Trans 077: Psychiatric Emergencies and Management Modalities Flashcards
Only four reasons for admitting a psychiatric patient:
- Harm to self (suicidal)
–> stabilize medically/ surgically first - Harm to others (homicidal)
- Refuses psych medications
• No longer such an emergency because of oro-dispersible/
dissolving tablets
Can be placed in the food or drinks of the patients and
melts in 5 minutes, so they wouldn’t know we gave them
medicine. - Social emergency (incest, war, postpartum psychosis)
4 things to consider in a suicide assessment?
• Planning depth
Alone or with others
Group or community ba yung mag suicide (hara-kiri)?
• Lethality
Nag overdose ba ng acido? Or gun? Or blade (not that
lethal, maybe just anxious or seeking attention)?
• Support system available
Does the patient have a supportive family or friends? Or
abandoned that’s why desperation is in the air?
How to help a friend?
• Ask about it
• Give options for help
• Seek support for your friend and for yourself
• Remember: you’re not responsible for ending the self-abuse.
Just continue to be a good friend.
behavioral predictors of violence
• Angry words • Loud language • Abuse language • Physical agitation such as making fists, pacing and restlessness
how to deescalate a patient?
• Use a calm voice
• Sit down with the patient
Needs to be eye-level with the patie
• Maintain adequate physical distance of at 2 arms length
The patient may spit, grab, or box you, so you need to
protect yourself.
Attempt to establish rapport
Ano po ba ang problema? Andito ako para tumulong.
Don’t threaten the patient even more (eg. Call police)
• Listen to the patients’ concerns
Open your ears and close your mouth. When they
speak, do not think on how you will rebattle them.
Instead, listen empathically.
Anger management skills?
• Deep breathing exercises – release serotonins
• Pray
• Alternate solutions – mind over instinct
• Walk away – prefrontal cortex
Walking away also gives the person “space”. Wrong for parents or couples to say, “wag kang umalis, pagusapan muna natin to!”
social emergencies
• Rape • Incest • War • Abuse – Child abuse (RA 7610) vs adult abuse (RA 9262)
Violence
- Physical
- Sexual
- Psychological
- Economic – adult
- Neglect – child
RA9262
Anti-violence Against Women And Their Children, Act Of 2004
• refers to an act which is sexual in nature, committed against a woman or her child:
Sexual violence
• refers to acts or omissions causing or likely to cause mental or emotional suffering of the victim:
– intimidation, harassment, stalking, damage to property, public ridicule or humiliation, repeated verbal abuse and mental infidelity.
– causing or allowing the victim to witness the physical, sexual or psychological abuse of a member of the family to which the victim belongs, or to witness pornography in any form or to witness abusive injury to pets or to unlawful or unwanted deprivation of the right to custody and/or visitation of common children.
Psychological Violence
- refers to acts that make or attempt to make a woman financially dependent:
- withdrawal of financial support or preventing the victim from engaging in any legitimate profession, occupation, business or activity, except in cases wherein the other spouse/partner objects on valid, serious and moral grounds as defined in Article 73 of the Family Code;
- deprivation or threat of deprivation of financial resources and the right to the use and enjoyment of the conjugal, community or property owned in common.
- destroying household property.
- controlling the victims’ own money or properties or solely controlling the conjugal money or properties.
Economic Abuse
- refers to a pattern of psychological and behavioral symptoms found in women living in battering relationships as a result of cumulative abuse
- It is better to live alone in the desert than with an ill-tempered spouse. Proverbs 21: 19
Battered woman Syndrome
PSYCHIATRIC MANAGEMENT MODALITIES
- Biological Therapies
- Psychological Therapy
- Social Therapy
We use all these three togethe
what are under biological therapies?
- Psychopharmacology
- ECT (electroconvulsive therapy)
- Detoxification
Usually used for drug abuse - Psychosurgery
We don’t do this anymore - Light therapy
Done usually for those with seasonal depression.
