="Monitor airway, oxygenation, rhythm after"/>
          <outline text="Prevent positional asphyxia, rhabdomyolysis"/>
        </outline>
      </outline>
      <outline text="Depressive and manic syndromes">
        <outline text="Major depression can coexist with bereavement"/>
        <outline text="Bipolar depression: monotherapy may destabilise"/>
        <outline text="Thyroid, sleep apnoea, steroids can mimic"/>
        <outline text="ECT for psychotic, catatonic, life-threatening illness"/>
        <outline text="Reduced need for sleep: the person feels rested"/>
        <outline text="Impairment, psychosis, admission mean mania"/>
        <outline text="Manage financial, sexual, driving consequences"/>
      </outline>
      <outline text="Psychosis and catatonia">
        <outline text="Psychosis is a syndrome, not schizophrenia"/>
        <outline text="Negative symptoms overlap depression, sedation"/>
        <outline text="Organic red flags in first episode">
          <outline text="Fever, seizures, autonomic instability, postpartum"/>
          <outline text="Tests chosen by phenotype, not a panel"/>
        </outline>
        <outline text="Baseline weight, glucose, lipids before treatment">
          <outline text="Separates drug harm from disease change"/>
        </outline>
        <outline text="Catatonia: stupor, mutism, waxy flexibility">
          <outline text="Aspiration, thrombosis, contracture, hyperthermia"/>
          <outline text="ECT highly effective; antipsychotics may worsen"/>
        </outline>
      </outline>
      <outline text="Eating disorders and refeeding">
        <outline text="Unstable at any body size"/>
        <outline text="Insulin drives phosphate, potassium, magnesium into cells">
          <outline text="Sodium and water retained"/>
          <outline text="Thiamine deficiency and cardiac failure"/>
        </outline>
        <outline text="Risk from rate of loss, not current size"/>
        <outline text="Replace thiamine and electrolytes first"/>
        <outline text="Excessive caution prolongs undernutrition"/>
      </outline>
      <outline text="Substances and the final plan">
        <outline text="Specific, nonjudgmental substance history"/>
        <outline text="Opioid overdose is ventilatory failure"/>
        <outline text="Toxicology shows exposure, not impairment"/>
        <outline text="Separate medical crisis, syndrome, capacity, risk"/>
        <outline text="Beyond medication: sleep, housing, finances"/>
        <outline text="Record reassessment time and responsible person">
          <outline text="Uncertainty must not blur the safety plan"/>
        </outline>
      </outline>
    </outline>
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