Psychiatric Emergencies -Heh

Question 1

Who has the highest rate of death by homicide in the US (age range and sex)?

Answer 1

Young males (10-24)

Question 2

What race has the highest homicide rate in the US?

Answer 2

non-hispanic black

Question 3

What is the most common weapon used in homicide in the US?

Answer 3

guns

Question 4

What is the most important predictor of future violence?

Answer 4

past violence

Question 5

What does a low CSF 5HIAA indicate?

Answer 5

it is a metabolite of serotonin

indicates low serotonin levels (may be seen in many violent patients)

Question 6

What are the 4 kinds of aggression?

Answer 6

verbal aggression

physical aggression against objects

physical aggression against self

physical aggression against other people

–> can see people progress through all 4.

Question 7

What age group has the highest rate of suicide?

Answer 7

elderly (65+)

males > females

Question 8

Which age group is suicide most commonly seen in women?

Answer 8

middle aged females (25-64 yo)

Question 9

Which profession has a higher suicide rate than other professions?

Answer 9

physicians (twice as likely as the general population to kill themselves–> even more in women)

Question 10

What is the primary method of suicide in 10-24 year old age group?

Answer 10

suffocation (can include hanging and CO poisoning)

important to ask about suffocation in the interview

Question 11

What seasons is suicide more prevalent?

Answer 11

late spring and fall

Question 12

What is the strongest correlate for suicide?

Answer 12

hopelessness

Question 13

What is the mnemonic for suicide risk assessment?

Answer 13

SADPERSONS

Sex (male) 
Age (45) 
Depression
Previous suicide attempt of psych care 
Excessive EtOH or drugs 
Rational thinking loss (psychosis, organic brain syndrome) 
Separated, divorced or widowed
Organized plan or serious attempt 
No social support 
Sickness, chronic disease 

0-2=low risk
3-4=mild risk
5-6=moderate risk
7-10=high risk of suicide (hospitalize or commit)

Question 14

What will you see with anti-cholinergic toxicity?

Answer 14

Hot as a hare (Hyperthermia)
Dry as a bone (Dry Skin)
Red as a beet (Flushed)
Blind as bat (Mydriasis)
Mad as a hatter (Delirium)

can’t see, can’t spit, can’t pee, can’t poop

also, tachycardia, HTN, and seizures

Question 15

What will you see with cholinergic toxicity?

Answer 15

DUMBBELSS

diarrhea, urination, miosis, mm weakness, bronchorrhea, bradycardia, emesis, lacrimation, salivation/sweating, hypothermia

Question 16

What types of symptoms will a pt with sympathomimetic toxicity present with?

Answer 16

AMS
Delusions
Diaphoresis
Hyperreflexia
Hypertension
Hyperthermia
Nystagmus
Arrythmias
Rapid irregular breathing
Pneumothorax
Anorexia
Nausea/vomiting
Diarrhea/GI upset
Hallucinations
Anxiety/restlessness
Suicidal ideation
Mydriasis
Paranoia
Seizures
Tachycardia

Question 17

Which medications can cause Neuroleptic Malignant Syndrome? What will these pts often present with?

Answer 17

1st and 2nd generation antipsychotic agents

get mm rigidity and mm breakdown (rhabdomyolysis)

often present: change in mental status; leukocytosis; elevated serum creatinine kinase (CK), hyperthermia, seizures, gradual onset, M>F

Question 18

Which medications can cause Serotonin Syndrome?

Answer 18

SSRIs (too much 5HT)

often presents with agitation, diarrhea, diaphoresis, mydriasis, HTN, tachycardia, hyperreflexia, clonus, tremor

Question 19

In what disease can you see lethal catatonia? What will alleviate catatonia?

Answer 19

severe schizophrenia

will have a gradual onset and no recent changes in meds can cause this

still show: change in mental status, mm rigidity, hyperthermia and elevated CPK, F>M

-alleviated by benzodiazepines and antipsychotics

Question 20

What will be seen with SSRI withdrawal?

Answer 20

mental status change after a discontinuation of SSRI (esp short half lives)