Psychiatric Emergencies--Piasecki Flashcards
What is the ratio of suicide to homicide in nevada?
2: 1
* *geriatric & military high
What is considered a psychiatric emergencies?
harm to self: suicide intent, parasuicidal behaviors
harm to others: homicidal intent, domestic, workplace, school violence
Where does Nevada score an F in social health indicators?
Child abuse Teenage Suicide Teenage Drug Abuse High School Completion Health Insurance Coverage Suicide among those over 65 Homicides 2 suicides for each homicide food stamp coverage
Where does suicide rank as cause of death in US?
11th #6 for men in NV
NV, Montana, Utah, Oregon, parts of Arizona & NM is a part of the ________ belt.
suicide
**overlaps with high prevalence of major depression
What is the most common cause of death by suicide?
70% committed by a firearm in mountain states
54.1% in general
After firearms…what is the next most likely cause of death by suicide?
suffocation
poisoning
other
For death by suicide…what is the cause? For attempted suicide…what is the cause?
Committed: firearm, suffocation
Attempted: poisoning, cutting
What is the highest risk time of the year for suicide?
early spring
Which gender attempts suicide more? Dies by suicide?
attempts: female
commits: male
What are the 2 highest risk ethnicities for death by suicide?
White
Native American
Which age group is the highest risk for death by suicide?
45-59
NV: elderly at high risk
What has happened to the suicide rate for children under 15 yo?
rate has doubled for 5-14 yo
Which gender in high school considers, plans, or attempts suicide more?
girls
Which NT is a marker for violent attempts at suicide?
reduced serotonin in CSF
also a marker for impulsive aggression
What are the demographic risk factors for suicide?
males>females medical illness: cancer, AIDS, COPD, hemodialysis nonmarried protestant or no religion are at higher risk women physicians military family hx incarceration psych diagnosis
T/F Women physicians are 3X more likely to commit suicide than women in general pop.
T
Which psych diagnoses are risk factors for suicide?
15%major depression/bipolar disorder
alcoholism
10% next level: schizophrenia, personality disorders
What are the ways we can save people from suicide?
50% or more saw a primary care MD within weeks before death
Most spoke about suicide the day of their death
What are precipitating circumstances for suicide?
intimate partner problem #1
physical health problem #2
job problem/financial problem
What is involved in a suicide assessment?
Ideation
Plan (lethality)
Means
Deterrents: what are the reasons for living?
Social Situation
Supports
What has changed since patient presented?
- *ASQ in the ER
- *Beck Depression Inventory
What are the important interventions for suicide risk?
Interventions Consultation (refer to ER) Hospitalization May need to be involuntary Suicide precautions Observation, hospital PJ’s, search belongings Follow up
T/F Owning a gun is an important risk factor for suicide.
True.
T/F Parasuicidal behavior is a diagnosis.
False. A symptom…usu of borderline personality disorder.
What are parasuicidal behaviors?
self mutilation
overdose
if they have diabetes: could be allowing themselves to go into diabetic ketoacidosis
T/F Violence is a symptom & not a diagnosis.
True
**safety preempts all other interventions
How do you evaluate risk of violence?
hx of violence: threats made weapons used attitude toward environment physical findings: scars, gang tattoos
What is emergency management of a patient who is potentially violent?
show of force
set a collaborative tone
verbal limits
know when to stop the interview
What is a profile of violence?
hx of violence age/gender/gang affiliation substances: meth etc. antisocial personality disorder psychopathy self destructive behavior
What are other aspects of violence assessment?
Current substance use (drug screen/ Blood Alcohol Concentration)
MSE: paranoia, cognitive impairment, Auditory Hallucinations
Past history of violence
What are physician obligations?
duty to warn & protect (Call police)
tarasoff
can violate patient confidentiality here
enlist patient as a participant in warning others
What are the requirements for involuntary hospitalization?
MD’s and other heath care professionals
Must personally observe the patient
Danger of harm to self or others
Danger from inability to care for self
Mentally ill
excludes dementia, seizures or substance related
What is the commitment process?
72 hour hold
Court hearing after 72 hours
Judge decides: Civil Commitment or release
If committed- a record is established and tracked with gun registry
What is competency?
a legal term for judicial proceedings
What is capacity?
Ability to: Make a will Stand trial Make Medical Decisions Manage own finances
What is legal insanity?
mental illness doesn’t excuse criminal behavior
except when delusional + didn’t know what they were doing
