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Paramedic > Psychiatric Behavioral Emergencies > Flashcards

Psychiatric Behavioral Emergencies Flashcards

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1
Q

Skills

Empathy

A

Do you really want to help this pt?

Act in their best interests?

Able to treat with dignity and respect?

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2
Q

Skills

Listening

A

What they say

How they say it

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3
Q

Skills

Observation

A

Body language and POSTURE

Agitation

Affect

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4
Q

Wisdom

A
  • Behavioral emergencies may be due to medical illness
  • Any illness or disease that creates a behavioral emergency needs treated
  • ”Psych” patients are PATIENTS
  • Many people suffer from psychiatric illness
  • Chemical imbalances in the brain
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5
Q

Common Misconceptions

A
  • Not true medical illness
  • Mental disorders are incurable
  • Always dangerous and violent; or bizarre
  • Due to bad parents
  • Personality Weakness
  • Schizophrenia is “split personality”
  • Depression is normal with aging
  • Depression doesn’t affect kids or teens
  • You can “will away” mental illness
  • Having a mental disorder is cause for embarrassment and shame
  • Addiction is a lifestyle choice
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6
Q

Behavior

A 
•Normal vs Abnormal?
 -Measured against norms of society 
•Emergencies 
 -Transient inability to cope 
 -Is there danger to self or others?
•Causes 
 -Organic
 -Biological 
 -Psychosocial 
 -Socio-cultural 
 -Injury 
 -Substance related
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7
Q

Scene Survey

A 
•Assess for:
 -violence 
 -Substance abuse
 -Suicide attempt 
•Appearance and behavior 
 -Psychomotor agitation 
 -Hygiene, dress
 -Out of place
 -Body Posture
•Limit number of people around pt
•Stay alert to signs of possible danger
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8
Q

Body Posture

A

Shows attitude and frame of mind

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9
Q

Patient Contact

A 
•Observe behavior 
•Posture 
 -Tone/volume voice, facial expression, body position, tension 
•Personal space 
•Stand at angle 
•No sudden movement, do not surprise 
•Compassion w/o friendliness 
 -Businesslike/calm
•Schizophrenia - DO NOT cause agitation!
•Limit number of people around pt
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10
Q

Speech/Thought

Form of thought

A

Ability to process information

Create logical ideas

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11
Q

Speech/Thought

Speech Rate

A

Mutism- refusing to answer

Poverty of speech- quick short answers (no elaboration)

Thought blocking- start to answer then stop part way through

Pressured- speaking a lot with no real pertinence to the question but just nonstop

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12
Q

Speech/Thought

Associations

A

Circumstantial thinking

Tangential thinking

Flight of ideas

Word salad

Speech

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13
Q

Thought Content

Psychosis

A

Distorted perception of reality

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14
Q

Thought Content

Hallucinations

A

False sensory- no bias in reality

Auditory- hearing voices

Visual- seeing things that aren’t there

Gustatory- metal taste

Touch

Olfactory- smells

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15
Q

Thought Content

Delusions

A

False perception of events, situations

Believes no matter what the evidence reveals

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16
Q

Thought Content

Neurosis

A

a relatively mild mental illness that is not caused by organic disease, involving symptoms of stress (depression, anxiety, obsessive behavior, hypochondria) but not a radical loss of touch with reality.

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17
Q

Thought Content

Paranoid Delusions

A

Persecution

Conspired against

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18
Q

Thought Content

Grandiose Delusions

A

Special powers

God-like

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19
Q

Thought Content

Somatic Delusions

A

Body

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20
Q

Thought Content

Delusions of Reference

A

Ordinary events have special, dangerous significance

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21
Q

Thought Content

Preoccupation

A

Ideas constantly dominate thoughts

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22
Q

Thought Content

Depersonalization

A

Detach self from body, mind, world

Like watching movie

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23
Q

Thought Content

Derealization

A

World is not real

Familiar things may seem alien, surreal

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24
Q

Affect

A

Outward expression of emotion; observed

-stable ➡️➡️ labile

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25
Q

Labile

A

Emotional expression characterized by hysterical laughter which quickly changes to sobbing

