Psychiatric Emergencies--Piasecki

Question 1

What is the ratio of suicide to homicide in nevada?

Answer 1

2: 1

* *geriatric & military high

Question 2

What is considered a psychiatric emergencies?

Answer 2

harm to self: suicide intent, parasuicidal behaviors

harm to others: homicidal intent, domestic, workplace, school violence

Question 3

Where does Nevada score an F in social health indicators?

Answer 3

Child abuse
Teenage Suicide
Teenage Drug Abuse
High School Completion
Health Insurance Coverage
Suicide among those over 65
Homicides
2 suicides for each homicide
food stamp coverage

Question 4

Where does suicide rank as cause of death in US?

Answer 4

11th
#6 for men in NV

Question 5

NV, Montana, Utah, Oregon, parts of Arizona & NM is a part of the ________ belt.

Answer 5

suicide

**overlaps with high prevalence of major depression

Question 6

What is the most common cause of death by suicide?

Answer 6

70% committed by a firearm in mountain states

54.1% in general

Question 7

After firearms…what is the next most likely cause of death by suicide?

Answer 7

suffocation
poisoning
other

Question 8

For death by suicide…what is the cause? For attempted suicide…what is the cause?

Answer 8

Committed: firearm, suffocation
Attempted: poisoning, cutting

Question 9

What is the highest risk time of the year for suicide?

Answer 9

early spring

Question 10

Which gender attempts suicide more? Dies by suicide?

Answer 10

attempts: female
commits: male

Question 11

What are the 2 highest risk ethnicities for death by suicide?

Answer 11

White

Native American

Question 12

Which age group is the highest risk for death by suicide?

Answer 12

45-59

NV: elderly at high risk

Question 13

What has happened to the suicide rate for children under 15 yo?

Answer 13

rate has doubled for 5-14 yo

Question 14

Which gender in high school considers, plans, or attempts suicide more?

Answer 14

girls

Question 15

Which NT is a marker for violent attempts at suicide?

Answer 15

reduced serotonin in CSF

also a marker for impulsive aggression

Question 16

What are the demographic risk factors for suicide?

Answer 16

males>females
medical illness: cancer, AIDS, COPD, hemodialysis
nonmarried
protestant or no religion are at higher risk
women physicians
military
family hx
incarceration
psych diagnosis

Question 17

T/F Women physicians are 3X more likely to commit suicide than women in general pop.

Answer 17

T

Question 18

Which psych diagnoses are risk factors for suicide?

Answer 18

15%major depression/bipolar disorder
alcoholism
10% next level: schizophrenia, personality disorders

Question 19

What are the ways we can save people from suicide?

Answer 19

50% or more saw a primary care MD within weeks before death

Most spoke about suicide the day of their death

Question 20

What are precipitating circumstances for suicide?

Answer 20

intimate partner problem #1
physical health problem #2
job problem/financial problem

Question 21

What is involved in a suicide assessment?

Answer 21

Ideation
Plan (lethality)
Means
Deterrents: what are the reasons for living?

Social Situation
Supports
What has changed since patient presented?

• *ASQ in the ER
• *Beck Depression Inventory

Question 22

What are the important interventions for suicide risk?

Answer 22

Interventions
Consultation (refer to ER)
Hospitalization
May need to be involuntary
Suicide precautions
Observation, hospital PJ’s, search belongings
Follow up

Question 23

T/F Owning a gun is an important risk factor for suicide.

Answer 23

True.

Question 24

T/F Parasuicidal behavior is a diagnosis.

Answer 24

False. A symptom…usu of borderline personality disorder.

Question 25

What are parasuicidal behaviors?

Answer 25

self mutilation
overdose
if they have diabetes: could be allowing themselves to go into diabetic ketoacidosis

Question 26

T/F Violence is a symptom & not a diagnosis.

Answer 26

True

**safety preempts all other interventions

Question 27

How do you evaluate risk of violence?

Answer 27

hx of violence:
threats made
weapons used
attitude toward environment
physical findings: scars, gang tattoos

Question 28

What is emergency management of a patient who is potentially violent?

Answer 28

show of force
set a collaborative tone
verbal limits
know when to stop the interview

Question 29

What is a profile of violence?

Answer 29

hx of violence
age/gender/gang affiliation
substances: meth etc.
antisocial personality disorder
psychopathy
self destructive behavior

Question 30

What are other aspects of violence assessment?

Answer 30

Current substance use (drug screen/ Blood Alcohol Concentration)
MSE: paranoia, cognitive impairment, Auditory Hallucinations
Past history of violence

Question 31

What are physician obligations?

Answer 31

duty to warn & protect (Call police)
tarasoff
can violate patient confidentiality here
enlist patient as a participant in warning others

Question 32

What are the requirements for involuntary hospitalization?

Answer 32

MD’s and other heath care professionals
Must personally observe the patient

Danger of harm to self or others
Danger from inability to care for self
Mentally ill
excludes dementia, seizures or substance related

Question 33

What is the commitment process?

Answer 33

72 hour hold
Court hearing after 72 hours
Judge decides: Civil Commitment or release
If committed- a record is established and tracked with gun registry

Question 34

What is competency?

Answer 34

a legal term for judicial proceedings

Question 35

What is capacity?

Answer 35

Ability to: 
Make a will
Stand trial
Make Medical Decisions
Manage own finances

Question 36

What is legal insanity?

Answer 36

mental illness doesn’t excuse criminal behavior

except when delusional + didn’t know what they were doing