1. Keith Slack Memorial ICL Training
Red Flags to possible capacity issues
(Crash course in psychiatry)

2. Capacity to instruct vs capacity to parent
Instructing
Understanding the facts and main choices.
Understand consequences of choices
Communicate their choices effectively.
Parenting

3. How can these capacities be disturbed by mental illness
Schizophrenia/ psychosis
Bipolar Affective Disorder (BPAD)
“depression”
Substance abuse
Personality disorders
Dementias
Intellectual impairment
Acquired Brain injury

4. Schizophrenia/ psychosis
Positive Symptoms (often transient)
Delusions
Ideas of reference
Passivity phenomena
Hallucinations
Thought disorder
Negative Symptoms (often persistant)
Apathy
Anhedonia
Diminished self care
Cognitive impairment- executive dysfunction

5. Bipolar Affective Disorder
“ mania +/- depression”
Mania
Rapid speech
Flight of ideas
Impulsivity/Risky behaviours
Grandiosity
Agitation
psychosis

6. Depression Major depression Characterological depression/ dysthymia
Low mood
Neurovegetative disturbance- sleep/ appetite/ energy/ concentration
Pervasive anhedonia
Hopelessness, helplessness, worthlessness
Cognitive slowing (pseudodementia)
nihilism
Characterological depression/ dysthymia
General absence of neurovegetative symptoms or psychomotor retardation
Reaction to life circumstances +personality

7. Substance abuse Acute Intoxication Prioritisation Withdrawal effects
Chronic intoxication
Psychosis/ mood disturbance

8. Personality disorders
“Borderline personality “
Impulsivity
Suicidal/ parasuicidality
Vulnerability/ emotionality
Transference/ counter transference

9. Dementias Not just old people Subcortical dementias
Frontotemporal dementias
Early onset alzheimers
Associated psychopathology

10. Intellectual impairment
From birth or early childhood
Usually “in the system” from childhood
Psychiatric assessment not that useful unless associated mental health issues
Neuropsychological assessment- psychiatric/ family consultant input in interpreting report

11. Acquired brain injury Stroke/ head injury/ MS
Cognitive impairments- memory/ executive functioning
Executive functioning
Planning
Impulse control
Abstract reasoning