Suicide and other psychiatric emergencies

Question 1

what are the common types of psychiatric emergencies?

Answer 1

• interpersonal violence / assault
• adolescent crisis
• substance related crises
• panic attacks
• PTSD symptoms
• disorganized behavior
• medication
• self-harm

Question 2

fear countertransference results in what provider behavior? what result in the patient?

Answer 2

• provider: more restrictive measures than necessary, or immobilization
• patient: actions to regain autonomy, breach of alliance, danger

Question 3

empathic over-identification countertransference results in what provider behavior? what result in the patient?

Answer 3

• provider: sympathy for condition of patient

- patient: relaxing of precautions and lack of appropriate response

Question 4

anger countertransference results in what provider behavior? what result in the patient?

Answer 4

• provider: over-react, control punish and or abandon

- patient: fear - decreased self-disclosure, lack of needed resources

Question 5

hopelessness countertransference results in what provider behavior? what result in the patient?

Answer 5

• provider: passive or slow to intervene

- patient: lack of appropriate response, collusion and reinforcement of hopelessness

Question 6

what is the best predictor of future behavior?

Answer 6

past behavior

Question 7

what are risk assessments for violence?

Answer 7

• thoughts of harming anyone else
• history of seriously injuring another
• what was the most violent act ever committed

Question 8

how can suicide misconceptions affect care?

Answer 8

• negative influence on patient care

- providers led to be more cautious overall

Question 9

what are common suicide misconceptions?

Answer 9

• “low lethality suicidal behaviors are usually manipulative”
• “it is best to hospitalize all ‘at risk’ patients”
• “no suicide contracts prevent suicide”

Question 10

what is the strongest predictor of future suicides?

Answer 10

prior attempts

Question 11

what are features of multiple suicide attempters?

Answer 11

• higher level of self-reported depression and helplessness
• significantly larger number of comorbid conditions
• greater intensity of suicidal ideation
• poorer social problem-solving skills
• less regret**

Question 12

what are important things to do for suicide prevention?

Answer 12

• maintain a positive and non-adversarial relationship with patient and monitor alliance
• manage your own emotional reactions**
• limit the number of at-risk patients you see
• provide reasonable access to care
• obtain prior treatment records**
• document
• consult about problems and concerns
• make treatment plan consistent with: diagnosis, dynamics, suicide risk, and capacity of patient to comply
• continue to regularly assess risk