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1

what is a psychiatric emergency?

situation requiring immediate evaluation and tx of a pt which is precipitated by a sudden change in the pts behavior of situation

2

what is the typical profile of a pt presenting for psychiatric emergency?

young adults, from lower SE, chronic behavioral probs with acute exacerbations

3

most common behaviors to prompt emergency tx?

suicidal, violent, agitated or extremes of affect, withdrawal

4

diagnoses most frequently associated with completed suicides?

mood disorders, scz, substance abuse

5

males v females: attempting suicide? completing?

females attempt more, males complete more

6

how many pts who complete a suicide have had a prior attempt?

about half

7

employment status and suicide attempts?

employed ppl at less risk than retired/unemployed. those with recent job loss are at higher risk. professionals have higher rate than blue-collar

8

psychiatric disorder and suicide attempts?

majority of suicides are attempted by pts with a major mental illness.

9

medical problems and suicide attempts?

chronic pain, terminal illness leads to higher rates of suicide

10

what is essential to evaluate in assessing risk of a suicide attempt?

intentionality. what is the level of expressed intention to die?
lethality. is there a plan/how lethal is the plan?
means. pt have the means to carry out plan?
viability. what is the ability of the pt to accept help?

11

when is hospitalization indicated?

when pt has a lethal plan, expressed intention to die, low viability, or lack of external support

12

what physiological conditions may predict violent/combatice behavior?

drug/alcohol (esp PCP), cognitive impairment disorders (delirium, dementia), scz, mania, paranoia, character disturbances

13

approach to the violent patient?

be safe
set clear limits for pt (will not be allowed to harm self), and identify consequences
empathy
restraint if needed

14

medication for controlling violent patients?

neuroleptic/benzodiazepine meds: Haldol, Lorazepam. can be repeated at intervals until agitation subsides.

15

passive intent v active intent?

passive: no plan but would prefer to be dead
active: has plan and wants to carry it out

16

top psychiatric risk factors for suicide?

affective illness (bipolar, SAD, depr)
drug/alc abuse
scz

17

what accounts for 50% completed suicides?

major depression. essential to screen for a neurovegetative state.

18

what increases the suicide risk for someone with scz?

delusions, hallucinations, depression, akathisia, abrupt discontinuation of neuroleptics

19

Akathisia: def?

need to move, very uncomfortable, can lead to suicide

20

character/personality factors that can lead --> suicide?

primarily borderline and antisocial types. dysphoria, impulsivity,

21

the risk of completed suicide is how much higher in the year following an attempt?

100x

22

peak ages for suicide?

bimodal: 15-24 y and >60

23

what types of medical illnesses are at highest risk for suicide?

sever/chronic are at highest risk, highest risks are with AIDS, cancer, trauautic brain injury,

24

what is the genetic risk for suicide?

there is a genetic risk even when all other factors are controlled for. unknown how this risk is conferred. also, family hx of mental illness, tramautic early family life, imitation/modeling

25

social risk factors for suicide?

-marital status: widowed is greatest, married is lowest.
-bereavement
-living along, loss of relationship, anniv of loss
-unemployed/unskilled
-poverty
-presence of firearms in house

26

where is evaluation of suicidal ideation best done?

ER: because there is constant observation, controlled environment.

27

children/adolescents: signs to consider when evaluating suicide?

progressively declining school work, irritability, impulsivity, substance abuse, bereavement/rejection

28

geriatric: things to consider when evaluating suicide?

high rate, often have lethal means available at home. also frail and less likely to survive an attempt.

29

preg/postpartum women: things to consider when evaluating suicide?

loss of maternal instinct is hugely concerning.

30

suicide assessment: what to ask?

suicidal ideation
plans
are the means available?
does pt have any plans for their future?
why now, is there a precipitating event?