Angus
North West Angus
Whitehills Community Care Centre Station Rd, Forfar, DD8 3DY
- Duty Worker Contact Number 01307 475288
- Consultant: Dr Paci
North East Angus
Susan Carnegie Centre Stracathro Hospital, Brechin, DD9 7QA
- Duty Worker Contact Number 01356 237111
- Consultant: Dr Rouke
South Angus
Bruce House Wellgate, Arbroath, DD11 3TP
- Duty Worker Contact Number 01241 465227
- Consultants: Dr Slack & Dr Nicholas
Dundee
Kingsway Care Centre, Kings Cross Road Dundee DD2 3PT
- Dundee West 01382 647299
- Dr Stephanie Sloan (West 1)
- Dr Louise Tayler-Grint (West 2)
- Dundee East 01382 647298
- Dr Rajesh Sekhri (East 1)
- Dr Stuart Campbell (East 2)
Perthshire
Murray Royal Hospital Muirhall Road Perth PH2 7BH
- North West P&K 01796 474818. Dr Gary Cousland, Locum Consultant
- Strathmore 01250 877843. Dr (Shyama) Kishore Gopalkaje, Locum Consultant
- South P&K, Kinross and Carse of Gowrie 01764 653173. Dr Amin, Locum Consultant
- Perth City 01738 562231 Dr Mhairi Hepburn, Perth City
The types of illness that we assess and manage are referred to as organic and functional:
Organic illnesses (Organic illness includes
dementia and
delirium)
- Dementia diagnosis is best made at an early stage in order that treatment with acetylcholinesterase inhibitors and/or memantine can be considered and so that post-diagnostic support can be offered.
- Encouraging the individual with mild cognitive impairment or dementia to arrange financial and welfare Powers of Attorney at an early stage can also make it more likely that an individual will effectively have their needs met in the future and that they can avoid unnecessary hospital admission at a later stage if they loses capacity to consent to home care or a move to a care home.For referrals relating to cognitive impairment, we expect that dementia screening bloods (FBC, urea, creatinine, TFTs, LFTs, calcium, B12 and folate) will have been carried out, untreated depression considered as a cause, cognitive testing carried out (please see below for appropriate tests/screening tools) and a CT head requested. Referrals will be rejected if these have not been considered/attempted.
Delirium has multiple potential causes in an older person including simple things like constipation. Delirium can be prolonged, even after the physical cause has been effectively treated. Therefore, we would recommend reviewing cognition 3 months after the onset of delirium before considering referral for assessment of a potential underlying dementia.
Functional Illnesses (incorporates
schizophrenia,
psychosis,
bipolar disorder,
depression, anxiety disorders and
personality disorders): - Particularly in an older adult population, physical ill-health must be considered and ruled out prior to referral or treatment for psychosis, depression, mania and anxiety.
- Appropriate pre-referral blood tests would include FBC, urea and creatinine, LFTs, TFTs, inflammatory markers and calcium.
We accept referrals for individuals over the age of 65 with the first presentation of any mental illnesses such as depression, anxiety, bipolar disorder, schizophrenia and other psychotic illnesses and personality disorders. We also accept referrals for any new onset memory issues where reversible causes have been ruled out. For those under the age of 65, we may accept referrals if these individuals have complex physical health problems and associated cognitive decline and/or frailty. For this patient cohort, it would be advisable to discuss individual cases prior to referral and ensure investigation and treatment of any reversible causes and/or mild to moderate depression and anxiety prior to the referral.
Emergency (same day) Please contact the CMHT duty worker or Consultant by telephone or email for advice. Possible scenarios are as follows;
- A patient putting themselves or others at significant risk as a result of their behaviour secondary to a suspected mental illness. Examples include:-
- Active suicidal ideation/self-harm/harm to others
- Severe agitation or aggression in dementia, delirium or another mental disorder
- Severe depression with unwillingness to eat and drink
Urgent (within 72 hours)
- Wandering in the context of dementia or delirium
- Passive suicidal/homicidal ideation in the context of mental illness
- Distressing delusions and hallucinations
Routine (within 12 weeks)
- Concerns about memory in a patient over 55
- For referrals relating to cognitive impairment, we expect that dementia screening bloods (FBC, urea, creatinine, TFTs, LFTs, calcium, B12 and folate) will have been carried out, untreated depression considered as a cause, cognitive testing carried out (please see below for appropriate tests/screening tools) and a CT head requested. Referrals will be rejected if these have not been considered/attempted.
- Mild to moderate depression or anxiety disorder after two adequate (6 to 8 weeks at treatment dose) trials of different antidepressants where there is no suicidal ideation. (Do not hesitate to contact us for advice if you are unsure of which antidepressant to choose or if there are issues with tolerability or polypharmacy but the following NHS Tayside Formulary guidance should help
- Chronic delusions or hallucinations or those not causing severe distress.
- Consideration will be given to referrals for those over the age of 65 with suspected ADHD and associated psychiatric co-morbidity. However, referrals are unlikely to be accepted for those seeking an ADHD diagnosis where there is no associated mental illness.