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26
Q

Flat Affect

A

Shows no emotion

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27
Q

Mood

A

Dominant sustained emotional state

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28
Q

Dysphoria

A

Depressed, sad, irritable

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29
Q

Euphoria

A

Elevated ecstatic

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30
Q

Euthymic

A

Normal

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31
Q

Physiological Changes

A

-New/changed/compliant medications?
-Substance abuse or misuse
-Rule out medical issues
-If acute crisis ➡️ consider medical causes
-Such as…
•other medical history
•Social history
•Is pt in danger of harming self or others?

32
Q

Medications

Antipsychotics

A

Dopamine antagonists

Some also antihistamine

Anticholinergic properties

33
Q

Medications

For Schizophrenia, delirium, acute psychosis

A 
•Haloperidol (Haldol)
•clozapine (Clozaril)
•risperidone (Risperidone)
•olanzapine (Zyprexa)
•quetiapine (Seroquel)
•Aripiprazole (Abilify)
 -Schizophrenia 
 -Bipolar 
 -Autism 
 -Adjunct major depression
34
Q

Antidepressants

Selective Serotonin Reuptake Inhibitors
SSRI

A

Citalopram (Celexa)

Escitalopram (Lexapro)

Paroxetine (Paxil)

Fluoxetine (Prozac)

Fluvoxamine (Luvox)

Sertraline (Zoloft)

35
Q

Antidepressants

Serotonin-norepinephrine reuptake inhibitors (SNRI’s)

A

Duloxetine (Cymbalta)

Venlafaxine (Effexor)

36
Q

Antidepressants

Tricyclic Antidepressants (TCA’s)

A 
Amitriptyline (Elavil)
Nortriptyline (Pamelor)
Protriptyline (Vivactil)
Imipramine (Tofranil)
Clomipramine (Anafranil)
Desipramine (Norpramin)
Doxepine (Sinequan)

TCA’s

  • Overdose = lethal arrhythmia
  • Caution in elderly
37
Q

Serotonin Syndrome

A 
•2 or more serotonergic drugs combined 
 -SSRI, SNRI, TCA, MAOI, St John’s wort, amphetamines, MDMA, cocaine, ondansetron, 
•Within 24 hr of taking 
•Very high body temps
 -Cooling measures
•Seizures 
 -Benzodiazepines 
•Extensive muscle breakdown 
 -Supportive 
•Sweating, dilated pupils, agitation, diarrhea
38
Q

Extra Pyramidal Symptoms (EPS)

A

Side affect from antipsychotic medications

•Blockage of Dopamine receptors in the brain
•Group of side effects
-Involuntary motor movement
-Uncontrollable muscle coordination

39
Q

Tardive Dyskinesia

A

Degenerative neurologic disorder

Repetitive movements of mouth & face
-Sucking, chewing, grimacing, pouting

Rock back and forth, tap feet

Long-term use of antipsychotic drugs

Suppress dopamine pathways in brain

Patient not aware of movements

40
Q

Dystonia

A

Abnormal muscle tone

41
Q

Acute Dystonic Reaction

A 
•Muscle spasms
 -Head/neck twists
 -Protrusion or swelling tongue 
 -Muscular rigidity/contracture/twisting arm
 -Back arching 
 -Restlessness, tremors 
•Onset- without warning 
•Young, males more often 
•Treat= Diphenhydramine 25-50 mg IV, IM
•Causes= Antipsychotic drugs
 -Chlorpromazine (Thorazine), Prochlorperazine (Compazine), Haloperidol (Haldol)
42
Q

