Psychiatric Emergencies

Question 1

Suicidal etiology

Answer 1

• sociological, psychological, physiological
• genetics: suicide runs in families
• Neurochemistry: pts who attempt suicide have lower 5-HIAA level in CSF

Question 2

Associations in Suicide

Answer 2

• up to 90% who commit suicide have at least one major psychiatric disorder
• MDD. Bipolar, Schizophrenia, substance abuse, anxiety, Personality disorder (borderline or antisocial)

Question 3

Suicide Risk Factors

Answer 3

• Age: adolescent and elderly: > 60 (less attempts, more successful)
• Male: men commit 4x more than women (women attempt 4x more)
• Single, widowed, separated/divorced : 4x more likely
• Presence of psych d/o: MDD, bipolar, schizo, dementia/delerium
• Presence of substance abuse
• Caucasian
• feelings of hopelessness, helplessness, Isolation, Chronic illness

Question 4

Ways men commit suicide

Answer 4

• firearms
• hanging
• jumping

Question 5

Ways women commit suicide

Answer 5

• overdose of meds

- poison

Question 6

parasuicidal behavior =

Answer 6

injure themselves by self mutilation but do not wish to die

Question 7

Risk factors for previous suicide attempt

Answer 7

• family h/o completed or attempted suicide
• recent psych hospitalization: within 3 mnths
• recent loss: job or rltnshp

Question 8

High Risk characteristics

Answer 8

> 45 y/o male
alcohol dependence
violent behavior
previous suicidal behavior
previous psych hospitalization

Question 9

Suicidal pts: when to hospitalize

Answer 9

• the absence of strong social support system, h/o impulsive behavior and a suicidal plan of action are all indications for hospitalization
• If pt cannot agree to call when reaching the point of uncertainty about their inability to control suicidal impulses should be hospitalized

Question 10

Tx for suicidal pts:

Answer 10

• tx underlying cndtns: antidepressants/antipsychotics
• supportive therapy
• dissuade pts from making life decisions while suicidally depressed

Question 11

Baker Acted

Answer 11

• situation in which an individual can be hospitalized against their will
• done if the pt is in serious danger to self or others, or if they are likely to suffer from neglect or harm if current behavior continues

Question 12

Dystonia =

Answer 12

-brief or prolonged contractions of muscles that result in abnormal mvmnts/postures, tongue protrusion, truisms, torticolis, laryngeal/pharyngeal dystonia, dystonia of libs/trunk

Question 13

Causes of dystonia

Answer 13

• potential side effect of antipysch meds
• usually occurs in first 4 days of tx or following an increase in dose
• less likely to occur in those on the newer antipysch drugs

Question 14

Meds that tx dystonia

Answer 14

• Benztropine (Cogentin)
• Diphenhydramine (Benadryl)
• Benzos (Valium or Ativan)

Question 15

Neuroleptic Malignant syndrome =

Answer 15

-life threatening complication of anti psych tx and can occur anytime during the course of tx

Question 16

Neuroleptic Malignant syndrome sx’s

Answer 16

-development of severe muscle rigidity and elevated temp PLUS
2 of following: diaphoresis, dysphagia, tremor, incontinence, changes in LOC, dystonia, mutism, obtundation, agitation, high fever, increased pulse/BP, leukocytosis, increased CPK

Question 17

Tx of Neuroleptic Malignant syndrome

Answer 17

• supportive care
• dopamine receptor agonists = bromocriptine
• muscle relaxants: Dantrolene
• Levodopa, ECT and benzos