Chapter 28libvolume7.xyz/physiotherapy/bsc/3rdyear/psychiatry/... · · 2015-01-08− Biologic or...
Transcript of Chapter 28libvolume7.xyz/physiotherapy/bsc/3rdyear/psychiatry/... · · 2015-01-08− Biologic or...
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Chapter 28Chapter 28
Psychiatric
Emergencies
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National EMS Education Standard CompetenciesNational EMS Education Standard Competencies
Medicine
Integrates assessment findings with principles
of epidemiology and pathophysiology to
formulate a field impression and implement a
comprehensive treatment/disposition plan for
a patient with a medical complaint.
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National EMS Education Standard CompetenciesNational EMS Education Standard Competencies
Psychiatric
• Recognition of
− Behaviors that pose a risk to the EMS provider, patient, or others
• Assessment and management of
− Basic principles of the mental health system
− Suicidal/risk
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National EMS Education Standard CompetenciesNational EMS Education Standard Competencies
Anatomy, physiology, epidemiology,
pathophysiology, psychosocial impact,
presentations, prognosis, and management of
− Acute psychosis
− Agitated delirium
− Cognitive disorders
− Thought disorders
− Mood disorders
− Neurotic disorders
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National EMS Education Standard CompetenciesNational EMS Education Standard Competencies
Anatomy, physiology, epidemiology,
pathophysiology, psychosocial impact,
presentations, prognosis, and management of
(cont’d)
− Substance-related disorders/addictive behavior
− Somatoform disorders
− Factitious disorders
− Personality disorders
− Patterns of violence/abuse/neglect
− Organic psychoses
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IntroductionIntroduction
• The mind and body are inseparable.
− Illness affects a person’s behavior.
− Changes in mental state affect physical health.
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Definition of Behavioral Emergency
Definition of Behavioral Emergency
• Most experts define behavior as the way
people act or perform.
− Overt behavior is generally understood by those
around the person.
− Covert behavior has hidden meanings or intentions.
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Definition of Behavioral Emergency
Definition of Behavioral Emergency
• Behavioral
emergency
− Some disorder of
mood, thought, or behavior that
interferes with
ADLs
• Psychiatric
emergency
− Behavior that
threatens a person’s health or
safety and the
health and safety
of another person
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Definition of Behavioral Emergency
Definition of Behavioral Emergency
• A behavioral or psychiatric emergency is
defined by the person who dials 9-1-1.
• It can be difficult to understand the patient’s
confused and frayed feelings.
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PrevalencePrevalence
• Average number of mentally unhealthy days
for Americans has increased
− 1993: 2.9 days/month
− Today: 3.5 days/month
• 45.1 million US adults with any mental
illness in the past year
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Medicolegal Considerations Medicolegal Considerations
• When behavior, speech, and thoughts are
erratic, it can be difficult to communicate.
− Spend time with the patient.
− Obtain consent when possible.
− Be clear in your explanations.
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Causes of Abnormal BehaviorCauses of Abnormal Behavior
• Four broad categories
− Biologic or organic in nature
− Resulting from the environment
− Resulting from acute injury or illness
− Substance-related
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Causes of Abnormal BehaviorCauses of Abnormal Behavior
• Biologic or organic
− Organic brain syndrome
− Conditions alter the functioning of the brain
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Causes of Abnormal BehaviorCauses of Abnormal Behavior
• Environmental
− Psychosocial and sociocultural influences
• When consistently exposed to stressful events
patients develop abnormal reactions.
• Sociological factors affect biology, behavior, and
responses to the stress of emergencies.
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Causes of Abnormal BehaviorCauses of Abnormal Behavior
• Injury and illness
− Illness results in
stress on coping
mechanisms.
− Acute trauma
creates stress.