Schizophrenia

A

Person has psychotic episodes that include hallucinations and delusions

Also, disorganized thoughts, impairment of reality testing

These symptoms occur for at least 6 months

Starts in late teens to mid 30’s. Can begin at age of 45

43
Q

Thought Disorder

Schizophrenia

A 
•Disorganized thoughts**
 -Word salad, loose association 
•Self care
 -Hygiene 
 -Eating 
 -Clothing 
•Social 
 -Masturbate in public 
 -Swear without reason 
 -Flat affect
 -Inappropriate gestures
 -Unable to hold a job
 -Remain in rigid position for days
•Hallucinations 
•Visual, tactile, olfactory 
•Auditory 
 -Multiple voices 
 -Say bad things 
 -People out to kill them
•Delusions 
 -Persecution 
 -Gesture, comments, song lyrics ➡️ directed toward them 
 -Grandeur 
 -Outside forces controlling them
44
Q

Mood Disorders

Bipolar

A 
•Manic state > 1 week 
•Irritation, anger
•Labile 
•Maybe delusional 
•Can’t keep up with own thoughts
 -Torrential downpour of thoughts 
•Pressured speech 
•Loos associations
45
Q

Mood Disorders

Major Depression

A
  • Serotonin levels low?
  • Dysphoria
  • Melancholy
  • Anhedonia
  • Low self-worth, self-esteem
  • Cognition, decisions difficult
  • Sleep disturbances
  • Appetite, libido altered
  • Suicidal thoughts, plans
46
Q

Major depression

Adult Findings

A

Withdrawal

Flat affect

Decreased cognitive functioning

Altered sleep

Physical pain

47
Q

Major Depression

Pediatric Findings

A

Not obeying rules

Poor test scores

Lack of school participation (extracurricular)

48
Q

Acute Anxiety Disorders

Panic Attack

A

Overwhelming fear

Apprehension

Impending doom

49
Q

Acute Anxiety Disorder

Phobia

A

Intense fear of object or situation

May have no basis ➡️ irrational

Agoraphobia- “market place”
-Cannot escape the situation ➡️ home bound

50
Q

Chronic Anxiety Disorders

Post Traumatic Stress Disorder PTSD

A
  • Threat of death, injury or actual event

- Alternate emotional numbness with vivid memories and dreams

51
Q

Chronic Anxiety Disorders

Obsessive Compulsive Disorder OCD

A
  • Intrusive thoughts- obsessions

- Rituals- compulsions

52
Q

Somataform Disorders

Conversion Disorder

A
  • Psychological distress converted
  • Motor or sensory symptoms
  • Seizures
53
Q

Somataform Disorders

Hypochondriasis

A
  • Preoccupied with serious medical conditions
  • Misinterpreting physical signs
  • Despite medical evaluations
54
Q

Factitious Disorders

A 
•Intentional s/s to feign illness 
•Knowledgeable of the illness 
•Munchausen Syndrome 
•Munchausen by proxy 
 -Illness/injury inflicted upon another 
 -Mother to child
•Malingering 
 -Feign illness or injury for gain
55
Q

Eating Disorders

Anorexia Nervosa

A 
-Distorted body image 
•Refuses to eat normally 
 -Think they are obese
•Measure themselves or look into mirror 
•Self esteem is dependent upon body image 
•Weight loss is good discipline 
•Don’t recognize they have a problem
56
Q

Eating Disorders

Bulimia Nervosa

A 
•Binges on food ➡️ then purges
 -Enormous amounts of food in 2 hr
 -Vomiting, laxatives, diuretics 
 -Exercise or fast for days 
•High calorie food (cake)
•Binge in secret
 -Becomes depressed
•Average weight 
•Low self-esteem 
•Electrolyte and cardiac arrhythmias
•Esophageal tears, gastric rupture
57
Q

Personality Disorders

Paranoid

A

Distrust and suspicion of others going to harm.

