SUBSTANCE USE DISORDERS

Differentiate misuse, abuse and socially accepted use.

1. Misuse-harmful use of substances (like drugs and alcohol) for non-medical purposes. 
the use of a substance for a purpose that is not consistent with legal or medical guidelines, most often
with prescription medications. 

2. abuse - DSM-5 no longer uses substance abuse or substance dependence.

 Health complications as a result of substance abuse

 Inability to carry out daily responsibilities
 Physical dependence
 Withdrawal symptoms if usage stops
 “Cravings” for drug or alcohol

3. socially accepted- Liquid lunch drinking and driving not ok

Be able to define intoxication, tolerance, dependence and withdrawal

1. Intoxication –induced by substance
2. Tolerance– Decreased responsiveness after repeated administration
3. Dependence–physiologic adaptation that occurs after prolonged exposure
4. Withdrawal – Adverse physiological or psychological reaction to reduced use of a substance. often
5. the opposite of the state of intoxication

Be able to differentiate between substance use and substance induced disorders.

1. substance use disorders- patterns of behavior around use, cravings
A cluster of cognitive, behavioral and physiologic
symptoms indicating that the individual continues using the
substance despite significant substance related problems”
“An important characteristic of substance use disorders is
an underlying change in brain circuitry that may persist
beyond detoxification”

2. substance induced disorders- Includes intoxication, withdrawal and other substance / medication induced
mental disorders
a. w/in 1mo of intoxication or w/d
b. substance can produce the mental d/o
c. CAUSE- genetic, MDD, GAD, social-poverty, environment
d. Schizo inc risk of substance abuse
e. Cuz- hallucination bc of drug use

1. intox, w/d, physical, psychological sx.

Alcohol induced psychotic disorder
Alcohol induced bipolar disorder

Roles of Dopamine in the reward pathways of the brain.

 1. Dopamine is the final common pathway for the mesolimbic reward system
a. Cocaine- potent dopamine 0-3hr
b. Nicotine 0-1hr
c. Amphetamin 1000K 0-2hr
d. Food, sex, gambling- less potent
e. POWERFUL dopamine reward motivates repeate
f. BUT- brain upreg less receptors, less dopamine. FEEL any pleasure gets lowered
2. GABA The universal inhibitor- Alcohol, Sedatives

Be familiar with the spectrum of substances recognized in the DSM, along with characteristics of associated use
disorders, intoxication, withdrawal and induced disorders associated with each.
1. Alcohol
a. Use do-strong desires, craveing, large amounts, desire
b. induced d/o- GAD, bipolar, schizophren, sleep, sexual, neurocog, psychotic
c. intoxication- aggressive, impaired, slurr, nystagmus, coma, stupor
d. w/d- tremors, , delirum

2. Caffeine
a. Use d/o-
b. induced d/o- GAD, sleep wake do
c. intoxication- flushed, restlessness, excite, diuresis, GI, muscle twitch, rambling, tachy
d. w/d-w/ 24hrs, HA, fatigue, irriatable, lack of concentatin, flu-like

3. Cannabis- THC delta 9 tehta hydrcannabinal, stimulant and sedative. Brain cannaboid receptors trigger
dopamine
a. Use d/o- impairment and distress cravings
b. induced d/o- psychotic, anxiety, sleep wake, impaired judgement, social withdrawa
c. intoxication- dry mouth, hallucinaton, inc RR, inc. appetite, eye injection
d. w/d- anger, irritable, anxiety, mood low. GI pain, tremor, sweating, chill HA

4. Hallucinogens
a. Use d/o craveing, large amounts, desire
b. induced d/o- hallucinong induced phsychotic, shizophrena, bipolar
c. intoxication- pupil dialate, tachy sweating, palpitation, blurring visaon, tremors. Gait.
d. w/d-

5. Inhalants
a. Use d/o- craveing, large amounts, desire
b. induced d/o- psychotic, GAD, neurocognitive, MDD, sucide
c. intoxication- MSK, DTR weak, dizzy, nystagmus, slur, gait, tremor, vision blure, euphoria
d. w/d-