• Post-traumatic
stress disorder
(PTSD)
Courtesy of Captain David Jackson, Saginaw Township Fire Department
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Causes of Abnormal BehaviorCauses of Abnormal Behavior
• Substance-related
− Alcohol
− Cigarettes
− Illicit drugs
− Other substances
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Psychiatric Signs and Symptoms
Psychiatric Signs and Symptoms
• When mental health is challenged,
mechanisms or behaviors work to return
homeostasis.
− Present as psychiatric signs and symptoms
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Psychiatric Signs and Symptoms
Psychiatric Signs and Symptoms
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Patient AssessmentPatient Assessment
• Assessment of the patient with a behavioral
emergency differs from other methods.
− You are the diagnostic instrument.
− The assessment is part of the treatment.
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Scene Size-UpScene Size-Up
• Situations with a strong behavioral
component may have a sudden and
unexpected turn of events.
− Determine whether it is dangerous to you and
your partner.
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Scene Size-UpScene Size-Up
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Scene Size-UpScene Size-Up
• The environment can give clues.
− Social history
− Living conditions
− Availability of support
− Activity level
− Medications
− Overall appearance
− Attitude/well-being
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Primary AssessmentPrimary Assessment
• Clearly identify yourself.
• Form a general impression.
− Assess appearance, posture, and pupils.
− Limit the number of people around the patient.
− Stay alert to potential danger.
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Primary AssessmentPrimary Assessment
• Airway and breathing
− Assess the airway and evaluate breathing.
− Provide interventions based on your findings.
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Primary AssessmentPrimary Assessment
• Circulation
− Assess the pulse rate, quality, and rhythm.
− Obtain systolic and diastolic blood pressures.
− Evaluate for shock and bleeding.
− Assess the patient’s perfusion level.
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Primary AssessmentPrimary Assessment
• Transport decision
− Disturbed patients should see a physician.
− If a patient withholds consent, they may be
taken against their will at the request of:
• Police
• County mental health physician
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Primary AssessmentPrimary Assessment
• Transport decision (cont’d)
− The same applies to the use of forcible restraint.
• Law enforcement officers should be summoned.
• Consult medical command as necessary.
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History TakingHistory Taking
• Mental status
examination
− Key part of
assessment
− Check each system using
COASTMAP.
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COASTMAPCOASTMAP
• Consciousness
− Level
− Concentration
• Orientation
− Year/month
− Location
• Activity
− Behavior
− Movement
• Speech
− Rate, volume, flow, articulation,
and intonation
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COASTMAPCOASTMAP
• Thought
− Is the patient
making sense?
• Memory
− Recent
− Remote
− Immediate
• Affect and mood
− Do the inner
feelings seem
appropriate?
• Perception
− “Do you hear
things others
can’t?”
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Secondary AssessmentSecondary Assessment
• Obtain vital signs.
• Examine skin temperature and moisture.
• Inspect the head and pupils.
• Note unusual odors on the breath.
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Secondary AssessmentSecondary Assessment
• In examining the extremities, check for:
− Needle tracks
− Tremors
− Unilateral weakness or loss of sensation
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ReassessmentReassessment
• Routinely performed during transport
• Your radio report should include:
− Medical and mental health history
− Medications prescribed
− Assessment findings
− Information from the mental status examination
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ReassessmentReassessment
• Discuss with the hospital the need for
restraints or medications.
− If the patient is aggressive or violent, provide
advance notice to the emergency department.
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Emergency Medical CareEmergency Medical Care
• If the erratic behavior could be caused by a
medical disorder:
− Treat that before presuming the behavior is due
to an emotional or psychiatric cause.
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Communication TechniquesCommunication Techniques
• Begin with an
open-ended
question.
• Let the patient talk.
• Listen, and show
that you are
listening.
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Jackson/I
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Communication TechniquesCommunication Techniques
• Don’t be afraid of
silences.
• Acknowledge and
label feelings.
• Don’t argue.
• Facilitate
communication.
• Direct the patient’s
attention.
− Confrontation
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Communication TechniquesCommunication Techniques
• Ask questions.
