Acute Psychiatric Presentation

Question 1

What is psychosis ?

Answer 1

A group of mental disorders that feature a loss of contact with reality

Question 2

What is a delusion ?

Answer 2

An irrationally held belief that cannot be altered by rational argument

Question 3

What is a hallucination ?

Answer 3

A false perception in the absence of external stimuli

Question 4

What is delirium ?

Answer 4

Acute disorder of mental processes accompanying organic disease

Question 5

What is dementia ?

Answer 5

An acquired global impairment of intellect, memory and personality without impairment of consciousness

Question 6

What are some organic causes of an acute psychiatric presentation ?

Answer 6

Trauma - head injury
Infective - HIV, encephalitis, syphilis, malaria, meningitis, cerebral toxoplasmosis
Neuro - Parkinson’s, epilepsy, huntingtons
Neoplasia of the frontal or temporal lobe, paraneoplastic problems
Thyroid disease, adrenocortical disease
Drugs - Alcohol, illicit drugs, steroids

Question 7

What are some signs and symptoms that suggest an organic cause of an acute psychiatric presentation ?

Answer 7

History of substance abuse
Over the age of 35 as first presentation
Fluctuating behaviour
Predominantly visual hallucinations
Lethargy
Abnormal vital signs
Poor cognitive function

Question 8

What investigations are important to order in an acute psychiatric presentation ?

Answer 8

U&E’s, TFT’s, FBC, LFT’s
CT head

Question 9

What are some de-escalation methods ?

Answer 9

Verbal
Physical restraint
Tranquilisation

Question 10

What are the 10 elements of verbal de-escalation ?

Answer 10

• Respect personal space
• Don’t be provocative
• Establish verbal contact
• Use concise, simple language
• identify feelings and desires
• listen closely
• agree or agree to disagree
• set clear limits
• offer choices and optimism
• debrief the patient and staff

Question 11

When should physical restraint be used ?

Answer 11

Imminent harm to others
Imminent harm to patient
Significant disruption of important treatment or damage to the environment
Continuation of an effective, ongoing behaviour treatment process

Question 12

who should use physical restraints ?

Answer 12

Trained staff - security

Question 13

What is the preferred drug for sedation ?

Answer 13

Lorazepam - 0.5 to 2 mg IV/IM

2. Midazolam 2.5-5 mg IV/IM