Psychiatric Emergencies, Study Guides, Projects, Research of Medical Sciences

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PSYCHIATRIC

EMERGENCIES

: ~.

= PSYCHIATRIC EMERGENCY

¢ Any disturbance in thoughts, feelings, or actions for

which immediate therapeutic intervention Is

necessary.

¢ Any unusual behavior, mood, or thought, which if not

rapidly attended to may result in harm to patient or

others.

¢ Patients behavior is disturbing to himself, his family or his community.

¢ Patient initiated threat of harm to self, health care personnel or others in the patients sohere of influence.

———_— ss EPIDEMIOLOGY ¢ER facilities are equally used by males and females ¢ 30% are suicidal ¢ 10% are violent ¢most common diagnosis mood disorders, schizophrenia, alcohol and substance dependence ¢ 40% require hospitalization «Most visits are at night

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GENERAL STRATEGY IN EVALUATING PATIENTS

«Prevent harm Cos Amol Al OA e AO mel (er(e[= ¢ Prevent violence to others

¢ Inform the patient that violence Is not

acceptable

¢ Approach in a non threatening manner

¢ Reassure and calm the patient or assist in reality

testing.

SS — (^) GENERAL (^) STRATEGY (^) IN

eel era NiCe wallaNi

¢Inform the patient that restraint or seclusion will be Used if necessary ¢Have team ready for restraints ¢ Monitor closely once restrained ¢Rule out cognitive disorders caused by a general medical condition ¢Rule out impending psychosis

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MINOR PSYCHIATRIC EMERGENCY

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¢ NEVER assume that a patient has a psychiatric illness Until all Possible Causes are ruled Out.

Sudden onset Visual, but not auditory hallucinations Memory loss, impairment Altered pupil size, symmetry, reactivity Excessive salivation Incontinence Unusual breath odors

CLUES SUGGESTING PHYSICAL CAUSES:

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— eS

METHODS OF CALMING PATIENT:

Identify yourself and your role Speak slowly and clearly ¢ Use acalm, reassuring tone Show you are listening to the patient by rephrasing back parts of what s/he says Do not be judgmental. Show compassion Use positive body language Acknowledge the patient's feelings Do not enter the patient’s soace, stay about 3° away Be alert for changes in the patient's emotional status 14

— eS

S10] (G/B) =

Suicide attempt is any willful act designated to end one's own life.

Derived from Latin for “self-murder’”

Fatal act that presents the person’s wish to die

Range from thinking about if and acting on it

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Table 19.1= Terms Comprising Suicidal Ideation and Behavior

Aborted suicide attempt: Potentially self-injurious behavior with explicit or implicit evidence that the person intended to die but stopped the attempt before physical damage occurred Deliberate self-harm: Willful self-inflicting of painful, destructive, or injurious acts without intent to die. Lethality of suicidal behavior: Objective danger to life associated with a suicide method or action. Note that lethality is distinct from and may not always coincide with an individual's expectation of what is medically dangerous. Suicidal ideation: Thought of serving as the agent of one’s own death; seriousness may vary depending on the specificity of suicidal plans and the degree of suicidal intent Suicidal intent: Subjective expectation and desire for a self-destructive act to end in death. Suicide attempt: Self-injurious behavior with a nonfatal outcome accompanied by explicit or implicit evidence that the person intended to die. Suicide: Self-inflicted death with explicit or implicit evidence that the person intended to die.

SUICIDE:

= SUICIDE:

¢ RISK FACTORS

¢ Men > 40 years old

¢ Single, widowed or divorced

Drug, alcohol abuse history Severe depression

Previous attempts

Highly lethal plans

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