− Avoid “yes-no” or leading questions.
− Use “how” and “what” questions.
• Adjust your approach as needed.
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Crisis Intervention SkillsCrisis Intervention Skills
• Be as calm and
direct as possible.
• Exclude disruptive
people.
• Sit down.
− Preferably at a
45-degree angle
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Crisis Intervention SkillsCrisis Intervention Skills
• Maintain a
nonjudgmental
attitude.
• Provide honest
reassurance.
• Develop a plan of
action.
− Once the plan is
set, allow the patient to exercise
some control.
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Crisis Intervention SkillsCrisis Intervention Skills
• Encourage some motor activity.
• Stay with the patient at all times.
• Bring all medications to the hospital.
• Never assume that it is impossible to talk
with any patient until you have tried.
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Physical RestraintPhysical Restraint
• Improvised or commercially made devices
• Be familiar with restraints used by your
agency.
• Make sure you have sufficient personnel.
− Minimum of four trained, able-bodied people
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Physical RestraintPhysical Restraint
• Discuss the plan of action before you begin.
− Include law enforcement.
− Use the minimum force necessary.
− Don’t immediately move toward the patient.
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Physical RestraintPhysical Restraint
• If the show of force doesn’t calm the patient,
move quickly.
− Grasp at the elbows, knees, and head.
− Apply restraints to all four extremities.
− The best position is supine.
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Physical RestraintPhysical Restraint
• Never:
− Tie ankles and
wrists together
− Hobble tie
− Place a patient
facedown in a
Reeves stretcher
• Once in place:
− Don’t remove
restraints.
− Don’t negotiate or
make deals.
− Place a mask over
the face of a spitting patient.
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Physical RestraintPhysical Restraint
• Continuously
monitor the patient.
• Never place your
patient face down.
• Check peripheral
circulation every
few minutes.© Jones & Bartlett Learning. Courtesy of MIEMSS.
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Physical RestraintPhysical Restraint
• Be careful if a combative patient suddenly
becomes calm.
• Document everything in the patient’s chart.
• You may defend yourself against an attack.
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Chemical RestraintChemical Restraint
• Use of medication to subdue a patient
− Only use with approval from medical control
− Follow local protocols and guidelines.
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Chemical RestraintChemical Restraint
• Haloperidol
− Administered either IM or IV
− Should not be administered to:
• Patients younger than 14 years
• Those with a suspected head injury
• Those who may be pregnant
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Chemical RestraintChemical Restraint
• Benzodiazepines
− Shorter-acting ones may be given intranasally.
− Only midazolam and lorazepam have reliable
intramuscular absorption.
− Side effects are usually mild and easily treated.
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Chemical RestraintChemical Restraint
• Closely monitor the patient’s:
− Pulse rate
− Blood pressure
− Respiratory rate
• Be prepared to support ventilation.
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Pathophysiology, Assessment, and Management of Specific EmergenciesPathophysiology, Assessment, and Management of Specific Emergencies
• Many factors
contribute to
disturbances of
behavior.
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Acute PsychosisAcute Psychosis
• Pathophysiology
− Person is out of touch with reality
− Occur for many reasons
− Episodes can be brief or last a lifetime.
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Acute PsychosisAcute Psychosis
• Assessment
− Characteristic: profound thought disorder
− A thorough examination is rarely possible.
− Transport the patient in an atraumatic fashion.
− Use COASTMAP.
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Acute PsychosisAcute Psychosis
• Consciousness
− Awake and alert
− Easily distracted
• Orientation
− Disturbances more common in
organic disorders
• Activity
− Most commonly
accelerated
• Speech
− Neologisms
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Acute PsychosisAcute Psychosis
• Thought
− Disturbed in
progression and
content
• Memory
− Relatively or
entirely intact
• Affect and mood
− Mood is likely to
be disturbed.
− Affect may reflect
mood or be flat.
