Psychiatric Emergencies -Heh Flashcards
Who has the highest rate of death by homicide in the US (age range and sex)?
Young males (10-24)
What race has the highest homicide rate in the US?
non-hispanic black
What is the most common weapon used in homicide in the US?
guns
What is the most important predictor of future violence?
past violence
What does a low CSF 5HIAA indicate?
it is a metabolite of serotonin
indicates low serotonin levels (may be seen in many violent patients)
What are the 4 kinds of aggression?
verbal aggression
physical aggression against objects
physical aggression against self
physical aggression against other people
–> can see people progress through all 4.
What age group has the highest rate of suicide?
elderly (65+)
males > females
Which age group is suicide most commonly seen in women?
middle aged females (25-64 yo)
Which profession has a higher suicide rate than other professions?
physicians (twice as likely as the general population to kill themselves–> even more in women)
What is the primary method of suicide in 10-24 year old age group?
suffocation (can include hanging and CO poisoning)
important to ask about suffocation in the interview
What seasons is suicide more prevalent?
late spring and fall
What is the strongest correlate for suicide?
hopelessness
What is the mnemonic for suicide risk assessment?
SADPERSONS
Sex (male) Age (45) Depression Previous suicide attempt of psych care Excessive EtOH or drugs Rational thinking loss (psychosis, organic brain syndrome) Separated, divorced or widowed Organized plan or serious attempt No social support Sickness, chronic disease
0-2=low risk
3-4=mild risk
5-6=moderate risk
7-10=high risk of suicide (hospitalize or commit)
What will you see with anti-cholinergic toxicity?
Hot as a hare (Hyperthermia) Dry as a bone (Dry Skin) Red as a beet (Flushed) Blind as bat (Mydriasis) Mad as a hatter (Delirium)
can’t see, can’t spit, can’t pee, can’t poop
also, tachycardia, HTN, and seizures
What will you see with cholinergic toxicity?
DUMBBELSS
diarrhea, urination, miosis, mm weakness, bronchorrhea, bradycardia, emesis, lacrimation, salivation/sweating, hypothermia
What types of symptoms will a pt with sympathomimetic toxicity present with?
AMS Delusions Diaphoresis Hyperreflexia Hypertension Hyperthermia Nystagmus Arrythmias Rapid irregular breathing Pneumothorax Anorexia Nausea/vomiting Diarrhea/GI upset Hallucinations Anxiety/restlessness Suicidal ideation Mydriasis Paranoia Seizures Tachycardia
Which medications can cause Neuroleptic Malignant Syndrome? What will these pts often present with?
1st and 2nd generation antipsychotic agents
get mm rigidity and mm breakdown (rhabdomyolysis)
often present: change in mental status; leukocytosis; elevated serum creatinine kinase (CK), hyperthermia, seizures, gradual onset, M>F
Which medications can cause Serotonin Syndrome?
SSRIs (too much 5HT)
often presents with agitation, diarrhea, diaphoresis, mydriasis, HTN, tachycardia, hyperreflexia, clonus, tremor
In what disease can you see lethal catatonia? What will alleviate catatonia?
severe schizophrenia
will have a gradual onset and no recent changes in meds can cause this
still show: change in mental status, mm rigidity, hyperthermia and elevated CPK, F>M
-alleviated by benzodiazepines and antipsychotics
What will be seen with SSRI withdrawal?
mental status change after a discontinuation of SSRI (esp short half lives)