6. Opioids
a. Use d/o- craveing, large amounts, desire
b. induced d/o- dysphoric mood, GAD, Sleep wake d/o, sex d/o
c. intoxication- euphoria followed by apathy, dysphoria, motor impaired, slowed, coma, slur,
pupliary constriction
d. w/d- pupil dialation, n/v, pain, rhinorrhea, yawning EXTREMELY unpleasant

7. Sedative Hypnotics
 a. Use d/o craveing, large amounts, desire
b. induced d/o- GAD, hallucinations
c. intoxication- slurr, incoordination, nystagmus, dec memory
d. w/d- sweat, PP over 100, tremor, N/v, grand mal seizures,

8. Stimulants- cocaine amphet, repeated us down regu in D2, can’t get to level they ant so OD and die
a. Use d/o- build a tolerance
b. induced d/o- heart failue, stoke seizures
c. intoxication- tachy or brady, pupil dialated, inc or low BP, n/v chills or sweat, chest pain,
seizures, respiratory depression
d. w/d- fatigue, unpleased dreams, inc appet , hyperomsina, slowed motor

9. Tobacco
a. Use d/o craveing, large amounts, desire
b. induced d/o- GAD, low mood
c. intoxication-
d. w/d- irritable, insomnia, inc appetitie, diff concentrating,

Principles of MAT such as when to consider and conditions for which it is available
1. Recovery for individual with substance do
2. When other approaches not working
3. Heavy usres
4. Client choice
5. Addition to counseling. NOT a DRUG tx
6. Substance use do
a. Nicotine
b. Alcohol
c. Opioid
i. Lower rates of hIV, HEP, mortaility
ii. Improve employment and relationship
iii. REPLACEMENT-Methodone, Suboxone
iv. BLOCKING- VIVITROL (NALTREXONE INJ)
v. OD PREVENTION- EMT, FAMILY, INHALE- NALOXONE dramatic recovery
Principles of “Social Model” treatment
1. Built on AA
2. Peer support- 12 step, personal recovery, interaction with environment

Principles of “Harm Reduction” treatment

1. Reduce negative consequences with SUD
2. Movement for social justice built for rights of people who use
3. Not abstinence

CHILD PSYCHIATRY
Prevalence of mental, behavioral and developmental disorders in children
1. 1 in 6 children 2-8y any 3. Anxiety: 12-17yo- MC
2. Depression: 12-17yo 4. Behavioral: 6-11yo
 5. 50%-start in childhood or adolescence, will 6. Suicide 2nd MC of death 10-34
experinec menal d/o
Importance of recognizing Adverse Childhood Experiences (ACEs). What are the different types of ACEs?
Adverse Childhood Experiences:
1. -abuse
2. -neglect
3. -household dysfunction
o -disrupted neurodevelopment
o -social, emotional, and cognitive impairment
o -adoption of health-risk behaviors
o -disease, disability, and social problems
o -early death
How may PTSD Differ in presentation between children and adults?
1. -RARE flashbacks or problems remembering parts of the trauma- ADULTS remember
2. -events in the wrong order- hard to determine what happened
3. -signs that the trauma was going to happen
4. -signs of PTSD in their play
Understand treatment strategies for PTSD in youth (including therapies and medications).
1. Antiadrenergic meds: lessesn sympathic response
-Clonidine-HA, Guanfacine-Drowsy, Prazosin

2. SSRIs:
-Sertraline, Fluoxetine, Citalopram, Escitalopram

3. !!Trauma Focused Cognitive Behavioral Therapy

Understand the presentation of Generalized Anxiety Disorder.