• Perception
− Auditory
hallucinations
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Acute PsychosisAcute Psychosis
• Management
− Reasoning doesn’t always work.
− Explain what is being done.
− Directions should be simple and consistent.
− Keep orienting the patient.
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Acute PsychosisAcute Psychosis
• Management (cont’d)
− Before pharmacologic treatments, try:
• Maintaining an emotional distance
• Explaining each step of the assessment
• Involving people the patient trusts
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Acute PsychosisAcute Psychosis
• Management (cont’d)
− When methods fail, it may be appropriate to:
• Safely restrain the patient.
• Administer a medication to help the behavior.
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Agitated DeliriumAgitated Delirium
• Pathophysiology
− Delirium: a state of global cognitive impairment
− Dementia: more chronic process
− Patients may become agitated and violent.
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Agitated DeliriumAgitated Delirium
• Assessment
− Try to reorient patients.
− Perform a thorough assessment.
• Management
− Identify the stressor or metabolic problem.
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Suicidal IdeationSuicidal Ideation
• Pathophysiology
− Suicide: any willful act designed to end one’s
life
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Suicidal IdeationSuicidal Ideation
• Assessment
− Every depressed
patient must be
evaluated for
suicide risk.
− Most patients are relieved when the
topic is brought up.
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Suicidal IdeationSuicidal Ideation
• Assessment (cont’d)
− Broach the subject in a stepwise fashion.
− Higher-risk patients include patients who have:
• Made previous attempts
• Detailed, concrete plans
• A history of suicide among close relatives
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Suicidal IdeationSuicidal Ideation
• Management
− Don’t leave the patient alone.
− Collect implements of self-destruction.
− Acknowledge the patient’s feelings.
− Encourage transport.
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Patterns of Violence, Abuse, and Neglect
Patterns of Violence, Abuse, and Neglect
• Abuse and neglect
− Assess the following:
• The patient
• The environment
• Other persons involved
− Document your findings, and report your concerns according to local protocols.
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Patterns of Violence, Abuse, and Neglect
Patterns of Violence, Abuse, and Neglect
• Violence
− Most angry patients can be calmed by a trained
person who conveys confidence.
− EMS personnel should prepare to deal with
hostile or violent behavior.
• Preventive action is best to ensure no harm.
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Patterns of Violence, Abuse, and Neglect
Patterns of Violence, Abuse, and Neglect
• Identify situations with the potential for
violence.
− Preventive action starts with being prepared for
a possible violent encounter.
− Develop “survival awareness.”
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Patterns of Violence, Abuse, and Neglect
Patterns of Violence, Abuse, and Neglect
• Risk factors
− Scenarios including:
• Alcohol or drug
consumption
• Crowd incidents
• Violence has already
occurred
− People who are:
• Intoxicated
• Experiencing
withdrawal
• Psychotic
• Delirious
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Patterns of Violence, Abuse, and Neglect
Patterns of Violence, Abuse, and Neglect
• Warning signs include:
− Posture: sitting tensely
− Speech: loud, critical, threatening
− Motor activity: unable to sit still, easily startled
− Clenched fists, avoidance of eye contact
− Your own feelings
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Patterns of Violence, Abuse, and Neglect
Patterns of Violence, Abuse, and Neglect
• Management of the violent patient
− Assess the whole situation.
− Observe your surroundings.
− Maintain a safe distance.
− Try verbal interventions first.
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Mood DisordersMood Disorders
• Unipolar mood disorder: mood remains at
one pole of the continuum
• Bipolar mood disorder: mood alternates
between mania and depression
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Mood DisordersMood Disorders
• Manic behavior
− Patients typically have abnormally exaggerated
happiness with hyperactivity and insomnia.
• Pressured and rapid speech
• “Tangential thinking”
• Grandiose and unrealistic ideas
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Mood DisordersMood Disorders
• Manic behavior (cont’d)
− Be calm, firm, and patient.
− Minimize external stimulation.
