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EMER 198 > LO7-8 Behavioural Emergencies > Flashcards

LO7-8 Behavioural Emergencies Flashcards

1
Q

Behavioural disorder and examples

A

interferes with a persons ability to perform activities of daily living

Mental health problem
Depression
Borderline, personality disorder

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2
Q

Behavioural emergency

A

exist when the abnormal behaviour threatens a persons health and safety with the health and safety of another
Imminent to have harm on others

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3
Q

Psychiatric emergency

A

person becomes suicidal, homicidal, or has a psychotic episode in which a person often experiences delusions and hallucinations

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4
Q

Delusions

Hallucinations

A

Delusions: false beliefs
Hallucinations: false perceptions

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5
Q

Causes of abnormal behaviour

A

Diabetes, seizure disorder, severe infections, metabolic disorders, head injury, stroke, alcohol, tumours in the brain and drugs may all cause derangements in behaviour

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6
Q

organic brain syndrome

A

abnormal behaviour are actually suffering from physical illness or are under the influence of a substance that effects normal cerebral function

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7
Q

Toxic and deficiency states

A 
Drug induced psychoses
Nutrition disorders 
Poisoning with bromide or other heavy metals 
Kidney failure 
Liver failure
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8
Q

Drug induced psychoses especially from:

A 
Digitalis 
Steroids 
Disulfiram 
Amphetamines 
LSD, PCP and other psychedelics
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9
Q

Delirium

A

Is a symptom not a disease

Temporary/reversible condition that results in rapid changes to behaviour

May complicate the assessment of the underlying problem

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10
Q

Excited delirium

A

is a controversial condition that arises typically in male subjects with a history of mental illness and/or acute or chronic drug abuse, particularly stimulant drugs.

Some groups claim that this condition was “invented” to cover up the use of excessive force by law enforcement

the American College of Emergency Physicians has accepted excited delirium as a unique syndrome, despite the World Health Organization, and the American Psychiatric Association failing to acknowledge it as a medical or psychiatric diagnosis.

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11
Q

Excited delirium is characterized by a combination of the following:

A
  • Delirium
  • Agitation or anxiety
  • Violent bizarre behaviour
  • Inappropriately clothed
  • Hallucinations or visual disturbances
  • Inability to feel pain
  • Superhuman strength
  • Elevated body temperature (hyperthermia)
  • Excessive sweating even in cold weather
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12
Q

Paramedics should consider the following when dealing with a patient displaying the signs of
excited delirium:

A

• Are we safe?
• Consider the need for physical restraint and sedation (ALS skill). Physical restraint is something that should be conducted with appropriate resources and preferably the assistance of law enforcement.
• Is the patient safe?
• Arms, legs, and body securely affixed to the cot?
• If the choice to restrain is made are we restraining the patient in such a way to allow for
breathing and airway control?
• If ALS sedates the patient are we in a position to assist with breathing and provide
supplemental oxygen?
• What else could be going on?
• remember that we need to rule but all other conditions before deciding on one specifically.

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13
Q

Psychosocial causes

A

Individuals may develop abnormal reactions to stressful psychosocial events or developmental influence

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14
Q

When exposed to stress this causes a crisis most of the time the patient will resolve the crisis in one of two ways they are:

A

Coping with it they will find ways to alter the situation to make it less stressful

Attempt to alleviate the discomfort by escaping including drug, alcohol, psychiatric symptoms and in some cases suicide

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15
Q

Categories of psychiatric disorders

A 
Cognitive 
Thought 
Mood 
Neurotic 
Substance related disorders and addictive behaviour 
Somatoform 
Factitious 
Impulse control 
Personality
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16
Q

Disorders of consciousness

A

Distractibility and inattention
Confusion
Delirium
Stupor and coma

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17
Q

Disorders of motor activity

A

Restlessness
steryotyped movement
compulsions
retarted movements

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18
Q

Stereotyped movements

Compulsions

A

Stereotyped movements: involves the repetition of movements that do not seem to serve any useful purpose

Compulsions: repetitive actions that are carried out to relieve the anxiety of obsessive thoughts

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19
Q

Neologisms

A

words that the patient invents

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20
Q

Echolalia

A

the patient echos the words of the examiner

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21
Q

Retardation of thought

A

it seems to take a very long time to get from one thought to the next

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22
Q

Circumstantial thinking

A

the patient includes many irrelevant details in his or her account of things

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23
Q

Preservation

A

refers to the repetition of the same idea over and over again

24
Q

Delusions of persecution

A

the individual believes that others are plotting against him or her

25
Q

Delusions of grandeur

A

the patient believes he or she is someone of great importance

26
Q

Amnesia

Confabulation

A

Amnesia: the loss of memory

Confabulation: patients with severe memory deficits from organic brain disease will invent experiences to fill in the gaps

27
Q

Illusion

Hallucination

A

Illusion: miss interpretation of sensory stimuli

Hallucination: it’s a perception that has no basis in reality and occurs without any external stimuli

28
Q

Generalized anxiety disorder

A

When a person worries about everything for no particular reason or if the worrying is unproductive in the individual cannot decide what to do about an upcoming situation

Must be present for more days than not for a period of at least six months and the worry must be difficult to turn off or control

29
Q

Phobias

A

Focusses all his or her anxieties onto one class of objects or situations

Confronted with the feared object or situation the person experiences intolerable anxiety

