Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 95 views

    Psychiatric Emergency

    Uploaded by

    Von Hippo
    The document discusses psychiatric emergencies, providing guidelines for evaluating and treating patients in crisis. It describes factors that indicate an emergency, such as threats to safety. A psychiatric emergency is evaluated through interviews, exams, and tests to determine if the problem is organic or functional, and if the patient is psychotic, suicidal, or homicidal. Treatment may involve tranquilization, restraints, or hospitalization depending on the patient's symptoms and level of risk. The safety of both patients and staff is the top priority during emergency psychiatric evaluations.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Psychiatric Emergency

    Uploaded by

    Von Hippo
    95 views3 pages
    The document discusses psychiatric emergencies, providing guidelines for evaluating and treating patients in crisis. It describes factors that indicate an emergency, such as threats to safety. A psychiatric emergency is evaluated through interviews, exams, and tests to determine if the problem is organic or functional, and if the patient is psychotic, suicidal, or homicidal. Treatment may involve tranquilization, restraints, or hospitalization depending on the patient's symptoms and level of risk. The safety of both patients and staff is the top priority during emergency psychiatric evaluations.

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document discusses psychiatric emergencies, providing guidelines for evaluating and treating patients in crisis. It describes factors that indicate an emergency, such as threats to safety. A psychiatric emergency is evaluated through interviews, exams, and tests to determine if the problem is organic or functional, and if the patient is psychotic, suicidal, or homicidal. Treatment may involve tranquilization, restraints, or hospitalization depending on the patient's symptoms and level of risk. The safety of both patients and staff is the top priority during emergency psychiatric evaluations.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    95 views3 pages

    Psychiatric Emergency

    Uploaded by

    Von Hippo
    The document discusses psychiatric emergencies, providing guidelines for evaluating and treating patients in crisis. It describes factors that indicate an emergency, such as threats to safety. A psychiatric emergency is evaluated through interviews, exams, and tests to determine if the problem is organic or functional, and if the patient is psychotic, suicidal, or homicidal. Treatment may involve tranquilization, restraints, or hospitalization depending on the patient's symptoms and level of risk. The safety of both patients and staff is the top priority during emergency psychiatric evaluations.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Understanding Psychiatric Emergencies  ABILITY TO COMPLY WITH TREATMENT

    RECOMMENDATION
    Psychiatric Disorders  CO MORBID PSYCHIATRIC AND PHYSICAL
    DISORDERS
    Diagnostic and Statistical Manual of Mental Disorders  QUALITY AND AVAILABILITY OF SUPPORT
    (Text Revision). SYSTEMS
    Commonly called the DSM-IV-TR  AVAILABLE RESOURCES
     CLIENT AND FAMILY PREFERENCES
    Multi-axial Assessment
    Axis I: Clinical disorders; other EMERGENCY ROOM PROCEDURES
    conditions that may be a focus of
    clinical attention.
    Axis II: Personality disorders; mental
    retardation.
    Axis III: General medical conditions.
    Axis IV: Psychosocial and environmental
    problems.
    Axis V: Global assessment of functioning.

    Often very difficult to sort out and many patients do


    not fit into the categories in the DSM.

    PSYCHIATRIC EMERGENCY
     DISTURBANCE IN THOUGHTS, FEELINGS, OR
    ACTION FOR WHICH IMMEDIATE THERAPEUTIC
    INTERVENTION IS NECESSARY

    Emergency if :
    Threat to:
     patient’s own bodily integrity by assault, self
    mutilation, drug ingestion
     Somebody else’s bodily integrity
     Patient’s own functional and psychological
    integrity- ability to perceive reality, feel
    appropriately, make judgments
     Psychological and functional integrity of the
    family or social unit

    DEFINITIONS
     AGITATION IS A STATE OF SEVERE INNER
    TENSION THAT GENERALLY PRODUCES MOTOR
    HYPERACTIVITY AND BEHAVIORAL
    DISORGANIZATION
     IMPULSIVITY TENDENCY TO ACT WITHOUT THE
    ABILITY TO MATCH THE ACT TO ITS CONTEXT TO
    CONSIDER THE CONSEQUENCES FOR THE SELF
    OR OTHERS
     AGGRESSION IS ANY BEHAVIOR THAT IS
    INTENDED TO BE DESTRUCTIVE TO PERSONS,
    ANIMALS OR OBJECTS

    PSYCHIATRIC EMERGENCY CONSULTATION


     FEMALES = MALES
     SINGLE> MARRIED
     20% SUICIDAL;10% VIOLENT
     40% HOSPITALIZED
     NIGHT HOURS

    DECISION MAKING
     ?HOSPITALIZATION
     DANGER OF HARM TO SELF OR OTHERS
     LEVEL OF FUNCTIONING AND CAPACITY FOR
    SELF CARE
     SEVERITY OF PSYCHIATRIC SYMPTOM
    CREATING AN APPROPRIATE ENVIRONMENT
     PROVIDE AMPLE SPACE
     AFFORD PRIVACY
     MINIMIZE NOISE AND ENVIRONMENTAL
    STIMULI
     HAVE A WELL LIT ROOM
     DEAL WITH SITUATION IN A TIMELY MANNER