− If the patient refuses transport, consult medical
control.
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Mood DisordersMood Disorders
• Depression
− Leading cause of disability in people 15- to
44-year olds
− Can occur in episodes with sudden onset and
limited duration
− Onset can also be insidious and chronic.
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Mood DisordersMood Disorders
• Depression (cont’d)
− Diagnostic features (GAS PIPES)
• Guilt
• Appetite
• Sleep disturbance
• Paying attention
• Interest
• Psychomotor abnormalities
• Energy
• Suicidal thoughts
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SchizophreniaSchizophrenia
• Typical onset occurs during early adulthood.
• Experience may include:
− Delusions
− Hallucinations
− A flat affect
− Erratic speech
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Neurotic DisordersNeurotic Disorders
• Collection of psychiatric disorders without
psychotic symptoms
− Includes anxiety disorders
• Mental disorders in which dominant moods are fear
and apprehension
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Neurotic DisordersNeurotic Disorders
• Generalized anxiety disorder (GAD)
− Patient worries for no particular reason or
worrying prevents decision-making abilities.
− Treated with pharmacologic agents and
counseling
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Neurotic DisordersNeurotic Disorders
• Generalized anxiety disorder (GAD) (cont’d)
− When dealing with a patient with GAD:
• Identify yourself in a calm, confident manner.
• Listen attentively.
• Talk with the person about their feelings.
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Neurotic DisordersNeurotic Disorders
• Phobias
− Unreasonable fear, apprehension, or dread of a
specific situation or thing
• Simple phobias focus all anxieties on one class of
objects or situations.
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Neurotic DisordersNeurotic Disorders
• Phobias (cont’d)
− When managing a patient, explain each step of
treatment in detail.
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Neurotic DisordersNeurotic Disorders
• Panic disorder
− Sudden feelings of fear and dread
− If allowed to continue, panic attacks can cause
severe lifestyle restrictions.
• Agoraphobia: fear of going into public places
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Neurotic DisordersNeurotic Disorders
• Panic disorder
(cont’d)
− Signs and
symptoms usually peak in
10 minutes.
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Neurotic DisordersNeurotic Disorders
• Panic disorder (cont’d)
− Separate from panicky bystanders.
− Provide a calm environment.
− Be tolerant of the disability.
− Reassure the patient.
− Give the symptoms a name.
− Help the patient regain control.
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Substance-Related DisordersSubstance-Related Disorders
• Regarded on four levels:
− Substance use
− Substance intoxication
− Substance abuse
− Substance dependence
• Determining the most effective treatment
requires an integrative approach.
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Eating DisordersEating Disorders
• Persons may experience severe electrolyte
imbalances.
• Two thirds report anxiety, depression, and
substance abuse disorders.
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Eating DisordersEating Disorders
• Bulimia nervosa
− Consumption of large amounts of food
− Compensated by purging techniques
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Eating DisordersEating Disorders
• Anorexia nervosa
− Weight loss jeopardizes health and lives
− Typical patient:
• Decreased body weight based on age and height
• Intense fear of obesity
• Experience amenorrhea
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Somatoform DisordersSomatoform Disorders
• Preoccupation with physical health and
appearance
− Hypochondriasis: Anxiety or fear that the person
may have a serious disease
− Conversion disorders: a physical problem results from faking a physical disorder
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Factitious DisordersFactitious Disorders
• Patient produces or feigns physical or
psychological signs or symptoms.
− Symptoms are under voluntary control.
• Factitious disorder by proxy: a parent
makes a child sick for attention and pity
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Impulse Control DisordersImpulse Control Disorders
• Lack of ability to resist a temptation
• Examples include:
− Intermittent explosive disorder
− Kleptomania
− Pyromania
− Pathologic gambling
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Personality DisordersPersonality Disorders
• Maladaptive patterns of thinking about the
environment and one’s self
− Cause functional impairment or subjective
distress
• Be calm and professional.
