Psychiatric Emergency-Piasecki

Question 1

What is the suicide homocide ration in Nevada?

Answer 1

twice as many suicides as homicides

Question 2

What are psychiatric emergencies?

Answer 2

-Harm to self
(suicide intent, parasuicidal behaviors)
-Harm to others
(homicidal intent, domestic, workplace and school violence)

**some states include threat to property as well

Question 3

People living in rural Nevada commit suicide at a much more than (blank) the rate of the nation as a whole. What populations have the highest rates of suicide?

Answer 3

twice

Military> geriatric

Question 4

Nevada is the worst state for social health because….?

Answer 4

• high rates of child abuse
• teenage suicide
• teenage drug abuse
• lack of high school completion
• lack of health insurance coverage
• greatest rate of suicide among those over 65
• high rates of homicide
• high rates of food stamp coverage

Question 5

What is parasuicide?

Answer 5

attempting suicide with no intent of completing

Question 6

Suicide in the US
Ranks (blank) as cause of death and (blank) cause of death for men in Nevada.

Every (blank) minutes
69 men, 16 women each day

1 in 65 people is a “survivor”– close relative of a person who died by suicide

Answer 6

11th
#6
18

Question 7

What is the suicide belt?

What are reasons for this?

Answer 7

it is a consolidated area in the US with high rates of suicide… Nevada is in it

-Rural, elevation, culture, access to care

Question 8

The suicide belt overlaps with ares of (blank).

What are risk factors?

Answer 8

higher major depression

-genetics, child abuse, trauma, substance abuse, etc.

Question 9

What is the most common way that people kill themselves?

Answer 9

firearms> suffocation> poisoning> other> fall

Question 10

What is the most common way that people attempt suicide and do not complete it?

Answer 10

Overdose> cutting/piercing

Question 11

What season has the most suicides?

Answer 11

spring (March>February)

Question 12

(blank) attempt suicide more often than the other gender but (blank) die by more suicide.
What is the highest risk groups?

Answer 12

Women
Men
Whites and American Indians/Alaskan Native AND Elderly (esp. 45-59)

Question 13

Rate of suicide has (blank) for 5-14 year olds

Still less than 10 per 100,000

Answer 13

doubled

Question 14

Are female or male high school students more suicidal?

Answer 14

female

Question 15

What age is at the highest risk for suicide?

Answer 15

elderly (up to 75 per 100,000)

Question 16

What is the link between suicide and serotonin?

Answer 16

decreased serotonin in CSF linked to violents/suicide-> may be an impulsivity thing

Question 17

Is there a genetic component to suicide

Answer 17

yup, increased concordance in MZ twins AND if you adopt a kid whos biologic parent was suicidal that adopted kid will have a much higher suicidal risk

Question 18

What are the demographic risk factors for suicide?

Answer 18

• Gender: M>F 3:1
• Medical illness: cancer, AIDS, COPD, hemodialysis
• Nonmarried > “partnered”
• Religion: Protestant> Catholic or Jewish> no religion
• Women physicians, military
• Family history
• Incarceration
• Psychiatric diagnosis

Question 19

What disorders have a risk between 5-15% of suicide?

Answer 19

Major depression/ Bipolar disorder: 15%
Alcoholism- 15%
Schizophrenia- 10%
Personality Disorders 5-10%

Question 20

Speaking about suicidal patients:
(blank) or more saw a primary care MD within weeks before death
Most spoke about suicide the (blank) of their death

Answer 20

50%

day

Question 21

What are the precipitating circumstances for suicide?

Answer 21

Intimate partner problem> disclosed intent to take life> physical health problems> job problem> financial problem

Question 22

How do you perform suicide assessment?

Answer 22

-Ideation
-Plan (lethality)
-Means (access)
-Deterrents
Social situation
-supports
-what has changed since patient presented?

Question 23

What are the screening tools for depression?

What is question 9?

Answer 23

ASQ (used in EDs)-> screening tool about mood
Beck depression inventory

Question 9.

0. I don’t have any thoughts of killing myself.
1. I have thoughts of killing myself, but I would not carry them out.
2. I would like to kill myself.
3. I would kill myself if I had the chance.

Question 24

Demographic risk factors are not predictive in (blank). Why?

Answer 24

short term

• describes populations, not individuals
• no validated assessment tool that “scores” suicide risk
• Screening and clinical assessment

Question 25

What is parasuicidal behavior?
What are examples of these behaviors?
What disorder is this associated with?

Answer 25

A maldaptive solution to chronic problems where you attempt suicide but the intent is not to die….

• self mutilation (cutting, burning)
• overdose
• deliberately going into diabetic ketoacidosis

-Borderline Personality Disorder

Question 26

What does forensic psychiatry do?

Answer 26

• risk assessment
• competency
• legal insanity

Question 27

Violence is a (blank), not a diagnosis.

Answer 27

symptom

safety preempts all other interventions

Question 28

What are the clues for violence?

Answer 28

• history
• threats
• weapons
• hypervigilance
• physical findings

Question 29

How do you manage potentially violent patients?

Answer 29

• show of force (not going by yourself)
• set a collaborative tone
• verbal limits
• know when to stop interview-leave, get help

Question 30

How do you get the profile of violence?

Answer 30

• history of violence
• age/gender/gang affiliation
• substances
• antisocial personality disorder
• psychopathy
• self destructive behavior

Question 31

How do you assess violence?

Answer 31

• current substance use (drug screen/ blood alcohol concentration)
• MSE: paranoia, cognitive impairment, auditory hallucinations
• Past history of violence

Question 32

What are the physicians obligations to calling police about violence?

Answer 32

Duty to warn and protect but nevada doesnt have a statute so we operate “as if”-> rarely you can violate confidentiality.
-Should enlist patient as a participant in wanring others

Question 33

Who can do the legal 2000? what is it? and in what instances can you do it?

Answer 33

MDs and other health 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)

Question 34

What is the commitment process of the legal 2000?

Answer 34

• 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

Question 35

What is competency?

Answer 35

a legal term that states you are sound of mind and have the capacity to do things:

• make a will
• strand trial
• make medical decisions
• manage own finances

Question 36

What is a patient with capacity able to do?

Answer 36

Communicate a Choice
Understand the Facts
Understand the Potential Consequences
Rationally manipulate information

Question 37

How often should you test for capacity?

Answer 37

at 2 different points in time (see how much info is retained)

Question 38

T or F

mental illness in itself does not excuse criminal behavior.

Answer 38

T

Question 39

What things do you need to be considered “not guilty by reason of insanity”?

Answer 39

Delusional and did not know what he was doing OR

Did not realize it was illegal