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Flashcards in Psychiatric Emergencies Deck (69)
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61

What disorders does the term mentally ill include:

Some states specifically exclude certain disorders, such as? 4

Again it varies widely

The statutes do not include specific psychiatric diagnoses

They define mental illness in terms of its effect on the individual’s thinking or behavior

Most include some deleterious effect of the illness and many include aspects of dangerousness

1. alcoholism,
2. drug addiction and
3. epilepsy;
4. others include these disorders

62

Types of Involuntary Hospitalization

Emergency detention:
1. Can be initiated by who? 3
2. Generally brief: can range from? 2

Obervational commitment
1. Usually limited to what?
2. Many states require what?

Extended commitment
1. What do you need?

Emergency detention:
1. Can be initiated by:
-another adult,
-the police,
-a physician
2. Generally brief:
-ranges from 24 hours,
-1-3 days Limited paperwork

Observational commitment:
1. Usually limited to physicians/hospital personnel,
2. Many states require court approval

1. Extended commitment:
-Formal application/sometimes 2 physicians
-Involves a hearing

63

Emergency hold:
Patient must meet criteria**
Must be evaluated by approved psychiatric personnel*
This step is the first step in initiating the involuntary commitment process:**
6

1. Legal/civil process
2. Form is filled out by Psychiatrist (usually)
3. Form goes to County attorney's office**
4. County attorney than decides if a petition should be filed
5. Once petition filed there is a initial hearing [patient is appointed a public defender]
6. Than there is a final hearing set—if patient is determined to need commitment to a state facility must be done in 5 days

64

Benzodiazepines
Use in the ER when? 4

1. Treatment of alcohol or sedative withdrawal
2. Acute agitation
3. Acute mania or agitated psychosis
4. Control drug-induced hyperexcitable states (Meth, PCP)‏

65

Benzodiazepines—SE
10

1. Sedation
2. Lethargy
3. **Respiratory depression
4. Impaired psychomotor skills and judgment
5. Cognitive dysfunction
6. Delirium (especially in elderly)‏
7. Ataxia
8. Exacerbation of COPD, sleep apnea
9. Cardiovascular instability
10. Death

66

Benzodiazepines--Overdose
1. Acute intoxication or overdose? 4

2. Severe overdose or in combo w/ other CNS drugs? 2

1. Acute intoxication or overdose:
-Slurred speech
-Incoordination
-Unsteady gait
-Impaired attention or memory

2. Severe overdose or in combo w/ other CNS drugs:
-Leads to stupor
-Can lead to coma

67

Antipsychotic Medications
“Neuroleptic” refers to?

first generation antipsychotics:
Chlorpromazine
Haloperidol

68

first generation antipsychotics:
Chlorpromazine
Haloperidol
1. With long term use have high risk of what? 3

2. Can also increase?

3. Other symptoms? 3

1. parkinsonian EPS
-Rigidity
-Bradykinesia
-Tremor

2. Can increase prolactin—causing galactorrhea and amenorrhea

3.
-NMS
-Prolonged QT interval
-Sudden death

69

Second Generation Antipsychotics

1. Agents? 3
2. Approved for tx of? 3
3. Primary SE? 4

1. Agents:
-Risperidone (Risperdol)‏
-Olanzapine (Zyprexa)‏
-Quetiapine (Seroquel)‏

2. Approved for treatment of:
-Schizophrenia
-Acute bipolar mania
-Acute agitation

3. Primary SE:
-Sedation
-Hypotension
-NMS
-Sudden death