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Medications for Psychiatric Disorders and Behavioral Emergencies
Medications for Psychiatric Disorders and Behavioral Emergencies
• Patients may be taking any of several types
of psychotropic drugs.
• During your assessment, determine:
− Which medications have been prescribed
− Whether they are being taken
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Psychiatric Medication TypesPsychiatric Medication Types
• Antidepressants
− Combat the
symptoms of
depressive illness
− Alter levels of
neurotransmitters in the autonomic
nervous system
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Psychiatric Medication TypesPsychiatric Medication Types
• Antidepressants (cont’d)
− Fluoxetine: the most commonly prescribed
• Side effects are minimal.
− Heterocyclic: used for major depression
• Side effects are common.
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Psychiatric Medication TypesPsychiatric Medication Types
• Antidepressants (cont’d)
− Monoamine oxidase inhibitors: recommended
for atypical major depressive episodes
• Potential side effects
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Psychiatric Medication TypesPsychiatric Medication Types
• Benzodiazepines
− May be prescribed for severe emotional distress
− Contraindicated in patients with:
• Known hypersensitivity to benzodiazepines
• Acute, narrow-angle glaucoma
• First-trimester pregnancy
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Psychiatric Medication TypesPsychiatric Medication Types
• Antipsychotics
− Newer medications have less risk of adverse
effects and are more effective.
• Known as atypical antipsychotic (AAP) drugs
− Relieve delusions and hallucinations.
− Improve symptoms of anxiety and depression.
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Psychiatric Medication TypesPsychiatric Medication Types
• Antipsychotics (cont’d)
− May cause metabolic side effects
− Cardiovascular effects depend on medication.
− May cause an acute dystonic reaction
− May cause atropine-like effects
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Psychiatric Medication TypesPsychiatric Medication Types
• Amphetamines
− CNS and PNS stimulants
− Help with ADHD.
− Raise systolic and diastolic blood pressure.
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Psychiatric Medication TypesPsychiatric Medication Types
• Amphetamines
− Psychological
effects depend on:
• Dose
• Mental state
• Personality
− Results include:
• Alertness
• Elevated mood
• Increased motor
and speech
activities
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Problems Associated with Medication NoncomplianceProblems Associated with Medication Noncompliance
• Increases the likelihood that a person with
mental illness will commit a violent act
• When obtaining medication history, include:
− Previously prescribed medications
− Missed doses
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Emergency Use of MedicationsEmergency Use of Medications
• Emergency use of medications are often
required with violence.
− The potential danger is too great not to
intervene.
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Emergency Use of MedicationsEmergency Use of Medications
• Before administering chemical restraint,
complete your assessment with:
− A thorough understanding of the chief complaint
− Attention to allergies
− Medical and medication history
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Pediatric Behavioral ProblemsPediatric Behavioral Problems
• 50% of childhood
mental illnesses
will present by age
14 years.
− More likely to have
coexisting
problems
− Difficult to diagnose
© Leah-Anne Thompson/ShutterStock, Inc.
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Pediatric Behavioral ProblemsPediatric Behavioral Problems
• Mental status assessment is similar to that
of an adult.
− Exception: Consider developmental level.
• Abnormal findings are often related to
adjustment disorders and stress.
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Geriatric Behavioral ProblemsGeriatric Behavioral Problems
• Distress and pain
may be caused by:
− Exposure to new
experiences
− Alterations to routines
© Leah-Anne Thompson/ShutterStock, Inc.
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Geriatric Behavioral ProblemsGeriatric Behavioral Problems
• Anxiety and depression are too often
considered a “normal part of aging.”
− Ageism: discrimination against older people
• Take stock of your own attitudes.
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SummarySummary
• Behavioral emergencies can present unique
challenges in patient management. Focus
on reducing the patient’s stress without
exposing yourself to unnecessary risks.
• A behavioral or psychiatric emergency is
any reaction to events that interferes with
activities of daily living.