    ORGANIC VS FUNCTIONAL
     FEATURES SUGGESTIVE TO ORGANIC CAUSES
    1. ACUTE ONSET
    2. FIRST EPISODE
    3. GERIATRIC AGE
    4. CURRENT MEDICAL ILLNESS OR INJURY
    5. SIGNIFICANT SUBSTANCE ABUSE
    6. NONAUDITORY DISTURBANCES OF PERCEPTION
    7. NEUROLOGICAL SYMPTOMS -DECREASED
    KEY SAFETY ISSUES LOC,SEIZURES, HEAD INJURY,CHANGE IN
     MAKE PERSONAL AND STAFF SAFETY A HEADACHE PATTERN, CHANGE IN VISION
    PRIORITY
     REALIZE THAT VIOLENCE CAN OCCUR ANYTIME, CLASSIC MENTAL STATUS SIGNS – DIMINISHED
    ANYWHERE ALERTNESS, DISORIENTATION, MEMORY
     POSITION YOURSELF BETWEEN THE CLIENT AND IMPAIRMENT, IMPAIRMENT IN
    THE EXIT CONCENTRATION, ATTENTION,
     GATHER AS MUCH INFO ABOUT THE PATIENT DYSCALCULIA,CONSTRUCTIONAL APRAXIA

    DIAGNOSIS SUMMARY OF EMERGENCY EVALUATION


     PSYCHIATRIC INTERVIEW- HISTORY WITH MSE  IS IT SAFE FOR THE PATIENT TO BE IN THE ER?
     PE AND ANCILLARY TESTS  IS THE PROBLEM ORGANIC OR FUNCTIONAL OR
     REQUEST FOR OLD RECORDS A COMBINATION?
     MULTILINGUAL STAFF  IS THE PATIENT PSYCHOTIC?
    RELATIVES NOT ADVISED AS TRANSLATORS  IS THE PATIENT SUICIDAL OR HOMICIDAL?
     TO WHAT DEGREE IS THE PATIENT CAPABLE OF
    GENERAL STRATEGY SELF CARE?

    PSYCHIATRIC EMERGENCY CONSULTATION


     FEMALES = MALES
     SINGLE> MARRIED
     20% SUICIDAL;10% VIOLENT
     40% HOSPITALIZED
     NIGHT HOURS

    AGITATED PATIENT
     Initial management should focus to calm
    patient through emphatic yet firm verbal means
    and establish collaborative relationship
     Inform patient that he may say or feel anything
    but are not free to act in violent or threatening
    manner
     Rapid neureptilization

    ACUTE PSYCHOTIC STATES


    1. IMPAIRMENT OF IMPULSE CONTROL
    CAPACITY TO RESTRAIN RAPIDLY
    ?ORGANIC OR NOT(ACUTE ALCOHOL
    INTOXICATION)
    NE/PE
    IMMEDIATE TRANQUILIZATION- EXCEPTION
    SEDATING DRUG IM OR IV

    2. IMPAIRMENT IN PERCEPTION
    ?ORGANICITY
    DRUG INTOXICATION
    DRUG WITHDRAWAL
    DEMENTIA

    3. IMPAIRMENT IN THINKING

    SCHIZOPHRENIC DISINTEGRATION:
    A. AGITATED, DISORGANIZED THINKING
    B.WITHDRAWN/ISOLATED/MUTE
    C.INCREASED SYMPTOMS
    ANXIETY, DEPRESSION, MANIA

    INTERVIEW SITUATIONS (PSYCHOSIS)


     WITHDRAWAL FROM OBJECTIVE REALITY
     PARANOIA USE OF RESTRAINTS
     COMMAND HALLUCINATIONS
     LIMIT POTENTIAL FOR AGITATION OR
    REGRESSION

    ACUTE PSYCHOTIC STATE


     MANIA
     QUALITY OF MANIC EPISODE
     FIRST RECOGNIZED MANIC EPISODE
     PATIENT’S PHYSICAL CONDITION
     IS PATIENT ON LITHIUM MAINTENANCE
     ?CONTENT OF THOUGHT

    DRUGS
     Lor azepam 2 to 6 mg po/im
     Haloperidol PO/IM 2 – 5 mg every 4 to 6 hrs.
     Risperidone PO 1 mg bid initially, increase as
    tolerated up to 3mg bid
     Olanzapine PO/IM 5 to 10 mg initially increase
    up to 20 mg daily

    PRINCIPLES
     DEAL WITH THE HEALTHY EGO
     ESTABLISH CONTROLS
     HALOPERIDOL IM 2 TO 10 MG Q 45MIN.
     RISPERIDONE QUICKLET
     IV DIAZEPAM

    INTERVIEW SITUATIONS (VIOLENT PATIENTS)


     PREDICTORS OF VIOLENCE
    1. EXCESSIVE ALCOHOL INTAKE
    2. HISTORY OF VIOLENT ACTS
    3. HISTORY OF CHILDHOOD ABUSE

    ASSESSING & PREDICTING VIOLENT BEHAVIOR Psychiatric Disorders


     Not so important to classify a patient’s
    psychiatric condition as it is to recognize
    patterns that may put the patient or others at
    risk.
     Important to exclude medical causes of
    behavioral problems before concluding they are
    psychiatric.
     Substance abuse complicates many psychiatric
    conditions, and may be the primary cause of
    others.

    Remember, sometimes the only


    difference between us and them is
    the fact that we have the keys!

    ---------------------VVV--------------------

    You might also like