1. worry that is difficult to control, lasts at least 6 months and creates impairment in functioning
a. GAD
b. at least one of the following: restlessness, fatigue, difficulty concentrating, irritability, muscle
tension, sleep disturbance
c. 10-13yo
d. Themes-academics, natural disasters, social life, physical assault

Understand prevalence and symptoms associated with and Separation Anxiety Disorder.
1- separation anxiety disorder- MC GAD in childhood
a. 7- 8y MC
b. adolescence (rare)
c. angry feelings towards parents are displaced, so the environment is perceived as threatening
d. developmentally inappropriate
e. excessive worry concerning separation from attached,
f. 3 criteria: distress social academics worry about harm, fear of alone, dec. sleep, nightmares,
physical complaints
i. Refusal of sleep
ii. HA, GI, n/v
iii. -at least 4wks
iv. -onset before 18
 g. -Co-morbid MDD, individual and family therapy and psycho-education
h. If not sufficient: SSRIs

Presentation of OCD in youth

Obsessions distressing thought, urge, images what if..-> anxiety- fear worry -> compulsions- task performed to
remove anxiety-> relief -temporary-> obsessions sooner
2- Compulsive is to reduce obsessive thoughts
3- Started in childhood/adolenece
4- TX- CBT!-sertraline (6+yo)-SSRI-fluvoxamine (8+yo)-SSRI
5- PANDAS- strep infx
Criteria for ADHD in the DSM5
 Careless mistakes  Losse things
 Diffulty sustaining attn  Forgetful
 Not listening  Hyper- fidgets, taps
 Fails to finish instructions  Refuses Remaining seated
 Organizing task  Driven by motor
 Reluctant to engage in task Blurt out
Cannt wait

Pros and cons of stimulant vs. non-stimulant medications for ADHD

1- Psychostimulants-DA Non Stimulant-NE
2- Pros: strong and immediate effects 4. Pros: non-scheduled
3- Cons: scheduled substance, significant side 5. Cons: weak effect, 6-10wk onset, significant
effects, titration required side effects, titration required

Side effects associated with common medications for ADHD

1. -decreased appetite 5. *manic symptoms
2. -weight loss 6. *sudden death pre-existing CV
- sleep 7. -HTN
3. -social withdrawal 8. -problems with growing
4. -aggressive behavior

Recommended monitoring for common medications for ADHD

1- heart condition? 5- -Blood pressure and pulse
2- Family hx of sudden death 30 or 40y 6- -refill monitoring
3- palpitations or abnormal heart rate 7- -CBC with diff
4- -Ht & wt 8- -treatment response

Criteria for Oppositional Defiant Disorder

1- 4 sx w/in 6 months (not only with siblings) 4- -Vindictiveness
2- -Angry/Irritable mood 5- Comorbid
3- -Argumentative/Defiant 6- -ADHD (most common!)
 7- -anxiety 9- -learning
8- -mood 10- -perform poorly in school

Understand features of Childhood Onset Bipolar Disorder and Schizophrenia

Schizophrenia 5- -language dysfunction
1- -rare, severe form of schizophrenia 6- -delayed motor development, poor
2- -gradual, rather than sudden onset, persist coordination
into adulthood, 7- -borderline to mild mental retardation
3- -negative impact on developing social and
academic competence
4- -social withdrawal
COBIPOLAOR D CoMORBID
1. -ADHD (up to 90%)
2. -anxiety d/o (56-76%)
3. -substance abuse risk
4. -4x risk of PTSD
MIMIC BIPOLAR
1. -learning disorders
5. -**substance use disorders
6. -TBIs
7. -toxicity
8. -nutrient deficiencies
9. -anxiety disorders
Understand treatment options for Childhood Onset Bipolar Disorder and Schizophrenia
NON RX Schizophrenia 5- RX
6- Risperdal (risperidone):
1- -psychoeducation pt and the family 7- Abilify (aripiprazole):
2- -CBT 8- Zyprexa (olanzapine):
3- -cognitive remediation 9- Seroquel (quetiapine): 13-17
4- -social skills and life skills training 10- Invega (paliperidone): 12-17
BIPOLAR RX NON RX
7. -stabilize their mood 1ST THEN open
2. Risperidone: 10-17 to other interventions
3. Aripiprazole: 8. -Family education
4. Quetiapine: 9. -Special education services
5. Olanzapine: 13-17 10. -family focused therapy,
6. Lithium carbonate: 12-17 interpersonal
What are the core symptoms of autism?
1. Social-Interaction Difficulties
2. Communication Challenges
3. Repetitive Behavior
4. B4 12mo s/s
a. -no joyful expressions
b. -no sharing sounds, facial expressions
c. -no babbling
d. -no waving or pointing
5. After 12mo s/s
a. -no words by 16 months
 b. or two-word phrases by 24 months
c. -lack of social interaction
d. behavioral issues

