Psych Flashcards
(107 cards)
What’s the top risk for suicide?
Previous suicide attempt or eating disorder and other mental ils
What is the difference between suicide and self harm
Intention to die = suicide. Self-harm is a coping mechanism with strong emotional distress.
What are the 4 Components of the suicide risk assessment
Risk, protective factors, suicidal ideation, level of risk + safety plan
When to do a suicide risk assessment?
1 st visit
Suicidal behaviour
Clinical chance
Inpatient before increasing Privileges or discharge
What is the threshold for considering hospitalization for sad persons score?
5+ (although no evidence for this threshold)
What does the acronym SAD PERSONS stand for?
male Sex
Age
Depression
Psychiatric disturbance / previous attempt EtOH Rational thinking loss Social isolation Organized plan No spouse Sickness
What information should you collect regarding past or recent attempts?
Circumstances, timing, plan (esp if escalation in means), intent, consequences (feelings, reactions)
Past attempts, prior care plan, length of time since previous attempt. Triggers?
How do you come up with a safety plan?
Keep safety plan in a place you can easily access. What activities that calm them down? Who they can call?
Crisis line, 911 if needed.
What language should you use in terms of suicide?
Use direct language. Avoid commit vs attempt & complete.
Do not imply that “good/great” if patient denies suicide
What are risks of violence due to the environment?
Long wait times, overcrowding, discomfort, distressing situations, evening / overnight
What are the patient-related risk factors for violence
Altered mental status: dementia, delirium, substance use or decompensated mental illness
What is agitation?
Behavioural emergency! repetitive motor symptoms, vocalizations, irritability & response to stimuli.
How do you assess violence with the DASA?
1) Negative attitude
2) impulsivity
3) irritability
4) verbal theats
5) sensitivity to percieved provocation
6) easily angered when requests denied
7) Unwillingness to follow directions
high risk is >3, must act if 1+
How do you manage agitation?
Help patient manage emotions and regain control of behaviour. Focus on safety of patient and care team.
Respectful, non-coercive.
How do you use SBAR to communicate about potentially violent situation?
Situation: what’s going on with patient
Background: clinical context
Assessment: What do I think the problem is?
Recommendation: what do I think we need to do?
What is Miller’s Law?
To understand what another person is saying, you must assume that it is true and try to imagine what it could be true of?
How do you set limits with DESC for a patient?
Describe situation to your pt.
Explain your concerns: state your concerns twice
Suggest alternatives: you want to help patient but need to feel not threatened
Consequences: be prepared to follow through with these so make sure they are realistic
What are the 2 concepts that must be present to hold a form 1.
Current risk of dangerous behaviour (self, others or lack of self care) DUE TO evidence of mental illness (not diagnosis, just evidence - mental status findings)
What timeline is allowed between seeing the patient and completing a form 1?
7 days - you can send form later if risk changes
How does the future test work on Form 1
Must link back to past/present test
Page 2
Evidence of mental illness (MSE) MUST be filled in
What is box B on a form 1?
When you know your patient really well - needs to be completed by a psychiatrist - many ANDS.
What are the 3 signatures required by the form 1? When does the 72 hrs start ticking?
Examining physician first
Then 2 sigs from the hospital
then letting the patient know with the form 42. Keep a copy on the chart.
What happens if the Form 1 is invalid?
Cannot contest form 1, but Form 3 will get thrown out if challenged at capacity / consent board.
Does the form 1 require an assessment by a psychiatrist?
No - it is not necessary, just requires an MD to do a psychiatric assessment?
