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rose_lotus

Alcohol and mental illness

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I wish to discuss an interesting patient we happened to see this morning.He was referred by his GP who inturn received a call from domestics about the patient being unwell physically.H/o of self neglect present.Alcohol has been an issue for many years.

He was seen by the GP today with regards to his physical health.Patient has got chest infection and has been usteady on his feet.There is H/O of diabetes and but its unclear.Past history of lung tumour[2 years ago].He is declining any kind of intervention as of now.

We happen to see him together[me,CPN,GP and the GP registrar].He was under the influence of alcohol.He was communicative and interactive.Did not wished to go to hospital.'I would rather die at home'.He seems to have capacity to withold treatment but needs further assessement[as he was under the influence of alcohol].

He has not been known to mental health services in the past.GP thinks that mental health issues may be contributing to self neglect..........

What would be the best way forward for this gentleman?

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Sounds like he needs a lot of support. He would need to be assessed when not intoxicated. Capacity is dynamic, so there might be a different picture soon. Is there underlying/ comorbid depression that needs to be treated? Has he any social network of support.

I hope he gets the help he needs.

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difficult to say if he had underlying/comorbid depression.But he is neglecting himself[do not know if it is in context of mental illness].Is self neglect/alcohol dependence/being vulnerable sufficient grounds for detaining a patient?There is a possibility that he is depressed secondary to alcohol misuse...and it hasn't been picked up so far.Also he hasn't been to GP for addressing his concerns.

Patients are detained under the mental health act---with a risk of self neglect in context with mental health issues.Then is is not possible to go on with similar route where there is suspicion of mental health issues[not clarified so far]..............keeping in mind that mental health problems

go unnoticed in the community most of the times.

Please express your views as to how to manage this patient[in his best interest]

Many thanks

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this patient is a difficult one to manage. as mentioned by justme that he needs to be get assessed when sober. it seems like he was under inflence to some extent when you all saw him, and he was a bit angry and refuse to accept any intervention.

i would like to enquire few things about this patient as to.......... is he in follow up for his, chest tumor and is it malignant. is he taking any treatment.

what about his diabeties is he compliant to his diabetic treatment.

how bad is chest infection may need to get in hospital under common law...

what quantity of alcohol is he consming as u said it is an issue...... is he dependant? what duration....

another issue is he is self neglecting................ what is the main cause for it............ is it alcohol dependance or is he physically so unwell he can not take care of himself or does he have any psychiatric diagnosis depression or psychotic. (needs assessment). what is the extent of self neglect is it dangerous.........

any other dug use

does he go out and buy his drinks daily, if so he is functional to some extent....

what about his food, does he cook or someone help him with that....

if he is saying he would rather prefer to die at home, there could be risk involve he may try to commit suicide.... is that a case with him... is there any past history of self harm.... if this is a case you may have reasons to use detention and detox him on ward, but life is never so easy.

this man is in terrible state and needs support for sure..... all depends on how far he agree to

accept support. assess capacity, discuss with him about options, a bit of motivational interviewing, involve community alcohol team....

family or friends?????

any risks to neighbours.... any forensic history.

he did let you in house so he may want to get treatment.... so keep trying i think so......

do reply back about outcome..................thanks

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He is in a state where he cannot be off alcohol in the community[withdrawals plus management problems].He needs to be in hospital for IV antibiotics[chest infection]and alcohol detox programme.I understand that capacity is a big issue-----------but capacity is assessed in context of mental disability.And if he is going to be under the influence of alcohol all the time then nobody can assess the capacity to conscent/with hold treatment[for he may understand the information but may be unable to retain it to make the right judgement ie may be unable to weigh

the risks and benefits.

So,keeping the difficult situation in mind can he be detained under the mental health act?Probably section 3 but again section 3 is for detaining patients for treatment of mental health issues and not physical health problems........then where does alcohol dependence stand?Alcohol dependence which may or maynot present with co-morbid depression.Section 2 is for assessement which could a way forward but can he be transferred to medical wards immediately?.N/S would never accept a patient who is so unwell physically.

Any other options?

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If this guy is not depressed, he must be mad! :lol:

you mean if he is not sad...

but he could be just plain bad ... 'if you know what I mean' (as quoted by Ryan Stiles)

BTW... How old is the guy...

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while we're on the subject of alcohol and mental illness...

if you see a patient with alcohol and depression and you feel that the alcohol abuse is primary and the depression is secondary to that, how long would he have to remain abstinent from alcohol for before he is prescribed an antidepressant (assuming no risks involved of course)???

I was under the impression of 4 weeks.. any thoughts anybody??

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He is in a state where he cannot be off alcohol in the community[withdrawals plus management problems].He needs to be in hospital for IV antibiotics[chest infection]and alcohol detox programme.I understand that capacity is a big issue-----------but capacity is assessed in context of mental disability.And if he is going to be under the influence of alcohol all the time then nobody can assess the capacity to conscent/with hold treatment[for he may understand the information  but may be unable to retain it to make the right judgement ie may be unable to weigh

the risks and benefits.

So,keeping the difficult situation in mind can he be detained under the mental health act?Probably section 3 but again section 3 is for detaining patients for treatment of mental health issues and not physical health problems........then where does alcohol dependence stand?Alcohol dependence which may or maynot present with co-morbid depression.Section 2 is for assessement which could a way forward but can he be transferred to medical wards immediately?.N/S would never accept a patient who is so unwell physically.

Any other options?

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If this guy is not depressed, he must be mad! :lol:

you mean if he is not sad...

but he could be just plain bad ... 'if you know what I mean' (as quoted by Ryan Stiles)

BTW... How old is the guy...

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while we're on the subject of alcohol and mental illness...

if you see a patient with alcohol and depression and you feel that the alcohol abuse is primary and the depression is secondary to that, how long would he have to remain abstinent from alcohol for before he is prescribed an antidepressant (assuming no risks involved of course)???

I was under the impression of 4 weeks.. any thoughts anybody??

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