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aparanjothi

medical issues

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Hi i've got a patient who's under the section 2 of the MHA currently admitted for psychotic symptoms.

she'a a known case of personality disorder.

She was on long term anticoagulation (warfarin) forllowing DVT's and PE.

currently she refuses to take the warfarin and her INR is 1.2.

she refuses all medication.

can we treat her with Low molecular weight heparin under the sect-2.

How to go about with this issue.

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mate how will u treat her with 'low molecular weight heparin' when u yourself have said that she is refusing all treatment??

Does heparin in ur trust look like sundae ice-cream?

cheers

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Certainly Not Mr Scorpio

Taken the past medical history, this patient had a high risk of DVT when mentally unwell and refusing warfarin.

I was worried and discussed with my consultant who told that we cannot treat medical illness under the sect-2, when i had a chat with the staff grade i was informed that we can treat under common law and i was asked to prescribe Fragmin s/c.

I was not completly satisfied and the nursing staff were weary too.

i was expecting something useful or a responce from someone who had a similar situation in the past,.,. NOT A COOL COOL ICE CREAM.

tHANKS

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can we treat her with Low molecular weight heparin under the sect-2.

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oreta is correct. if you do decide she lacks capacity, i'd also suggest making sure that the how you came to that decision, the rationale for treatment, the fact that it is being done in her best interests under common law due to lack of capacity, the fact that you discussed it with your consultant who agreed (and preferrably saw and assessed the patient) is clearly documented.

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Also it would be good idea to speak to trust solicitors and MDU as you cannot treat medical illness under setion 2 if patient has capacity to consent

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Why is the patient on section 2(which is an assessment section), if you know what the mental disorder is(psychotic symptoms as seem to say)

No comment has been made with regards to capacity.Remember the new capacity legislation in England & Wales.

Common law( I am no expert) to the best of my knowledge is only to be used to prevent immediate harm to life, not for a preventive measure(which is what Heparin is to the best of my knowledge)

Assessing this patient's capacity should be Done in the presence of Physicians( to explain side effects,risks of not taking Heparin etc.).

Finally speaking to other colleagues in the Trust,MPS or MDU & the Trust Solicitors is also essential to make sure you are firm ground.

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Why is the patient on section 2(which is an assessment section), if you know what the mental disorder is(psychotic symptoms as seem to say)

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If the patient has capacity to make to decision, then sometimes you just have to accept that patients make choices that do not seem sensible to us, and are entitled to do so. The mental health act only allows treatment for mental disorder. Although this may need to be reworded in the future as we learn more about the physical basis of mental illness. (I mean surely altering the receptor densities of a person's brain is a physical treatment...)

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ah, but as far as i know the current act isn't worder like that. it talks about treatment for metal disorder and allows you to treat that, so if you have someone with an acute confusional state you can treat the cause (which may well be antibiotics for the infection) it doesn't specifically exclude treatment of physical disorders, it just doesn't include them. (i could be wrong on all that though, cos i don't know the act inside out, that's just how i remember my sectio 12 course).

i do remember that it doesn't mention capacity at all, cos capacity wasn't invented back then.

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If her refusal for warfarin treatment is related to her psychosis ( i.e, delusional beliefs about taking warfarin) i guess you could treat her................ similar to treating anorexia under section,

but this again invovles the concept of capacity where in you have to establish her decision taking capacity is compromised because of abnormal mental state as a result of psychosis

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