Treatment of autism
1. TX- RX NONE, treat comorbid prn
2. Applied Behavioral Analysis, Sensory Integration
3. Speech Therapy, OT, PT
4. Community and Parent
5. Medication: Anxiety, ADHD, Mood Disorder
a. Risperidone: 10-17
b. Aripiprazole:

PERSONALITY DISORDERS, OCD

What is a personality Disorder? Diagnostic and statistical manual of mental disorders
1. Giles- PD- stable patterns of cognition and behaviors relating to the self, others, and the world
1. DSM5- enduring pattern of inner experience and behavior the deviates markedly from the expectation of
the individuals’ culture. Pervasive and inflexible,
a. Onset Adolescent or early adulthood
b. Stable overtime
c. L/T distress or impairment
d. Traits cannot be respone from psychosocial stress
e. Externalizers
f. Cleaer sensorium

Longstanding nature (not acute)

 EgoDsyntonic- PD characteristic
o Values their symptoms
o Looks down on others
o Causes distress- MDD , substance abuse

 EgoSyntonic-OCD characteristic
o Values change
o Wants help

What are the criteria for the DSM5 recognized personality disorders (you may want to refer to Dr. Giles’ notes
and the DSM5 itself).
1. cognition - ways of interpreting the self, others, and events
2. affectivity - problems in range intensity and lability of emotional experience/response
3. interpersonal functioning
4. impulse control
5. inflexible and pervasive
6. distress
7. long duration
8. not explained by another mental d/o
9. not explained by physiological or drugs
How would you recognize a personality disorder from a vignette?
1. Cluster A- 5.7%. Rarely seek mental health TX. Seek from HCP (schizo- root separate, split, o
phrenia d/o)
a. Paranoid- M, distrust, genetic, NO psychosis
b. SchizOID (ODD)- detachment from social relationship, loners, childhood. Rare. NO
schizophrenia. NOT genetic
c. SchizoTYPAL- Genetic lilely, ACUTE discomfort in relationships, magical thinking,
eccentric behavior

2. Cluster B- 1.5% Clinical, seek TX to show spouse

a. Antisocial-sociopath, psychopath, conning, aggressive, M, genetic risk conduct issue b4 15y,
addictions
b. Borderline-chronic dysphoria (unwell), MDD, ED, PTSD, psychosis or neurois w/ stress,
recurrent suicidal, extreme evaluation or devaluation, impulse sex, drug, $$,
c. Narcissistic- grandiose ideals, want special TX, Perfect or worthless, NO empathy,
emotionally stable, NO self harm, NO criminality
d. Histrionic- exaggerates certain skills, dramatic, center of attn., vain, sexual

3. Cluster C 6.0%-
a. Avoidant- timid, fear of rejection
b. Dependent- clinging fear of separation, youngest
c. OCD- perfectionist, NOT flexible or open, intermittently, M, oldest child

Obsessive Compulsive disorder DSM5 Criteria, symptoms.

 1- OCD- anxiety d/o2.1-7.9 MP PD
a. Obsession and compulsions
b. EGOSYNTONIC
c. Persistent thought urges, images of unwanted
d. Ignores or represses by actions, repetitive
e. NO physiological or drugs

2- OCPD-
a. EGODYSTONIC
b. Preoccupied w/ rules, lists point when major point is lost
c. Perfectionism to point of cant complete task
d. Devotis to work, excludeds friends activities
e. Scrupulous and inflexible
f. Hoarder $$ and objects
g. Reluctant to delegate task unless their way
h. Stubborn
i. Uncomfortable with emotionally expressive people
Differentiate between an obsession and a compulsion
1- OBSESSIONS
a. thoughts, impulses, or images that are experiences as intrusive and cause distress
b. common obsessions: contamination, aggression, safety or harm, need for exactness or symmetry
and somatic fears
2- COMPULSION-
a. Repetitive behaviors or mental acts assoc w/ feared obsessive thought

