Impatience or time pressure from clinicians may be viewed as...?
Lack of interest.
Why should clinicians limit their amount of self-disclosure when it is often used to demonstrate empathy?
Pts in crisis are unlikely to view it as such.
A person's level of suicide risk should be assessed by what four factors?
True or false: a more defined suicide plan indicates a higher level of planning and possibly increased risk.
Is it appropriate to ask a person directly if they have thought about killing themselves?
What questions are appropriate to ask someone when assessing their suicide plan?
- "Have you thought about killing yourself?"
- "What are you planning on doing?"
- "How do you intend on committing suicide?"
What is meant by finding a person's 'means' when assessing their suicide risk?
Finding out whether the pt has what they need to carry out the suicide attempt.
What questions are appropriate to ask when identifying someone's intended means for suicide?
- "Do you haveaccess to the pills/knife/gun/equipment to carry out your plan?"
- "Are you current collecting what you need to commit suicide?"
What is meant by assessing a person's timeframe for suicide?
Establishing the pt's intended time of attempt.
Why it is important to identify timeframe when assessing suicidality?
A clear and/or shorter timeframe may increase risk or indicate how long you have to manage the situation.
What questions are appropriate to ask when assessing timeframe?
- "When are you planning on committing suicide?"
- "Are there any significant events/anniversaries approaching?"
List some examples of questions to ask when obtaining hx of a suicidal pt.
- Do you have any medical/psychiatric illnesses?
- Have you ever tried to commit suicide before?
- Do you know anyone who has committed suicide?
- Have there been any recent triggers or events that have initiated suicidal thoughts?
True or false: it's important to dispute delusions or hallucinations so they aren't reinforced.
What two aspects of care need to be identified in crisis management?
What the pt wants to happen, and what you think needs to happen based on your clinical assessment.
Describe characteristics of hostile aggression.
Describe characteristics of instrumental aggression.
- More proactive than hostile aggression
Hot aggression threats are part of ____.
Cold aggression threats are part of ____ and ____.
Hot threats are commonly caused by...
Cold threats are common in persons diagnosed with what kind of disorder?
What is the purpose of cold threats?
To get needs met.
What kind of threat episodes are more commonly seen in mental health, hot or cold?
List the components of hot episodes in the five-set behavioural assessment.
- Minor movements (e.g. clenching fists)
- Verbal abuse and threats
- Major motor movements (e.g. pacing)
List the five components of the assault cycle.
- Triggering event
- Post-depression crisis
What are the current practices of crisis management?
- Sedation (chemical restraint)
What is the definition of de-escalation?
The gradual resolution of a potentially violent and/or aggressive situation through the use of verbal and physical expressions of empathy, alliance, and non-confrontational limit setting that is based on respect.
List the principles of de-escalation.
- Maintaining autonomy and dignity of the patient
- Using self-knowledge to achieve goals
- Being self-aware
- Intervening early
- Providing options and choice
- Avoiding physical confrontations
List some verbal de-escalation strategies.
- Allow time for person to respond if confused or disoriented
- Allocate one person to communicate with the pt
- Active listening
- Ask carer/family for advice/strategies
- Calm, respectful language
- Open-ended sentences
- Avoid challenges and promises that can't be kept
- Be firm but compassionate
- Calm, lowered tone of voice
What are some strategies for de-escalation of cold threats?
- Set clear, firm boundaries on behaviour and offer alternatives
- Give less time to listening when person is acting inappropriately or being manipulative
List some psychologial de-escalation strategies.
- Offer limited choices to allow pt to retain sense of control
- Encourage pt to gain control over their behaviour
- Try to identify and understand the reasons for their anger
- Use distraction and redirection
- Keep the pt and/or carer informed where possible
- Allow the pt an out so they can back down without losing face
- Suggest more appropriate behaviour
List some physical de-escalation strategies.
- Calmer personal space
- Approach pt with caution
- Don't startle the pt
- Be aware of exits
- Remove dangerous objects from the pt
- Be aware of the environment
- Encourage pt to sit down
List some physical de-escalation strategies for hot threats.
- Open body language
- Eye contact
- Show interest in what they are saying
- Be respectful
- Try to match levels
List some physical de-escalation strategies for cold threats.
- Match levels with the pt
- Open body language if their communication is appropriate
- Closed body language communicates disinterest in manipulation and threats
What are the components of a mental status assessment (MSA)?
- Thought form
- Thought content
- Insight and judgement
What comes under appearance in an MSA?
What comes under behaviour in an MSA?
- Eye contact
- Activity level
What is included when assessing speech in the MSA?
What is noted when describing mood in the MSA?
- Emotion as described:
What is noted when describing affect in an MSA?
- Emotion as observed:
What comes under thought form in an MSA?
- Flight of ideas
What comes under thought content in an MSA?
What is assessed under perception in an MSA?
- Thought insertion
What comes under judgement and insight in an MSA?
- Cause and effect
What is the value range of the SAT?
-3 to +3
What two aspects are assessed under the SAT?
Responsiveness and speech.
List the responsiveness components of the SAT.
+3 = combative, violent, out of control
+2 = very anxious and agitated
+1 = anxious/restless
0 = awake and calm/cooperative
-1 = asleep but rouses if name is called
-2 = responds to physical stimulation
-3 = no response to stimulation
List the speech components of the SAT.
+3 = continual loud outbursts
+2 = loud outbursts
+1 = normal/talkative
0 = speaks normally
-1 = slurring or prominent slowing
-2 = few recognisable words
-3 = nil
What are the three criteria that must be met for an EEA?