Psychiatric Behavioral Emergencies Flashcards

(76 cards)

1
Q

Skills

Empathy

A

Do you really want to help this pt?

Act in their best interests?

Able to treat with dignity and respect?

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2
Q

Skills

Listening

A

What they say

How they say it

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3
Q

Skills

Observation

A

Body language and POSTURE

Agitation

Affect

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4
Q

Wisdom

A
  • Behavioral emergencies may be due to medical illness
  • Any illness or disease that creates a behavioral emergency needs treated
  • ”Psych” patients are PATIENTS
  • Many people suffer from psychiatric illness
  • Chemical imbalances in the brain
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5
Q

Common Misconceptions

A
  • Not true medical illness
  • Mental disorders are incurable
  • Always dangerous and violent; or bizarre
  • Due to bad parents
  • Personality Weakness
  • Schizophrenia is “split personality”
  • Depression is normal with aging
  • Depression doesn’t affect kids or teens
  • You can “will away” mental illness
  • Having a mental disorder is cause for embarrassment and shame
  • Addiction is a lifestyle choice
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6
Q

Behavior

A
•Normal vs Abnormal?
 -Measured against norms of society 
•Emergencies 
 -Transient inability to cope 
 -Is there danger to self or others?
•Causes 
 -Organic
 -Biological 
 -Psychosocial 
 -Socio-cultural 
 -Injury 
 -Substance related
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7
Q

Scene Survey

A
•Assess for:
 -violence 
 -Substance abuse
 -Suicide attempt 
•Appearance and behavior 
 -Psychomotor agitation 
 -Hygiene, dress
 -Out of place
 -Body Posture
•Limit number of people around pt
•Stay alert to signs of possible danger
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8
Q

Body Posture

A

Shows attitude and frame of mind

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9
Q

Patient Contact

A
•Observe behavior 
•Posture 
 -Tone/volume voice, facial expression, body position, tension 
•Personal space 
•Stand at angle 
•No sudden movement, do not surprise 
•Compassion w/o friendliness 
 -Businesslike/calm
•Schizophrenia - DO NOT cause agitation!
•Limit number of people around pt
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10
Q

Speech/Thought

Form of thought

A

Ability to process information

Create logical ideas

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11
Q

Speech/Thought

Speech Rate

A

Mutism- refusing to answer

Poverty of speech- quick short answers (no elaboration)

Thought blocking- start to answer then stop part way through

Pressured- speaking a lot with no real pertinence to the question but just nonstop

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12
Q

Speech/Thought

Associations

A

Circumstantial thinking

Tangential thinking

Flight of ideas

Word salad

Speech

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13
Q

Thought Content

Psychosis

A

Distorted perception of reality

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14
Q

Thought Content

Hallucinations

A

False sensory- no bias in reality

Auditory- hearing voices

Visual- seeing things that aren’t there

Gustatory- metal taste

Touch

Olfactory- smells

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15
Q

Thought Content

Delusions

A

False perception of events, situations

Believes no matter what the evidence reveals

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16
Q

Thought Content

Neurosis

A

a relatively mild mental illness that is not caused by organic disease, involving symptoms of stress (depression, anxiety, obsessive behavior, hypochondria) but not a radical loss of touch with reality.