Treatment regimens for OCD (therapy as well as medications)

1- response prevention - stop the person from engaging in the compulsion
2- CBT and SSRIs - NO cure OCD
a. DEC 5HT serotonin lead to INC. DA
b. 5HT (serotonin) -antidepressant effectiveness in impacting 5HT limiting uptake
c. 35% reduction in symptoms
d. Dosing is HIGHER for someone with OCD, tirtrate up
e. therapeutic effect 6-12wks vs. 4-8wks for MDD
f. dopamine!-antipsychotics added to SSRI reduces severity than SSRIs alone

SLEEP, FEEDING, SEXUAL DISORDERS

Understand criteria for diagnosis of Anorexia Nervosa and Bulimia Nervosa
1- AN
a. -intense fear of gaining weight
b. -disturbance in the way ones body weight or shape is experienced
c. 1. Family-based therapy-only evidence based teenagers
d. -life threatening-damage major organ systems
e. -suicide
f. -mood symptoms- separate or secondary to the undernourished state
g. -frequent co-morbidity and overlap with Body Dysmorphic Disorders and OCD
 h. - depression and anxiety
2- BN
a. binge eating
b. -prevent weight gain -vomiting, laxatives, diuretics, exercise
c. -1 per week for three months
d. influenced by body shape and weight
e. most pts do recover but symptoms don't go away entirely

Insomnia definition and treatment

1- -dissatisfaction with sleep quality or quantity:
2- difficulty initiating sleep,
3- difficulty maintaining sleep, early morning awakening with inability to return to sleep, non-restorative
sleep
4- -3 nights per week for 3 months
5- -may involve daytime impairments fatigue, sleepiness, impaired cognitive performance

 -episodic- symptoms last at least 1MONTH BUT LESS THAN 3MONTHS

 Chronic- symptoms last 3 MONTHS OR LONGER
 ACUTE/SHORT TEMR- symptoms <3 mo, but meet all other criteria

Comorbids- 80% MDD experience insomnia

a. early morning awakening with inability to return to sleep
b. "secondary insomnia" --> anxiety, depression, other behavioral/medical d/o
6- TX
a. -relaxation strategies
b. -sleep hygiene - stimulus control
c. -CBT
d. -medical treatment benzos, non-benzos: antihistamines
e. -alternative treatments

Narcolepsy definition, criteria and treatment

1- irrepressible need to sleep, lapsing into sleep or napping
2- 3 times per week for 3 months
3- -one of the following: cataplexy, hypocretin deficiency CSF,
4- REM sleep latency less than or equal to 15 minutes
TX
a. drugs stimulate the CNS
b. armodafinil (Nuvigil) - first line therapy!
c. Modifinil (Provigil)
d. Methylphenidate or various amphetamines - effective but can be addictive; cause nervousness
and palpitatio
e. NO cure. lifestyle modifications can help manage symptoms
f. -SSRIs and SNRIs: suppress REM sleep, cataplexy, hypnagogic hallucinations and sleep
paralysis
g. -TCAs: suppress cataplexy increase REM latency
h. -Sodium oxybate (Xyrem): GHB --> highly effective for cataplexy, helps improve nighttime
sleep, may control daytime sleepiness. CATE- II, difficulty breathing, coma, death

Hypersomnolense disorder criteria

 1- self reported excessive sleepiness with sleep period of at least 7 hours
2- -normal to prolonged sleep duration
3- -normal REM pattern
4- -persistent daytime sleepiness vs sleep attacks
5- -lack of cataplexy
6- -no hypocretin deficiencies
Restless Legs Syndrome symptoms and treatment
1- -an urge to move the legs in response to unpleasant sensations creeping, tingling, burning, itching
2- -relief obtained by moving the legs
3- -worse during times of rest
4- -worse in the evening
5- -may delay sleep onset and awaken the individual from sleep
a. TX
b. dopamine: Ropinirole, Requip, rotigotine - Neupro,
c. pramipexole - Mirape
d. drugs affecting calcium channels gabapentin - Neurontin,
e. pregabalin - Lyrica
f. opioids
g. muscle relaxants and sleep medications don't eliminate the leg sensations

