Pschiatric Emergencies

Question 1

Predictors of violence

Answer 1

Physical signs and symptoms: hyperactivity (pacing, restless), increased anxiety and tension, verbal abuse, loud or very soft voice, intense eye contact or avoidance of eye contact.
Recent acts of violence.
Stone silence
ETOH or drug intoxication
Possession of a weapon
Isolation (new)

Question 2

Milieu chacterisitcs

Answer 2

Overcrowding
Staff inexperience
Provocative or controlling staff
Poor limit setting
Arbitrary revocation of privileges

Question 3

Interventions: the main idea

Answer 3

1. Ideally, intervene at the earliest sign of escalation.
2. Seek to understand what is behind angry behaviors
3. Acknowledge their needs.

Question 4

De-escalation

Answer 4

Tell the patient you are concerned and want to listen.
Convey a calm, controlled, open, nonthreatening, and caring attitude.
Respect patient’s personal care
Speak slowly and in short sentences
Give the patient options
Pay attention to environment; choose quiet place visible to staff for safety.

Question 5

Personal safety

Answer 5

Avoid dangling earrings or necklaces
Ensure there is enough staff for backup
Always know the layout of the area
Don’t block the patient’s exit
If you notice escalation, provide feedback
Avoid verbal confrontation and shows of force

Question 6

Pharmacological interventions

Answer 6

If a patient shows signs of anxiety or agitation, it is perfectly acceptable to offer PRN medication. Antipsychotics: conventional- haloperidol. Atypical- olanzapine (zyprexa), ziprasidone (geodon), risperidone (risperdal)
Antianxiety: lorazepam (Ativan)

Question 7

Types of abuse

Answer 7

Physical abuse
Sexual abuse
Emotional abuse
Neglect
Economic abuse

Question 8

Controlled style of coping

Answer 8

A coping style characterized by a high degree of objectivity and intellectualization which tends toward focusing on understanding what is happening

Question 9

Statistics of child abuse

Answer 9

Neglect is the most common form of child abuse (64% of cases)
40% of cases is the mother acting alone; 18% is the father acting alone; 18% is both parents.

Question 10

Statistics of intimate partner abuse

Answer 10

50% of married couples have instances of abuse
10% of homicides are due to spousal murder
33% of females murdered were in intimate relationships with the killer

Question 11

Statistics of older adult abuse

Answer 11

For every case reported, five go unreported.

Question 12

Characteristics of perpetrators of abuse

Answer 12

Considers their own needs more important than needs of others.
Poor social skills.
Men who abuse believe in male supremacy.
Extreme pathological jealousy.
May control family finances.
Likely to abuse alcohol or drugs.

Question 13

The cycle of violence

Answer 13

Honeymoon
Tension building
Serious battering phase

Question 14

Vulnerable women

Answer 14

Pregnancy may trigger or increase violence.
Violence may escalate when wife makes move toward independence
Greatest risk for violence when attempts to leave relationship.

Question 15

Vulnerable children

Answer 15

Younger than 3
Perceived as different
Remind parents of someone they do not like
Product if unwanted pregnancy
Interference with emotional bonding between parent and child

Question 16

Vulnerable older adults

Answer 16

Poor mental or physical health
Dependent on perpetrator
Female, older than 75, white, living with a relative
Elderly father cared for by daughter he abused as a child
Elderly woman that is cared for by husband that abuses her in the past

Question 17

Primary prevention

Answer 17

Measures taken to prevent the occurrence of abuse

Question 18

Secondary prevention

Answer 18

Early intervention in abusive situation to minimize their disabling or long term effects

Question 19

Tertiary prevention

Answer 19

Facilitating healing and rehabilitative process.
Providing support
Assisting survivors of violence to achieve their optimal level if safety, health and wellbeing