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17
Q

Thought Content

Paranoid Delusions

A

Persecution

Conspired against

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18
Q

Thought Content

Grandiose Delusions

A

Special powers

God-like

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19
Q

Thought Content

Somatic Delusions

A

Body

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20
Q

Thought Content

Delusions of Reference

A

Ordinary events have special, dangerous significance

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21
Q

Thought Content

Preoccupation

A

Ideas constantly dominate thoughts

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22
Q

Thought Content

Depersonalization

A

Detach self from body, mind, world

Like watching movie

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23
Q

Thought Content

Derealization

A

World is not real

Familiar things may seem alien, surreal

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24
Q

Affect

A

Outward expression of emotion; observed

-stable ➡️➡️ labile

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25
Labile
Emotional expression characterized by hysterical laughter which quickly changes to sobbing
26
Flat Affect
Shows no emotion
27
Mood
Dominant sustained emotional state
28
Dysphoria
Depressed, sad, irritable
29
Euphoria
Elevated ecstatic
30
Euthymic
Normal
31
Physiological Changes
-New/changed/compliant medications? -Substance abuse or misuse -Rule out medical issues -If acute crisis ➡️ consider medical causes -Such as... •other medical history •Social history •***Is pt in danger of harming self or others?***
32
Medications Antipsychotics
Dopamine antagonists Some also antihistamine Anticholinergic properties
33
Medications For Schizophrenia, delirium, acute psychosis
``` •Haloperidol (Haldol) •clozapine (Clozaril) •risperidone (Risperidone) •olanzapine (Zyprexa) •quetiapine (Seroquel) •Aripiprazole (Abilify) -Schizophrenia -Bipolar -Autism -Adjunct major depression ```
34
Antidepressants | Selective Serotonin Reuptake Inhibitors SSRI
Citalopram (Celexa) Escitalopram (Lexapro) Paroxetine (Paxil) Fluoxetine (Prozac) Fluvoxamine (Luvox) Sertraline (Zoloft)
35
Antidepressants Serotonin-norepinephrine reuptake inhibitors (SNRI’s)
Duloxetine (Cymbalta) Venlafaxine (Effexor)
36
Antidepressants Tricyclic Antidepressants (TCA’s)
``` Amitriptyline (Elavil) Nortriptyline (Pamelor) Protriptyline (Vivactil) Imipramine (Tofranil) Clomipramine (Anafranil) Desipramine (Norpramin) Doxepine (Sinequan) ``` TCA’s - Overdose = lethal arrhythmia - Caution in elderly
37
Serotonin Syndrome
``` •2 or more serotonergic drugs combined -SSRI, SNRI, TCA, MAOI, St John’s wort, amphetamines, MDMA, cocaine, ondansetron, •Within 24 hr of taking •Very high body temps -Cooling measures •Seizures -Benzodiazepines •Extensive muscle breakdown -Supportive •Sweating, dilated pupils, agitation, diarrhea ```
38
Extra Pyramidal Symptoms (EPS)
Side affect from antipsychotic medications •Blockage of Dopamine receptors in the brain •Group of side effects -Involuntary motor movement -Uncontrollable muscle coordination
39
Tardive Dyskinesia
Degenerative neurologic disorder Repetitive movements of mouth & face -Sucking, chewing, grimacing, pouting Rock back and forth, tap feet Long-term use of antipsychotic drugs Suppress dopamine pathways in brain Patient not aware of movements
40
Dystonia
Abnormal muscle tone
41
Acute Dystonic Reaction
``` •Muscle spasms -Head/neck twists -Protrusion or swelling tongue -Muscular rigidity/contracture/twisting arm -Back arching -Restlessness, tremors •Onset- without warning •Young, males more often •Treat= Diphenhydramine 25-50 mg IV, IM •Causes= Antipsychotic drugs -Chlorpromazine (Thorazine), Prochlorperazine (Compazine), Haloperidol (Haldol) ```
42
Schizophrenia
Person has psychotic episodes that include hallucinations and delusions Also, disorganized thoughts, impairment of reality testing These symptoms occur for at least 6 months Starts in late teens to mid 30’s. Can begin at age of 45
43
Thought Disorder Schizophrenia
``` •Disorganized thoughts** -Word salad, loose association •Self care -Hygiene -Eating -Clothing •Social -Masturbate in public -Swear without reason -Flat affect -Inappropriate gestures -Unable to hold a job -Remain in rigid position for days •Hallucinations •Visual, tactile, olfactory •Auditory -Multiple voices -Say bad things -People out to kill them •Delusions -Persecution -Gesture, comments, song lyrics ➡️ directed toward them -Grandeur -Outside forces controlling them ```
44
Mood Disorders Bipolar
``` •Manic state > 1 week •Irritation, anger •Labile •Maybe delusional •Can’t keep up with own thoughts -Torrential downpour of thoughts •Pressured speech •Loos associations ```
45
Mood Disorders Major Depression
* Serotonin levels low? * Dysphoria * Melancholy * Anhedonia * Low self-worth, self-esteem * Cognition, decisions difficult * Sleep disturbances * Appetite, libido altered * Suicidal thoughts, plans
46
Major depression Adult Findings
Withdrawal Flat affect Decreased cognitive functioning Altered sleep Physical pain
47
Major Depression Pediatric Findings
