Psych Flashcards
age that most psych illnesses are diagnosed by
45 years
most common psych illness
anxiety
PE, ACS, Aortic Dissection, Thyroid disfunction, Arrythmias, Hypoglycemia, Elicit Drugs, EtOH withdrawal, caffeine/energy drinks, marijuana, phobia, PTSD, OCD
differentials for anxiety
intense fear + tension + restlessness + palpitations + SOB + hyperventilation + paresthesisa + carpal/pedal spasm + dizziness + agitation
anxiety
Management of acute anxiety reaction
benzodiazepine → NOT in the ED
MC diagnose in the ED for combative patients
drug and alcohol withdrawal
What should you obtain in all patients
rapid serum glucose
pulse ox
complete set of vitals
Accronym for causes of agitation
FIND ME
[Functional, Infectious, Neurologic, Drugs, Metabolic, Endocrine]
first step in evaluating combative patient
risk assessment and attention to safety
what should you never do to an agitated patient?
lie to them
which patients require immediate restraint
actively violent
severely agitated
those who exhibit signs of impending violence
Physical restraints
4 point restraints on extremities + one arm up/down + HOB elevated + padding to prevent neurovascular injury
How often do you check for neurovascular injury on patient with physical restraint
q 15 - 30 min
What do you always have to do for patient with physical restraints
document reason
which limbs are restrained
frequency of NV checks
review the need every 12 hours
types of chemical restraints
IM, IV, or SubQ Benzo or Antipsychotic
what do you need to be on the lookout for with Benzo?
decreased respiratory drive
MC chemical restraint ?
What is it good especially for?
Lorazepam (Ativan)
excellent for EtOH withdrawal
Preferred chemical restraint agents in pediatrics?
haloperidol and lorazepam
disturbance in cognition that impairs memory, judgement, personality, higher critical function and abstract thought process
dementia
How does dementia start and how is level of consciousness?
gradual onset
level of consciousness maintained
How does delerium differ from dementia?
Delirium → acute impairment of cognitive function and decreased LOC, Visual hallucinations are common
MC cause of delirium
infection → UTI, meningitis, pneumonia, electrolyte abnormalities
persistent dysphoric mood or loss of interest and please in usual activities (anehedonia)
feeling guilty or worthless
hopeless, thoughts of death/suicide
weight loss, decreased appetite, insomnia/hypersomnia, decreased concentration, flat affect, decreased hygeine
depression
Red flag for depression
giving away possessions
What must you do with depressed patients?
ask all about suicidal ideation
Job with handling Depression in the ED
rule out organic causes first → CBC, TSH, HIV, RPR, CMP, EtOH, UDS, Ammonia, CT of head
what do you never do with depressed patient in ED?
Never give new or previous diagnosis of depression in the ED → ALWAYS consult psych
risk factors for suicide
caucasian/native american, family history, male, >65 years, unmarried, lives alone, recent stressor, substance abuse, TMI, MH disorder, prior attempt/plan, access to carry out plan
If your patient in the ED had a suicide attempt, what should you do ?
place in safe rom 1:1 with sitter → paper gowns and no ties/strings
unnatural shifts in mood, energy acitivty levels
Bipolar Disorder
Three types of Bipolar Disorder
Manic Depressive
Bipolar Affective
Cyclothymic
Described manic phase of bipolar disorder
grandiosity easily distracted pressured speech insomnia racing thoughts/flight of ideas increased focus on activity excessive pleasurable activities poor judgement
depressed phase of Bipolar Disorder
Suicidal Ideation
feeling worthless
Which phase of bipolar episode with have delusions/hallucinations?
either phase
potential causes of bipolar episode that you must rule out
infection HIV syphilis head injury thyroid dysfunction schizophrenia
bizarre hallucinations + paranoia + social withdrawal + delusions + distrubed thinking processes + flat affect + abnormal behavior
Schizophrenia
when does the onset of schizophrenia usually occur?
late teens and mid 30s
major symptoms of schizophrenia
psychosis
when are most schizophrenic patients seen in the ED?
first psychotic break or acute flares (due to noncompliance of meds)
How does psychosis differ from schizophrenia?
psychosis symptoms include delusions + hallucinations + impaired relationship with reality + short lasting
what is schizophrenia?
disorder of thinking and perception → information processing and reality testing are impaired → unable to distinguish fantasy and reality [delusions and hallucinations]
four categories of schizophrenia symptoms
positive
negative
cognitive
mood
four types of positive symptoms in schizophrenia
hallucinations
delusions
disorganized speech
behavior
Types of hallucinations seen in schizophrenia
auditory (if visual or tactile think organic etiology)
types of delusions seen in schizophrenia
bizarre or illogical false beliefs, often paranoids, grandoise, persecutory, or religious
false interpretation of normal perceptions, taunting voices, 2 or more discussing or arguing with eachother
How will the speech be in a patient with schizophrenia?
disorganized → tangential, incoherent, rambling speech, neologisms
Negative symptoms seen in shcizophrenia
decrease in emotion
poverty of speech
loss of interest and drive
cognitive symptoms seen in schizophrenia
neurocognitive deficits (memory, attention, executive funcitons) difficulty understanding subtle interpersonal cues/relationships
Mood symptoms in schizophrenia
labile, anxious, depressed, suspicious, angry, cheerful
ED management for schizophrenic patient
haldol, risperdal, olanzapine
treat agitation
psych consult
assault by forcible, inappropriate sexual behavior
sexual assault
What should you include in history of patient who was sexually assaulted?
brief description of incident time it occurred location of assault weapon/drugs changed clothes, showered, douched since incident?
when would you do GU exam in sexual asault patient?
concern for life thretening injury (hemorrhaging)
When can you have evaluation from specially sexual assault trained RN?
assault must be within 3 days
labs you may want to order for sexual assault patient
UA/UPT, GC/Chlamydia, Wet Prep, HIV, Hep B, Syphilis
Sign of child abuse in infants
failure to thrive without underlying cause
Where are unusual fracture sites or injuries that may indicate child abuse ?
clavicle ribs arms seizures retinal hemorrhages
What is most often the indication of a presenting child that child abuse is going on?
inappropriate delay in seeking care
