Psychiatric Emergencies

Question 1

One of the greatest potential errors in the Emergency Room in Psychiatry is:

Answer 1

Overlooking a physical illness as a cause of an emotional illness

Question 2

T/F: having auditory disturbances of perception is one of the clues that point to a medical cause than a primary psychiatric condition

Answer 2

F
Having NON-auditory disturbances (tactile, smell)

Question 3

T/F: having an acute onset of psych symptom is one of the clues that point to a medical cause than a primary psychiatric condition

Answer 3

T

Question 4

T/F: having mental status signs is one of the clues that point to a medical cause than a primary psychiatric condition

Answer 4

T
examples are: seizures, loss of consciousness, head injury, gait, speech, movement disorders

Question 6

The best predictors of violent behavior are:

Answer 6

Excessive alcohol intake
A history of violent acts, with arrests or criminal activity
History of child abuse

Question 6

The root cause of aggression, violence and hostility is from the imbalance of _______ and _______

Answer 6

Impulse and control

Question 7

The first task in evaluation of violent patients is to ascertain the ___ of violence

Answer 7

Cause

Question 8

T/F: The cause of violence does not direct treatment

Answer 8

F
The cause will direct treatment

Question 9

T/F: paranoid features in a psychotic patient is one of the signs of impending violence

Answer 9

T

Question 10

T/F: Manic episodes can be a sign of impending violence

Answer 10

T

Question 11

T/F: It is alright to talk to patients alone

Answer 11

F
Have others present, like the patient’s relatives or a mental health care professional

Question 12

T/F: To prevent patient aggression, you can agree with the patient if they tell stories of their paranoia

Answer 12

F
but you can say, “I believe that YOU BELIEVE that…”

Question 13

T/F: To calm a patient down who hears voices, you must talk to the voices that the patient is hearing

Answer 13

F
Do not talk to the voices

Question 14

T/F: you should hide from the patient the fact that restraint will be used if necessary

Answer 14

F
Must inform patient

Question 15

T/F: Don’t put your hands at the back because it makes the patient think you have medicines or restraints with you

Answer 15

T

Question 16

T/F: Stay against the wall when interviewing a patient

Answer 16

F
Stay on the SIDE of the patient

Question 17

T/F: Head must be slightly raised when restraining the patient

Answer 17

T

Question 18

When patient gains control of him/herself, restraints may be removed one at a time every ___ minutes

Answer 18

5

Question 19

How do you take out restraints one by one?

Answer 19

One hand > one foot > one hand > one foot

don’t take out the hands on both sides right away

Question 20

Major indicators for chemical restraints

Answer 20

Violent or assaultive behavior
Massive anxiety or panic
Extrapyramidal reactions to antipsychotics

Question 21

These antipsychotics are given for patients who are delusional or in a state of catatonic excitement requiring tranquilization

(drug, mg ampule dosage, route of administration)

Answer 21

Haloperidol, 5 mg ampules, IM
Chlorpromazine, 5mg ampule, IM
Olanzapine, 5mg, ORAL
Risperidone 2mg, oral solution or quicklet

Question 22

This route of administration is done best if you cannot persuade the patient to take oral medicines

Answer 22

IM Injection

Question 23

T/F: Benzodiazepines will NOT take away patient’s hallucinations and will only make them sleep

Answer 23

T
they will wake up and still be paranoid

Question 24

When a recreational drug has strong anticholinergic properties, ________ drugs are more appropriate than antipsychotics

Answer 24

Benzodiazepines (Depressants)

Question 25

The sleep produced by a relatively small amount of an IV benzodiazepine medication to a patient with furor caused by alcohol/ post-seizure psychomotor disturbance could last for ______. T/F: On awakening, patients are often alert and rational, and has complete amnesia about the violent episode

Answer 25

Hours T

Question 26

Drugs given during extrapyramidal emergencies (drug, mg dosage, route of administration)

Answer 26

Biperiden (akineton) 5mg amp, IM Diphenhydramine (Benadryl), 50 mg IM

Question 27

Drugs of choice for rapid tranquilization (drug, mg dosage, route of administration)

Answer 27

Haloperidol, 5mg oral or IM Olanzapine, 10 mg oral or IM

Question 28

T/F: Goal to rapid tranquilization is to produce sedation and calm the patient down

Answer 28

F NOT to produce sedation but to calm patient for them to cooperate in the assessment process

Question 29

T/F: Intentional questioning is done in an interview with suicidal patients Ex. Do you still feel like drinking the liquid to poison yourself?

Answer 29

T

Question 30

T/F: Clinicians should always ask about suicidal ideas as part of MSE, especially if the patient is depressed

Answer 30

T

Question 31

T/F: All suicidal patients are hospitalized

Answer 31

F Not all suicidal patients are hospitalized

Question 32

How do you assess the levels of intent and lethality of suicide?

Answer 32

Assess the: Nature of the proposed method Access to a proposed method Presence of other persons who can prevent suicidal act or offer support

Question 33

Suicide is considered (low/moderate/high) risk if there is serious consideration of harm, ideas of a plan and means, no access, the existence of some support, some risk factors present

Answer 33

Moderate risk

Question 34

Suicide is considered (low/moderate/high) risk if there is details in the plan, the greater the degree of lethality and strength of risk factors and absence of support

Answer 34

High risk

Question 35

Suicide is considered (low/moderate/high) risk if there is presence of ideation or passing thoughts without a plan and means

Answer 35

Low risk

Question 36

T/F: When self injurious behavior occurred, hospitalization in a pediatric unit is required for treatment or injury or observation after toxic ingestion

Answer 36

T

Question 37

T/F: Admission is indicated when patient has a persisting suicidal ideation and shows signs of psychosis, severe depression, or marked ambivalence about suicide

Answer 37

T

Question 38

T/F: Young children who made suicide attempts that are of LOW risk require psychiatric admission

Answer 38

T

Question 39

Risk of self harm if the patient with prior attempts has decided a method of doing so at a tentative time/place, with an easy access means, and have prepared some planning already.

Answer 39

MEDIUM

Question 40

Risk of self-harm if the patient with no prior attempts has decided a method of doing so, with means already in possession and has steps taken to do it at a defined/chosen time or place.

Answer 40

HIGH