The patient should ACU Agree  Be competent   Have clear and full understanding of the situation 

An adult patient is severely depressed refuses get treated for HCV infection. How should this patient be dealt with ?  First treat depression and then for HCV Treat for HCV and depression without consent Obtain a court order to treat for both The answer is 1, Here are the steps:  Step 1 treat the psychiatric condition Step 2 treat the medical condition If psychiatric condition can not be treated, consider legal action e.g. Court order or consent from relative

MAL Mental disorder Age being young Learning disability

One of these cannot be considered as an exception to direct informed consent?  A. Waiver  B. Detention under mental health act  C. Emergencies where full information cannot be given  D. Incompetent patient  E. Passively compliant patient The answer is E, passive compliance is not an exception, rather an implied consent is.  The situations in which explicit consent is not required are :  Implied consent given Necessity (harm likely, competency doubted) Emergency 

The doctor decides in the best interests of the patient.  Careful record should be made Other relevant medical staff should be consulted 

Very PainFul SWaG Visual disturbances Parasthesias Flue-like Symptoms  Stiffness  Weakness  Gastrointestinal disturbances 

SaD FuN Somnolence Dizziness Fatigue Nystagmus 

34C POSH eGFR less than 30ml /min eGFR falling at above 4ml /min every year Creatinine rising progressively in 3 or more tests Proteinuria Other Symptoms suggestive of chronic renal failure eg anemia Hematuria

Most Common Malignancy  in Down's Syndrome The most common Malignancy in Downs Syndrome is Leukemia. Please read the topic on Down's Syndrome in the Shorter Oxford Textbook of Psychiatry, 7th Edition. 

Offer to discuss the concerns and name the involved persons of the family Offer information about medications before prescription  Discuss the information actively  The information should include the name , mechanism, effects and side effects of the medication Involve the patient in decisions Recognise and address the concerns of the patient as treatment progresses For schizophrenic patients, social and family support be ensured