Not obeying rules Poor test scores Lack of school participation (extracurricular)
48
Acute Anxiety Disorders Panic Attack
Overwhelming fear Apprehension Impending doom
49
Acute Anxiety Disorder Phobia
Intense fear of object or situation May have no basis ➡️ irrational Agoraphobia- “market place” -Cannot escape the situation ➡️ home bound
50
Chronic Anxiety Disorders Post Traumatic Stress Disorder PTSD
- Threat of death, injury or actual event | - Alternate emotional numbness with vivid memories and dreams
51
Chronic Anxiety Disorders Obsessive Compulsive Disorder OCD
- Intrusive thoughts- obsessions | - Rituals- compulsions
52
Somataform Disorders Conversion Disorder
- Psychological distress converted - Motor or sensory symptoms - Seizures
53
Somataform Disorders Hypochondriasis
- Preoccupied with serious medical conditions - Misinterpreting physical signs - Despite medical evaluations
54
Factitious Disorders
``` •Intentional s/s to feign illness •Knowledgeable of the illness •Munchausen Syndrome •Munchausen by proxy -Illness/injury inflicted upon another -Mother to child •Malingering -Feign illness or injury for gain ```
55
Eating Disorders Anorexia Nervosa
``` -Distorted body image •Refuses to eat normally -Think they are obese •Measure themselves or look into mirror •Self esteem is dependent upon body image •Weight loss is good discipline •Don’t recognize they have a problem ```
56
Eating Disorders Bulimia Nervosa
``` •Binges on food ➡️ then purges -Enormous amounts of food in 2 hr -Vomiting, laxatives, diuretics -Exercise or fast for days •High calorie food (cake) •Binge in secret -Becomes depressed •Average weight •Low self-esteem •Electrolyte and cardiac arrhythmias •Esophageal tears, gastric rupture ```
57
Personality Disorders Paranoid
Distrust and suspicion of others going to harm. Pervasive, ongoing pattern of suspicion
58
Personality Disorders Schizoid
Pattern of detachment from social relationships and limited emotions Eccentric Solitary Disinterested in social interaction
59
Personality Disorders Antisocial
Disregard for, violation of rights of others Pervasive, impoverished moral sense or lack of moral conscience
60
Personality Disorders Borderline
Instability in relationships,self-image, and impulsive Acts impulsively
61
Personality Disorders Histrionic
Shows excessive emotion and attention seeking behavior Theatrical Dramatic
62
Personality Disorders Narcissistic
Pattern of grandiosity, need for admiration and lack of empathy Preoccupied with self
63
Personality Disorders Avoidant
Social inhibition Feeling of inadequacy Sensitive to criticism
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Personality Disorders Dependent
Excessive need to be taken care of and will submit to others for fear of separation
65
Personality Disorders Obsessive Compulsive
Need orderliness and perfectionism
66
Impulse Control Disorders
* Inability to resist impulse or temptation * Pathological gambling * Kleptomania- urge to steal * Pyromania- urge to burn * Trichotillomania- pulling out hair
67
Suicide
``` •Act of ending one’s own life •Suicide ideation- thought, fantasy, plans •Attempt- unsuccessful effort •History of: -Self-injury •Mutilation, cutting •Aim ➡️ bring back some feeling or “pain” high •Less than 45 - frequent attempts •Older than 60 - more likely to succeed •Females- attempt more often •Males- succeed more often •Firearms- most common method ```
68
Suicide Assessment & Treatment
``` •Scene safety •Suicide attempt? Vs Ideation? -Ethical and legal responsibility to provide help •Attempt- -Life-threats •After life-threats managed: -Respect -Listen -Dignified transport ```
69
Verbal Restraint
``` •Gather YOUR wits first •Use low voice, identify yourself •Acknowledge pt’s behavior •Encourage pt to talk ➡️ then LISTEN •Ask ➡️ - “Do you feel like you will lose control?” - “Are you carrying any weapons?” •Set limits on their behavior •Back off and get help •Don’t attempt “talk down” -Uncontrollable/ unknown chemicals/ situation involved ```
70
Restraint Methods
•Begin with gentle, non threatening approach •Progress as needed •Explain options to patient before force is used -Last resort- harm to self or others •Assess surrounding before starting restraint •Do not enter pt’s physical space until all involved in restraint action are ready -5 people minimum •Be familiar with restraint devices •Handcuffs- officer MUST ride with you!
71
Physical Restraints
``` •Physically restrained pt’s may require chemical restraints •Excited delirium •Pattern- watch for: -Delirium & violent -Calm / quiet for short period -Respiratory/cardiac arrest -Asystole -Doesn’t respond to ACLS treatment ```
72
Chemical Restraints Lorazepam (Ativan)
- 2 mg IM/IV - Respiratory depression - Hypotension
73
Chemical Restraints Haloperidol (Haldol)
- 5-10 mg IM/IV - Respiratory rate - Acute dystonic reaction - Prolonged QT/ torsades - Mental status changes
74
Anhedonia
Lack of enjoyment in activities that were once pleasurable
75
Chemical Restraint Ketamine
•Quicker - 4-5 mg/kg IM - Acts in 3 min - 1-2 mg/kg IV - Onset 30 sec
76
Chemical Restraints B-52
``` 50 mg of Benadryl (separate syringe) + 5 mg Haldol + (in same syringe) 2 mg Ativan ```