Psych

Question 1

The mnemonic _______________ can assist in recalling the focused psychiatric assessment.

Answer 1

MOMMAS2

Question 2

Review the MOMMAS2 mnemonic for focused psychiatric assessment.

Answer 2

M: Memory long and short term
O: Orientation to person, place and time
M: Mood (a symptom), “How do you feel?” “Happy,” “Mad,” “Sad?”
M: Mentation Ask about hallucinations, delusions, paranoia
A: Affect (a sign), How does the patient act? What are the eye contact, speech and demeanor?
S: Speech Is it organized and logical or disorganized and tangential?
S: Suicidality Is there a plan, intent, objective, preparation and/or rehearsal?

Question 3

Review the SAD PERSONS mnemonic for SRA.

Answer 3

S = Sex (male)
A = Age (<19 or >45)
D  = Depressive symptoms and hopelessness*
P = Previous suicide attempt or psychiatric illness
E= Excessive alcohol or drug use
R= Rational thinking loss*
S = Single, separated, divorced or widowed
O = Organized or serious suicide attempt*
N = No social support
S = Stated future intent*

Give 2 points for each positive answer marked with a *. All other positives score 1 point.

SCORE:
5 or below = Low risk, consider potential discharge
6-8 = Moderate risk, consider psychiatric consult
9 or more = High risk, likely admission

Question 4

f transfer is required to a psychiatric facility, it should be via____________.

Answer 4

EMS (never with family or friends in a private vehicle)

Question 5

True or false:

Contracting for safety is a proven method of suicide reduction.

Answer 5

False

Question 6

True or false:

Patients with acute psychosis are usually not disoriented.

Answer 6

True

Question 7

Differential diagnosis for delirium can be remembered with the mnemonic DIMTOPS:

Answer 7

> Drugs-intoxication, poisoning or withdrawal
Infections-UTI, PNA, meningitis/encephalitis…
Metabolic Disturbance-Glucose and other endocrine derangements as well as electrolyte disorders
Trauma-Head injury
Oxygen-Hypoxia
Postictal State
Space Occupying Lesion-Intracranial Tumor

Question 8

Is AH or VH more common in psychiatric etiology of delirium? Organic etiology?

Answer 8

Psychiatric: AH
Organic: VH

Question 9

Is being able to redirect vs unable to sustain attention more common in psychiatric etiology of delirium? Organic etiology?

Answer 9

Psychiatric: able to redirect
Organic: unable to sustain attention

Question 10

The most important concept in verbal de-escalation is for the physician to convey:

Answer 10

professional concern and respect for the patient.

- The patient should be advised of consequences for such continued behavior

Question 11

Five point immobilization is utilized to ensure patient and team safety utilizing at least 5 team members. Restraints should be (hard or soft?).

Answer 11

Soft

- easy to remove if needed (e.g. in case of seizure)

Question 12

True or false:

You can initiate chemical restraints for staff convenience if they don’t want to initiate physical restraints.

Answer 12

False

- never