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Block 8 Week 6 > Psychiatric Emergency-Piasecki > Flashcards

Flashcards in Psychiatric Emergency-Piasecki Deck (39)
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1
Q

What is the suicide homocide ration in Nevada?

A

twice as many suicides as homicides

2
Q

What are psychiatric emergencies?

A

-Harm to self
(suicide intent, parasuicidal behaviors)
-Harm to others
(homicidal intent, domestic, workplace and school violence)

**some states include threat to property as well

3
Q

People living in rural Nevada commit suicide at a much more than (blank) the rate of the nation as a whole. What populations have the highest rates of suicide?

A

twice

Military> geriatric

4
Q

Nevada is the worst state for social health because….?

A
  • high rates of child abuse
  • teenage suicide
  • teenage drug abuse
  • lack of high school completion
  • lack of health insurance coverage
  • greatest rate of suicide among those over 65
  • high rates of homicide
  • high rates of food stamp coverage
5
Q

What is parasuicide?

A

attempting suicide with no intent of completing

6
Q

Suicide in the US
Ranks (blank) as cause of death and (blank) cause of death for men in Nevada.

Every (blank) minutes
69 men, 16 women each day

1 in 65 people is a “survivor”– close relative of a person who died by suicide

A

11th
#6
18

7
Q

What is the suicide belt?

What are reasons for this?

A

it is a consolidated area in the US with high rates of suicide… Nevada is in it

-Rural, elevation, culture, access to care

8
Q

The suicide belt overlaps with ares of (blank).

What are risk factors?

A

higher major depression

-genetics, child abuse, trauma, substance abuse, etc.

9
Q

What is the most common way that people kill themselves?

A

firearms> suffocation> poisoning> other> fall

10
Q

What is the most common way that people attempt suicide and do not complete it?

A

Overdose> cutting/piercing

11
Q

What season has the most suicides?

A

spring (March>February)

12
Q

(blank) attempt suicide more often than the other gender but (blank) die by more suicide.
What is the highest risk groups?

A

Women
Men
Whites and American Indians/Alaskan Native AND Elderly (esp. 45-59)

13
Q

Rate of suicide has (blank) for 5-14 year olds

Still less than 10 per 100,000

A

doubled

14
Q

Are female or male high school students more suicidal?

A

female

15
Q

What age is at the highest risk for suicide?

A

elderly (up to 75 per 100,000)

16
Q

What is the link between suicide and serotonin?

A

decreased serotonin in CSF linked to violents/suicide-> may be an impulsivity thing

17
Q

Is there a genetic component to suicide

A

yup, increased concordance in MZ twins AND if you adopt a kid whos biologic parent was suicidal that adopted kid will have a much higher suicidal risk

18
Q

What are the demographic risk factors for suicide?

A
  • Gender: M>F 3:1
  • Medical illness: cancer, AIDS, COPD, hemodialysis
  • Nonmarried > “partnered”
  • Religion: Protestant> Catholic or Jewish> no religion
  • Women physicians, military
  • Family history
  • Incarceration
  • Psychiatric diagnosis
19
Q

What disorders have a risk between 5-15% of suicide?

A

Major depression/ Bipolar disorder: 15%
Alcoholism- 15%
Schizophrenia- 10%
Personality Disorders 5-10%

20
Q

Speaking about suicidal patients:
(blank) or more saw a primary care MD within weeks before death
Most spoke about suicide the (blank) of their death

A

50%

day

21
Q

What are the precipitating circumstances for suicide?

A

Intimate partner problem> disclosed intent to take life> physical health problems> job problem> financial problem

22
Q

How do you perform suicide assessment?

A

-Ideation
-Plan (lethality)
-Means (access)
-Deterrents
Social situation
-supports
-what has changed since patient presented?

23
Q

What are the screening tools for depression?

What is question 9?

A

ASQ (used in EDs)-> screening tool about mood
Beck depression inventory

Question 9.

  1. I don’t have any thoughts of killing myself.
  2. I have thoughts of killing myself, but I would not carry them out.
  3. I would like to kill myself.
  4. I would kill myself if I had the chance.
24
Q

Demographic risk factors are not predictive in (blank). Why?

A

short term

  • describes populations, not individuals
  • no validated assessment tool that “scores” suicide risk
  • Screening and clinical assessment
25
Q

What is parasuicidal behavior?
What are examples of these behaviors?
What disorder is this associated with?

A

A maldaptive solution to chronic problems where you attempt suicide but the intent is not to die….

  • self mutilation (cutting, burning)
  • overdose
  • deliberately going into diabetic ketoacidosis

-Borderline Personality Disorder

26
Q

What does forensic psychiatry do?

A
  • risk assessment
  • competency
  • legal insanity
27
Q

Violence is a (blank), not a diagnosis.

A

symptom

safety preempts all other interventions

28
Q

What are the clues for violence?

A
  • history
  • threats
  • weapons
  • hypervigilance
  • physical findings
29
Q

How do you manage potentially violent patients?

A
  • show of force (not going by yourself)
  • set a collaborative tone
  • verbal limits
  • know when to stop interview-leave, get help
30
Q

How do you get the profile of violence?

A
  • history of violence
  • age/gender/gang affiliation
  • substances
  • antisocial personality disorder
  • psychopathy
  • self destructive behavior
31
Q

How do you assess violence?

A
  • current substance use (drug screen/ blood alcohol concentration)
  • MSE: paranoia, cognitive impairment, auditory hallucinations
  • Past history of violence
32
Q

What are the physicians obligations to calling police about violence?

A

Duty to warn and protect but nevada doesnt have a statute so we operate “as if”-> rarely you can violate confidentiality.
-Should enlist patient as a participant in wanring others

33
Q

Who can do the legal 2000? what is it? and in what instances can you do it?

A

MDs and other health 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)
34
Q

What is the commitment process of the legal 2000?

A
  • 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
35
Q

What is competency?

A

a legal term that states you are sound of mind and have the capacity to do things:

  • make a will
  • strand trial
  • make medical decisions
  • manage own finances
36
Q

What is a patient with capacity able to do?

A

Communicate a Choice
Understand the Facts
Understand the Potential Consequences
Rationally manipulate information

37
Q

How often should you test for capacity?

A

at 2 different points in time (see how much info is retained)

38
Q

T or F

mental illness in itself does not excuse criminal behavior.

A

T

39
Q

What things do you need to be considered “not guilty by reason of insanity”?

A

Delusional and did not know what he was doing OR

Did not realize it was illegal