We need sunlight to activate vit. D on skin and vit. D is needed for formation of serotonin, and serotonin is needed for melatonin for sleep. - Sleep deprivation
We don’t recommend this much because you might create another problem with this. - Acupuncture/Acupressure – adj
- Endocrinological – limited →CA
Load the person with hormones. Downside is patient may have cancer - Coma therapy – dangerous!!!
what are the neurotransmitters to regulate in biological therapy?
- Biogenic amines
2. Amino Acids
There neurotransmitters are synthesized in the axon terminal? examples?
Biogenic Amines - Dopamine, NE, Serotonin
NT that uses 2nd messengers
Amino Acids - GABA, Glutamate, Ach
in psychosis, if there is a dopamine over production in mesolimbic, what sx?
positive sx
in psychosis, if there is a dopamine under production in meso cortical, what sx?
negative symptoms
• Dopamine dysequilibrium
– Mesolimbic – over → positive Sx
– Mesocortical – hypo → negative Sx
• Decreased NorEpinephrine will lead to?
Poor concentration
Lack of motivation
if there is serotonin imbalance, what sx?
– irritability, anxiety, depression, mania
• Depletion of glutamate will lead to?
– delusion
– auditory hallucination
– conceptual disorganization
– negative Sx
If there is decreased GABA, waht sx?
Insomnia
in mood disorders, if there is decreased dopamin, what will happen to NE?
Decreases
if dopamine is blocked, what endocrine dysfunction could arise?
Hyperprolactinemia
Menstrual dysfxn
sexual dysfxn
characterized by choreic movements affecting the face, eyes, tongue, and trunk; the disorder usually appears after prolonged treatment with antipsychotic medications such as the phenothiazines.
tardive dyskinesia
You get your endocrine dysfunction because of its effect on the ______________ pathway. You have your movement disorder or extrapyramidal symptoms because of the __________pathway.
tuberoinfundibular;
nigrostriatal
Muscarinic blockade (Ach) adverse effect?
o Red as a beet – drowsiness
o Dry as a bone – constipation, urinary retention, dry mouth
o Blind as a bat – blurred vision
o Mad as a hatter – include seizure, drowsiness
serotonin antagonist
Cyproheptadine
is the only injectables available in the Philippines. If you have a violent and psychotic patient, you may need to use this
haloperidol
what drugs to give to breastfeeding patients?
ORQA
olanzapine
Risperidone
Quetiapine
Aripirazole
what drug has a very high accumulation in breast milk; has reports of infant seizures
Clozapine
for pregnant patients (placental transfer) there is no congenital malformations in what?
ORQC olanzapine Risperidone quitiapine Clozapine
is safe for children. It used for children with Autism, mental disabilities, throwing tantrums, or psychosis
Aripiprazole
Only SNRI that has a sedating effect
mirtrazapine
• Venlafaxine (Effexor)
• Desvenlafaxine (Pristiq)
• Duloxetine (Cymbalta)
what drug class?
SNRI
what drug class is this?
clomipramine imipramine amitryptyline amoxapine doxepine
TCA
what mood stabilizers to give in rapid cycling?
Valproate and Carbamazepine and Oxcarbazepine
is the oldest mood stabilizer.
Lithium
short acting benzodiazepine, with high possiblity of addiciton as well?
Alprazolam, Bromazepam, Lorazepam, oxazepam
Long acting benzodiazepine
The safest ones to give in alcohol withdrawal
Clonazepam, diazepam, clorazepate
Patient preparation for ECT?
- NPO 6hrs prior
- Mouth check
- IV
- Bite block
- O2 5 li/min
- Emergency ABC kit
in ECT, seizure threshold is higher in?
Men and elderly
and inc head size
Contraindications of ECT?
- Space Occupying Lesions (Tumors)
- High ICP
- Intracerebral bleed (1 month PTA min)
- Recent MI (3 months PTA min)
- Retinal detachment
- Pheochromocytoma
- High anesthesia risk
how long does methamphetamine stay in the body?
6 months
basic rules in pyschotherapy?
- Sit at eye level
- Sit at arm’s length to 2 arm’s lengths away
- Do not cross your arm
- Dress appropriately
- Do not touch patient
- Allow to cry, do not touch when crying, not even patting the back
- Religion and Psychiatry do not mix