Criteria and treatment for Erectile Disorder

1- -difficulty obtaining maintaining an erection during sexual activity
2- -decrease rigidity
3- -must be on almost all occasions
4- -minimum 6 month duration
5- -separate from "secondary to" conditions
6- significantly impacts self-esteem, self-confidence, and sense of masculinity
7- TX
psychological counseling #1
exercise
PDE-5 inhibitors

Criteria and treatment for Female Sexual Interest/Arousal Disorder

1- reduced sexual interest or arousal
2- -absent/reduced thoughts or fantasies, sexual excitement or pleasure
3- -reduced initiation
4- minimum of 6 months duration
5- Distress Key
6- TX
a. psychological counseling
b. estrogen therapy
c. androgen therapy
d. Flibanserin
Basic definitions for all DSM5 recognized paraphilic disorders.
Criteria to rule-in vs. rule out “Disorder”
1- Acted on with non-consenting
2- Distress, impairment social occupation areas of function
3- Arousal from
 Exhibitionistic Disorder Exposing one’s genitals to an unsuspecting person or performing sexual acts that can be watched
by others

Frotteuristic Disorder(TT- Touching or rubbing against a non-consenting person

touch)

Voyeuristic Disorder (V- Urges to observe an unsuspecting person who is naked, undressing or engaging in sexual
visual) activities, or in activities deemed to be of a private nature

Fetishistic Disorder Use of inanimate objects to gain sexual excitement, feet MC

Pedophilic Disorder (peds- Sexual preference for prepubescent children

child)

Sexual Masochism Disorder Wanting to be humiliated, beaten, bound or otherwise made to suffer for sexual pleasure
(masochist)

Sexual Sadism (sadist) In which pain or humiliation of a person is sexually pleasing,

Transvestic  Arousal from clothing associated with members of the opposite sex
Fetishism

Ephebophilia (ephe -early Sexual interest in children later stages in puberty

manhood)

Hebephilia (hebe Greek youth) Sexual interest in early pubery post-pubescent

SOMATIC, PRIMARY CARE PSYCHIATRY

Basic prevalence of behavioral health complaints and disorders in primary care settings
1- 30% visist mental health
2- 11-36% of primary care patients have a psychiatric disorder
3- 40% in urban/underserved areas
4- 80%! MMD w/ physical symptoms
5- 68% -adults with mental disorders have medical conditions
6- 29% medical conditions have mental disorders

7- -cancer & depression: 15-25%

8- -MI & depression: 20%;
9- anxiety: 30-40%;
10- PTSD: 5-15%
11- -stroke, pain & depression: 30%
12- -migraines & depression: 50%;
13- -IBD & depression: 20%;

Basic understanding of the criteria for the following disorders

a. Somatic Symptom Disorder
i. Disrupt ADL
ii. Excessive thougts regarding sx
iii. Co-occur-Post MI GAD to exercise
iv. Medical utilization does not help
 b. Illness Anxiety Disorder
i. Preoccupied with having/acquiring a illness
ii. Somatic not present or mild
iii. Excesive health care
iv. NO sigs in exam
v. Alarmed easily

c. Conversion Disorder
i. True Symptom incompatiable with findings

d. Factitious Disorder
i. Deceptive, imposed on self or others
ii. Try to secure sick role
iii. Need attention
iv. Muchasusen

e. Malingering
i. Exaggerated physical sx
ii. Trying to avoid, drug seek
iii. Antisocial PD

What are some of the challenges with referring patient’s from primary care to specialty psychiatric care?
1- -stigma:
2- -transportation and logistics:
3- -insurance:
4- -availability:

5- 50% will connect with one

MH-50 minutes
6- -small practices
7- -data private
8- -time fixed, slower paced
9- -firm boundaries
10- -termination is goal

MENTAL HEALTH LAW

Federal vs. State roles on Mental Health Law
1. gov. works with states to address mental health
2. regulates systems and providers (ex: DEA licence), protects rights of consumers, provides funding for
services, supports research and innovation; establishes and enforces minimum standards that states can
build upon
3. power in making decisions about their mental health system;
a. vary state to state
b. meet certain standards set by the federal gov
c. free to expand

What was the Supreme Court Olmstead Decision? Impact?

