Emergency Psychiatry Flashcards
Goals of Emergency Psychiatry
Triage
Assessment
Diagnosis
Short term management
Discharge planning
Describe triage
Collection first line information
Prioritise as per need
Communicate/escalate appropriately to arrange further care
Describe assessment
Appropriate assessment to seek further diagnostic information pertinent to manage presenting problem.
Rapid understanding of aetiology is a key skill required.
Describe short term management
Options such as medications, hospitalisation, seclusion/restraint and crisis social interventions and psychoeducation.
Describe discharge planning
Longer term interventions should be planned including preventative strategies aimed at averting crises and rational follow-up strategies.
What sx would make one suspect of withdrawal or intoxication of substances?
Disorientation
Impaired consciousness
Ataxia
Autonomic dysfunction
Hallucinations
What sx would make one suspect agitated depression?
Subdued mood
Anxiety
Catastrophic/guilt delusions
What would make one suspect of organic cause of catatonia?
No psychiatric hx
Worsens with benzos
What makes one suspect depressive stupor?
Low mood
Hx of depression
Hopelessness
What makes one suspect psychotropic induced catatonia such as NMS?
Rapid onset
Marked rigidity
Autonomic instability without posturing
Causes of catatonia
Organic
Depressive stupor
Schizophrenia
Manic excitement
Psychotropic induced - NMS
Autism/neurodevelopmental disorders
What can cause starvation in the psychiatric patient?
ED
Psychotic depression
Schizophrenia
Manic neglect
Psychotropic induced - NMS
OCD - food obsessions
How can schizophrenia lead to starvation?
Suspicions around poisoning, disorganised behaviour
How can OCD lead to starvation?
Recurrent irrational worries about safety, ritualistic behaviour
Total global mortality from suicide
1-2%
How high does suicide rank in developed countries?
Fifth most common cause
How many deaths in England and Wales are from suicide?
1%
Rate of suicide in England and Wales
8 per 100,000 per year
In which group are suicide rates increasing?
Young men
Most common suicide method in men
Hanging
How many deaths by men are from hanging?
40%
Second most common cause of death by men
OD
How many deaths from OD are caused by men?
20%
Third most common cause of death by men
Poisoning by car exhaust fumes
How many men die by poisoning from car exhaust fumes?
10%
Most common method of suicide by women
OD
Second most common method of suicide by women
Hanging
Third most common method of suicide by women
Drowning
How many women die by OD
46%
How many women die by hanging?
27%
How many women die by drowning?
7%
In most countries which age group has the highest rate of suicide?
> 75
Predictors of suicide in the elderly
Depression
Social isolation
Impaired physical health
Personality traits - anxious, obsessive
Where is there an increase in suicide rates in kids?
Males aged 15-19
Principal methods of suicide in young males
Hanging
Poisoning with car exhaust fumes
Traits amongst children who die by suicide
Antisocial behaviour
Suicide behaviour
Depressive disorders amongst parents and siblings
In which ethnic group is there a higher rate of suicide?
Asian women
Which occupational groups are at high risk of suicide?
Doctors - especially female
Anaesthetists, GPs and Psychiatrists
Farmers
Suicide due to depression
36-90%
Suicide due to alcohol abuse
43-54%
Suicide due to drug abuse
4-45%
Suicide due to schizophrenia
3-10%
Suicide due to organic mental disorder
2-7%
Suicide due to PD
5-44$
How many patients with a mood disorder will die by suicide?
6-10%
Which patients with depression are at highest risk?
Inpatients
Hx of impulsive and aggressive behaviour
Alcohol and drug misuse
Cluster B PD
How much does the risk of suicide increase if there is a history of a suicide attempt?
40x increase
Lifetime risk of suicide in alcohol dependence
7%
Suicide rate in heavy drinks
3.5x higher than general population
Suicide rate in alcohol use disorders
15x higher than general population
Suicide rate in drug dependence
15x higher than general population
Suicide rate in Anorexia
20-fold higher than general population
Lifetime suicide risk in schizophrenia
6%
10x higher than genera population
When do majority of schizophrenia patients commit suicide?
Active phase of disorder after suffering depressive sx
Characteristic traits of patients with PD who commit suicide
Comorbid depression or substance misuse
Impulsive and aggressive behaviour
Younger
Global annual suicide rate
1 in 6000/year
Male:female ratio of suicide
2-4:1
Most common age of suicide
15-24 females
25-34 males
In which age group is suicide rate decreasing?
> 65
Most common psychiatric diagnosis in suicide
Depression 30-31%
Alcohol dependence 17-24%
Mental disorders without much increase in suicide rate
Mental retardation
Dementia
OCD - if no depression
Suicides that have at least one recorded DSH attempt
40-60%
Number of people that will repeat DSH in one year
30%
Patients who were in contact with MH services at time of suicide
25%
Patients on psychiatry OP registers at time of suicide
25%
Patients who attempt suicide under alcohol influence
25%
50% of those who had alcohol within 6 hours
Patients who committed suicide who had seen a psychiatrist in the previous week
12.5%
Patients who commit suicide who had seen a health worker in last 3 weeks
33%
Patients who commit suicide who had seen their GP in last four weeks
66%
Patients who commit suicide who had seen their GP in the last week
40%
Most common method of IP suicide
Hanging - belt, curtain rail
How many IP suicides occur during first week of admission
25%
How many IP suicides occur when under routine (not constant or intermittent observations)
80%
How many patients who commit suicide were not compliant with meds?
20%