9. Psychiatric Emergencies

Question 1

Types of Psychiatric Emergencies:

Answer 1

• Anger, hostility and aggression
• Suicide and suicidal behaviors
• Violence and abuse

Question 2

A Psychiatric Emergency is:

Answer 2

A disturbance in thought, mood and/or action which causes sudden distress to the individual/others and sudden disability or death, thus requiring immediate management. Suicidal attempt, deliberate harm to self or others.

Question 3

Characteristics of anger:

Answer 3

• Intense or no eye contact
• Easily offended
• Passive-aggressive
• Emotional overcontrol and flushed face
• Intense discomfort
• Tension

Question 4

TRUE/FALSE

• Anger becomes negative when the person denies it, suppresses it, or expresses it in appropriately.
• Anger that is expressed inappropriately can not lead to hostility and aggression.
• The nurse can help clients express anger appropriately by serving as a model and by role playing assertive communication techniques.
• Most clients with psychiatric disorders are not aggressive, clients with a variety of psychiatric diagnoses can exhibit angry, hostile, and aggressive behavior.

Answer 4

• True
• False
• True
• True

Question 5

Ways to cope with anger:

Answer 5

• Calm down
• Cope with the real problem
• Activities that are not aggressive, such as
  walking or talking with another person, are more likely to be effective in decreasing anger.
• Assertive communication uses “I” statements that express feelings and are specific to the situation, for example, “I am angry that you changed the work schedule without talking to me.”
• Statements such as these allow appropriate expression of anger and can lead to productive problem-solving discussions and reduced anger.

Question 6

• …..also called verbal aggression, is an emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior.

Answer 6

• Hostility
• A person may express hostility when he or she feels threatened or powerless.
• Hostile behavior is intended to intimidate or cause emotional harm to another, and it can lead to physical aggression.

Question 7

• …..it is behavior in which a person attacks or injures another person or that involves destruction of property.

Answer 7

Physical aggression

• Both verbal and physical aggression are meant to harm or punish another person or to force someone into compliance.
• Some clients with psychiatric disorders display hostile or physically aggressive behavior that represents a challenge to nurses and other staff members.

Question 8

• Clients believe others are out to get them; believing they are protecting themselves, they retaliate with hostility or aggression.

Answer 8

Paranoid delusions

Question 9

• Some clients have….that command them to hurt others.

Answer 9

Auditory hallucinations

Question 10

• Is seen in clients with dementia, delirium, head injuries, intoxication with alcohol or other drugs, and antisocial and borderline personality disorders.

Answer 10

Aggressive behavior

Question 11

5 phase Aggression cycle:

Answer 11

PHASE 1: TRIGGER - a negative experience or event to which they respond with anger. This initiates the aggression cycle.

• Manage or Eliminate the Trigger Event.

PHASE 2: ESCALATION - level of
agitation increases.

• Interrupt the Anger

PHASE 3: CRISIS - loss of control.

• Maintain Safety and Defuse Anger

PHASE 4: RECOVERY - regains control of emotions and behavior.

• Support recovery
• PHASE 5: POST-CRISIS - full recovery/control of emotions and behavior.
• Engage in Reflection and Problem-Solving