1. case regarding discrimination against people with mental disabilities
 2. Americans with Disabilities Act, individuals w/ mental disabilities have the right to live in the
community rather than in institutions

What did Lanterman-Petris-Short (LPS) accomplish and why?

1. California -1960s to change how persons with mental disabilities were treated
2. treated in the least restrictive setting and given the right to be heard in court when detained involuntarily
3. Ended the inappropriate, indefinite, involuntary commitment of mentally disordered persons;
4. Prompt evaluation and tX
5. provide prompt evaluation and treatment
6. Public safety
a. Prior to LPS- no standards for involuntary stays, pts had little rights
Understand involuntary holds in California.
5150 72hr
1. Who can place holds? Profession by county mental, PO local/schools, Sheriffs, Rangers, Parole,
2. For how long? 72 hrs
3. With what due process? Involuntary, place hold for evaluation. Not under arrest. Name of person who
reported. Right by staff
4. Using what criteria? Serious harm to self or others. Unwilling can length stay. Gravely disabled
a. HCP can determing to drop 5150

5250- 14 Day certification

1. Who can place holds? Same, but that person can be placed on addnl 14day hold
2. For how long? 14d
3. With what due process? Probably cause, right to judicial hearing
4. Using what criteria?
a. Released
b. Referred
c. Addn 14dy
d. 180dy dagner to persons
e. 30dy for grave disability
f. Conservatory LPS-

AB1421 Laura Law

1. Who can place holds? HCP individual in server crisis unable
2. For how long?until person is well enough to maint on their own
3. With what due process? If all else fails go Assisted outpatient treatment.
4. Using what criteria? Hx of violence untreated mental illness repeated hospitziation

LPS-Conservatorship
1. Who can place holds? HCP believes person is gravely disabled d/t mental d/oa court gives one-person
(conservator) authority to make specific kinds of decisions on behalf of another person (conservatee
1. For how long? One year of pettion
2. With what due process? -requres court and jury
3. Using what criteria? Ameliorate the conservatee grave isability

What are the reporting requirements for Child Abuse, Elder Abuse, Domestic Violence?
 1. Child Abuse
a. Who- Abuse
b. When- w/in 36hrsDOJ forms
c. How- immediately by phone county department.
i. HCP have immunity

2. Elder Abuse
a. Who- Pt who witness, recive info, disclosure
b. When- w/in 2 working days
c. How- call local enforcement w/ body harm 2hrs

3. Domestic Violence
a. Who- Pt who allow you to consent to treat their injury. Suspicion even if pt denies
b. When- writing report w/ 48h
c. How- call the police in city where it happened. Include past DV, name of person, maps, copy
i. HCP must report even if they deny. Pt must allow consent their inury. They can decline
to be examined
ii. They cannot refuse the reporting if they deny and you supscion

What is the process to make these mandated reports? How do they differ?
1. Required to give name
2. But immunity for liability
3. Child-immediate report, written 36h, DOJ/PO/county
4. Elder-by phone ASAP, w/in 2d. Bodily w/in 2hrs
5. Domestic violence-report if treating for suspect abuse, even If denies. Call Police written by 48hrs in
city
a. No legal requirement to inform the patient of the report
b. Ethically tell them you area mandated reported
c. Must report if the patient consent to reporting
d. Pt not allowed to refuse report
e. Pt must consent to treatment

What is the Tarasoff reporting requirement (Duty to warn / Duty to protect)? When is this required and what is
the process?
1. -duty to protect individuals who are being threatened with bodily harm by a patient
2. -notifying the police, warning the intended victim,
3. -required to report to law enforcement within 24hrs someone who makes a serious threat of violence