Pervasive, ongoing pattern of suspicion

58
Q

Personality Disorders

Schizoid

A

Pattern of detachment from social relationships and limited emotions

Eccentric

Solitary

Disinterested in social interaction

59
Q

Personality Disorders

Antisocial

A

Disregard for, violation of rights of others

Pervasive, impoverished moral sense or lack of moral conscience

60
Q

Personality Disorders

Borderline

A

Instability in relationships,self-image, and impulsive

Acts impulsively

61
Q

Personality Disorders

Histrionic

A

Shows excessive emotion and attention seeking behavior

Theatrical

Dramatic

62
Q

Personality Disorders

Narcissistic

A

Pattern of grandiosity, need for admiration and lack of empathy

Preoccupied with self

63
Q

Personality Disorders

Avoidant

A

Social inhibition

Feeling of inadequacy

Sensitive to criticism

64
Q

Personality Disorders

Dependent

A

Excessive need to be taken care of and will submit to others for fear of separation

65
Q

Personality Disorders

Obsessive Compulsive

A

Need orderliness and perfectionism

66
Q

Impulse Control Disorders

A
  • Inability to resist impulse or temptation
  • Pathological gambling
  • Kleptomania- urge to steal
  • Pyromania- urge to burn
  • Trichotillomania- pulling out hair
67
Q

Suicide

A 
•Act of ending one’s own life 
•Suicide ideation- thought, fantasy, plans
•Attempt- unsuccessful effort 
•History of:
 -Self-injury 
   •Mutilation, cutting 
   •Aim ➡️ bring back some feeling or “pain” high
•Less than 45 - frequent attempts 
•Older than 60 - more likely to succeed 
•Females- attempt more often 
•Males- succeed more often 
•Firearms- most common method
68
Q

Suicide Assessment & Treatment

A 
•Scene safety 
•Suicide attempt? Vs Ideation?
 -Ethical and legal responsibility to provide help 
•Attempt- 
 -Life-threats
•After life-threats managed:
 -Respect 
 -Listen 
 -Dignified transport
69
Q

Verbal Restraint

A 
•Gather YOUR wits first 
•Use low voice, identify yourself 
•Acknowledge pt’s behavior 
•Encourage pt to talk ➡️ then LISTEN 
•Ask ➡️
 - “Do you feel like you will lose control?”
 - “Are you carrying any weapons?”
•Set limits on their behavior 
•Back off and get help
•Don’t attempt “talk down”
 -Uncontrollable/ unknown chemicals/ situation involved
70
Q

Restraint Methods

A

•Begin with gentle, non threatening approach
•Progress as needed
•Explain options to patient before force is used
-Last resort- harm to self or others
•Assess surrounding before starting restraint
•Do not enter pt’s physical space until all involved in restraint action are ready
-5 people minimum
•Be familiar with restraint devices
•Handcuffs- officer MUST ride with you!

71
Q

Physical Restraints

A 
•Physically restrained pt’s may require chemical restraints 
•Excited delirium 
•Pattern- watch for:
 -Delirium & violent
 -Calm / quiet for short period 
 -Respiratory/cardiac arrest 
 -Asystole
 -Doesn’t respond to ACLS treatment
72
Q

Chemical Restraints

Lorazepam (Ativan)

A
  • 2 mg IM/IV
  • Respiratory depression
  • Hypotension
73
Q

Chemical Restraints

Haloperidol (Haldol)

A
  • 5-10 mg IM/IV
  • Respiratory rate
  • Acute dystonic reaction
  • Prolonged QT/ torsades
  • Mental status changes
74
Q

Anhedonia

A

Lack of enjoyment in activities that were once pleasurable

75
Q

Chemical Restraint

Ketamine

A

•Quicker

  • 4-5 mg/kg IM
  • Acts in 3 min
  • 1-2 mg/kg IV
  • Onset 30 sec
76
Q

Chemical Restraints

B-52

A 
50 mg of Benadryl (separate syringe)
   \+
5 mg Haldol 
   \+ (in same syringe)
2 mg Ativan

Paramedic (3 decks)

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