30
Q

Panic disorder

Agoraphobia

A

Characterized by sudden usually unexpected and overwhelming feelings of fear and dread accompanied by a variety of other symptoms

Agoraphobia: the fear of going into public places : the fear of going into public places

31
Q

Depression mnemonic

A

GASP PIPES: guilt, appetite, sleep disturbance, paying attention, interest, psychomotor abnormalitites

32
Q

Manic behaviour

A

One of the most striking psychiatric conditions

The manic patient is more likely to report being on top of the world I’ve never felt any better when they are not

33
Q

Mental status examination

A

COASTMAP: consciousness, orientation, activity, speech, thought, memory, mood, affect and perception

34
Q

The mental exam on a manic patient

A

Consciousness: easily distracted

Orientation to place and time: disrupted

Activity: hyperactive almost always report is significantly decreased need for sleep and I go for days without sleeping

Speech: pressured and rapid very talkative

Thought: flight of ideas and delusions patient may report of butter racing

Affect: oh hallmark of mania the patient seems to be on a high and is usually cheerful

Perception: may be disrupted

35
Q

Somatoform disorders

A

People who are overly concerned with their physical health and appearance

36
Q

Munchausen syndrome

A

intentionally getting sick for attention

37
Q

Psychosis

A

state where patient is out of touch with reality and are focused on their version of it

38
Q

schizophrenia

A

complex disorder that is neither easily defined nor readily treated

Typical onset occurs during early adulthood

May experience positive negative or disorganized symptoms

39
Q

Positive symptoms

Negative symptoms

Disorganized symptoms

A

Positive symptoms: include delusions and hallucinations

Negative symptoms: include apathy, mutism, a lack of interest in pleasure

Disorganized symptoms: erratic speech, emotional response and motor behaviour

40
Q

Paranoid schizophrenia

A

characterized by delusions or hallucinations usually centred on a specific theme

41
Q

Disorganized schizophrenia

A

usually display the wrong emotion for a particular situation and have disorganize speech behaviour

42
Q

Catatonic schizophrenia

A

Display odd motor activity such as strange expressions in their face or remaining rigid

43
Q

Mental Status examination for the psychotic patient

A

Consciousness: awake and alert but may be easily distracted

Orientation: may be disoriented as to time and place in severe cases

Activity: most commonly accelerated with agitation and hyperactivity bizarre stereotyped movement are common

Speech: may be pressured or sound strange because I’m an usual words that the patient has invented

Thought:
loosening associations
thought insertion:
thought withdrawl:

affect and mood: likely to be disturbed in psychosis

perception: auditory hallucinations are common in psychosis

44
Q

loosening associations:

thought insertion:

thought withdrawl:

A

loosening associations: the logical connection between what idea in the next becomes obscure at least a listener

thought insertion: the believe that thoughts are being thrust into his or her mind by another person

thought withdrawl: the believe that thoughts are being removed

45
Q

Medication for psychosis

A

Separated into two groups

Atypical antipsychotic (AAP) agents

Traditional antipsychotic agents

46
Q

Atypical antipsychotic (AAP) agents

A

Acute dystonic reaction: the patient develops muscle spasms of the neck, face and back within a few days of starting treatment with the medication

47
Q

Traditional antipsychotic agents

A

Atropine like effects: dry mouth, blurred vision, urinary retention and cardiac dysrhythmias

48
Q

Attention Deficit Disorder

A

neurobiological condition characterized by developmentally inappropriate level of attention,
concentration, activity, distractibility, impulsivity, and in the case of ADHD, hyperactivity

the most commonly diagnosed childhood behavioural disorder with symptoms beginning by three years of age

49
Q

ADHD Signs and Symptoms

A

Does not pay close attention to details
• Makes careless mistakes at work, school, or other activities
• Difficulty maintaining attention on tasks or play activities
• Difficulty organizing tasks
• Easily distracted
• Unable to follow more than one instruction at a time
• Talks excessively
• Has trouble participating in “quiet” activities

50
Q

Autism spectrum disorder

A

is a complex developmental disorder that appears in the first three years of life, but may be diagnosed much later.

Autism affects the brain’s normal development of social and communication skills.

Core features include impaired social interactions, impaired verbal and nonverbal communication, and restricted and repetitive patterns of behaviour.

51
Q

autism Signs and Symptoms

A
  • Unusual responses to the environment
  • Impaired social interaction
  • Repetitive movements such as rocking and twirling
  • Self-abusive behavior
  • Gross deficits in language development and speech patterns
  • Frequently associated findings:
  • Congenital blindness
  • Mentally impaired
  • Normal or even exceptional development with memory or math calculations
  • Grand mal seizures before adolescence
52
Q

Anxiety meds overdose signs and symptoms

A 
Severe hypoventilation 
Severe hypotension 
Bradycardia 
Slurred speech 
Altered mental status 
Impaired coordination
53
Q

SSRIs

A

Side effects: headaches, dizziness, sexual dysfunction,nausea, diarrhea and insomnia

54
Q

Heterocylic antidepressents

A

Side effects: anti cholinergic (dry) or cardiotoxic ( ecg changes and dysrhythmias)

55
Q

Monoamine oxidase inhibitors (MAOIs)

A

Recommended for aytipical major depressive episodes

Side effects: CNS irritabili

EMER 198 (4 decks)

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