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SummarySummary
• Behavioral emergencies can be a
temporary response to a traumatic event.
• Calls for behavioral emergencies have
special medical and legal considerations.
• You have limited legal authority to require a
patient to undergo care in the absence of a
life-threatening emergency. Always involve
law enforcement personnel when you are
called to assist a patient with a severe
behavior or psychiatric crisis.
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SummarySummary
• If a patient poses an immediate threat,
leave the area until law enforcement
personnel secure the scene.
• Underlying causes of behavioral
emergencies fall into four categories:
biologic (organic) causes, causes resulting
from the person’s environment, causes
resulting from acute injury or illness, and
causes that are substance related.
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SummarySummary
• Psychiatric signs and symptoms occur
when mental health is challenged and
psychological mechanisms or behaviors
mobilize to return the person’s mental state
to homeostasis.
• Assessment of a disturbed patient differs
from other assessment methods in that you
are the diagnostic instrument. Assessment
is also part of the treatment.
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SummarySummary
• When providing care, be direct, honest, and
calm; have a definitive plan of action; stay
with the patient at all times; and express
interest in the patient’s story.
• When sizing up the scene, pay special
attention to potential dangers and objects
that may be used as potential weapons,
hazardous chemicals, etc. Remove
potentially harmful objects.
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SummarySummary
• Primary assessment includes identifying
yourself, forming a general impression of
the patient’s condition and the nature of the
problem, assessing the ABCs, making a
decision about transport, and taking a
history via the mental status examination.
• Secondary assessment involves looking for
signs of an organic cause of the behavioral
emergency.
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SummarySummary
• Management is focused on ensuring scene
safety and maintaining awareness of life-
threatening conditions, while treating the
patient for any medical disorders.
• Effective communication techniques include
beginning with an open-ended question,
showing that you are listening, allowing
silence when appropriate, avoiding
argument, facilitating communication, and
asking questions.
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SummarySummary
• Crisis intervention skills include staying
calm and being direct, excluding disruptive
people from the scene, maintaining a
nonjudgmental attitude, developing a plan
of action, encouraging motor activity, and
assuming that the patient can hear and
understand everything you say.
• Use of chemical or physical restraints is
reserved for times when verbal intervention
fails to reduce severe agitation.
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SummarySummary
• Pathophysiologic factors that contribute to
behavioral disturbances include cognitive
impairment, thought disorders, mood
disorders, neurotic disorders, substance-
related disorders and addictive behavior,
somatoform disorders, factitious disorders,
impulse control disorders, and personality
disorders.
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SummarySummary
• You may encounter patients with psychosis,
a thought disorder characterized by a statue
of delusion in which the person is out of
touch with reality.
• You may encounter patients with agitated
delirium. This is impairment of cognitive
function that can present with disorientation,
hallucinations, or delusions, and is
characterized by restless and irregular
physical activity.
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SummarySummary
• The threat of suicide requires immediate
intervention. Depression is the most
significant risk factor for suicide.
• Situations involving violence, abuse, and
neglect can have the potential for escalation
and the possibility of evoking emotional
responses in you.
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SummarySummary
• Patients with psychiatric emergencies may
be taking any of several types of
psychotropic drugs. During assessment,
determine which medications have been
prescribed and whether the patient is
actually taking them.
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CreditsCredits
• Chapter opener: © Mark C. Ide
• Backgrounds: Orange—© Keith Brofsky/
Photodisc/Getty Images; Blue—Jones & Bartlett
Learning. Courtesy of MIEMSS; Blue—Courtesy of
Rhonda Beck; Green—Courtesy of Rhonda Beck;
Purple—Courtesy of Rhonda Beck.
• Unless otherwise indicated, all photographs and illustrations are under copyright of Jones & Bartlett
Learning, courtesy of Maryland Institute for
Emergency Medical Services Systems, or have
been provided by the American Academy of
Orthopaedic Surgeons.