PsychoSocial Emergencies

Question 1

What is Anxiety?

Answer 1

• “faceless fear”
• Patient responds with difficulty to stressors that otherwise would not become problems for the average individual.

Question 2

What are the 3 major sources of Anxiety?

Answer 2

• Biological (food, shelter, clothing)
• Psychological (low self esteem, death of a loved one, abandonment)
• Sociological (lack of a sense of belonging)

Question 3

What are some manifestations of an Acute Anxiety Attack?

Answer 3

• Hyperactive
• restless hand movements
• Tremors
• Dyspnea
• Dry mouth
• Chest pain
• Dysphagia
• Palpitations
• Hyperventilation
• Tachycardia
• Increased urination
• Feeling of “impending doom”
• Diaphoresis
• Choking sensation
• Sweaty palms
• Attempt to escape environment.

Question 4

What are some differential diagnosis that you need to rule out before diagnosing a patient with having an Acute Anxiety Attack?

Answer 4

• alcohol/substance abuse
• Hyperventilation syndrome
• cerebral carcinoma
• schizophrenia
• Angina
• Hypoglycemia
• Neuropathies
• Tachydysrhythmias
• CHF/Pulmonary edema
• Pneumonia
• Toxicities
• Depression/Suicidal ideation
• Mitral valve prolapse
• Pneumothorax
• Withdrawals
• Thyroid disturbances
• Acute myocardial infarction
• Pulmonary embolus
• Costochondritis

Question 5

What is a Grief/Bereavement/Situational Crisis?

Answer 5

• response to significant loss which does not have to be a death.
  -process of mourning influenced by many factors.

Question 6

What are some manifestations of a Grief/Bereavement/Situational Crisis?

Answer 6

• Labile
• Decreased speech
• Inability to concentrate
• Differing emotions
• Focus on “lost object”
• Helplessness
• Normal vital signs
• Sleep disturbances
• Change in weight/ appetite.

Question 7

What are the 5 stages of grief?

Answer 7

1) Denial
2) Anger
3) Bargaining
4) Depression
5) Acceptance

Question 8

What are the etiologies of Depression?

Answer 8

• changes in receptor/ neurotransmitters
• Biological/ Physiologic/ Genetic psychosocial factors
• Medications
• Familial

Question 9

What are the primary manifestations of Depression?

Answer 9

Primary
- persistent sadness
- no pleasure from usual activities

Question 10

What are the secondary manifestations of Depression?

Answer 10

• Helplessness
• feelings of guilt
• fatigue
• inability to concentrate
• restlessness
• somatic complaints
• worthlessness
• Pessimism
• decreased energy
• inability to make decisions
• weight changes
• decreased libido
• loneliness
• crying
• decreased memory
• irritability
• sleep disturbances
• pacing

Question 11

What are 3 special patient populations with regard to Depression?

Answer 11

• Children
• Adolescents
• Seniors

Question 12

What are some manifestations that may occur in children with Depression?

Answer 12

• Hyperactivity
• Enuresis
• Regressive behavior

Question 13

What are some manifestations that may occur in adolescents with Depression?

Answer 13

• Delinquency
• Traumatic injuries
• Sexual promiscuity
• Acting out behavior
• Alcohol/drug use

Question 14

What are some manifestations that may occur in seniors with Depression?

Answer 14

• Memory loss
• Saying “I don’t know” a lot.

Question 15

Before diagnosing with Depression, you need to rule out these other physical etiologies:

Answer 15

• Chronic fatigue
• Electrolyte disturbances
• Hypothermia
• Liver failure
• Medication side effects/ abuse/ Overdose
• Endocrine disorders
• Renal failure
• Vitamin deficiency
• Withdrawal syndrome

Question 16

What are some risk factors for Suicide?

Answer 16

• Gender
• Age
• Foreign born
• Homosexuality
• Religion
• Marital status
• Season
• Day of the week

Question 17

What are some manifestations of Suicide?

Answer 17

• Suicide attempts
• Hopelessness
• Indifference
• G-I complaints
• Fatigue
• Agitated/ irritable
• Worthlessness
• Helplessness
• Insomnia
• Restlessness
• Decrease in physical activity

Question 18

What are some Psychoses?

Answer 18

• Schizophrenia
• Paranoia
• Hypomania/Manic psychosis
• Bi-polar Affective Disorder

Question 19

When is Schizophrenia usually diagnosed?

Answer 19

Under the age of 45.

Question 20

What are some manifestations of Schizophrenia?

Answer 20

• Delusional
• Hallucinations (usually auditory)
• Disordered thought with a clear sensorium.
• Behavior (range from combative to catatonic)
• Bizarre Gesturing
• False interpretations of normal perceptions
• Speech patterns
• Affect
• Social Withdrawal

Question 21

What should you DO with Schizophrenics?

Answer 21

• Use simple concrete sentences.
• Be confident
• Avoid figures of speech.
• Always have an escape.
• Give anti-psychotics
• Do not agree with reality disturbances.
• Avoid arguing
• Patient should be in gown.

Question 22

What are some side effects of Anti-psychotics?

Answer 22

• fever
• tachycardia
• heat stroke
• Tardive Dyskinesia
• Tremors
• Muscle rigidity

Question 23

What is important to note about a Paranoid patient?

Answer 23

They can be very dangerous.

Question 24

What should you DO with a paranoid patient?

Answer 24

• avoid threats
• provide limits
• simple, concrete expressions
• be in control
• use slow movements
• speak in a low tone
• Do not assume a “power” position.
• Allow verbalization
• Notify authorities of threats.

Question 25

What are some manifestations of Bi-Polar Affective Disorder?

Answer 25

• Elation
• Sexual acting out.
• Overdone make up
• Demanding
• Rapid speech
• Decreased sleep
• Grandiose Ideas
• Focus on sexual content
• Loud clothing
• Irritable
• Increased motor activity
• Increased Mental excitement.