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Behavior includes the things we do—how we act or react to situations.
Behavior may be abnormal as defined by society, your boss, a parent, or friend.
Abnormal behavior by itself may not be an emergency.
In a behavioral emergency, the individual’s presenting problem is a disorder of
thought, mood, or behavior that interferes with the activities of daily living.
The behavioral emergency becomes a psychiatric emergency when the patient
becomes suicidal, homicidal, or acutely psychotic.
Abnormal behavior can stem from a situational crisis, organic problems, or
psychiatric causes.
When assessing psychiatric problems, you collect information about the person’s
state of mind and thinking. Your actions and attitude often provide some of the
therapy sought by the patient. Be prepared to spend some time with the patient as
you assess his or her thinking.
Dissociative disorders are characterized by depersonalization (stepping out of
one’s current experience) and derealization (an altered perception of objects or
people in an experience). In the most severe form of dissociative disorders,
multiple personalities may emerge.
The mind generates specific signs and symptoms when it is not functioning well.
Paramedics must sharpen their assessment skills to properly identify how the
patient is functioning mentally. The COASTMAP mnemonic can be used to
remember various disorders of behavior.
In anxiety disorders, the dominant mood is fear and apprehension. Fear can turn
into a phobia when it becomes unreasonable. Anxiety, when sudden and
overwhelming, may become a panic disorder. Anxiety, phobias, and panic
disorder may complicate your efforts to treat a person.
Mood disorders are the most common psychiatric disorders. In mania, the patient
often feels great to the point of exaggeration, with hyperactivity, insomnia, and
grandiose ideas. Feelings of depression can be accompanied by guilt, apathy, and
sleep disturbances. Depression may become so severe that the person may attempt
suicide.
Suicide and attempted suicide are problems affecting all age groups and people of
all socioeconomic status. Men are often more successful at suicide because they
use more lethal means, although women make more attempts. Every suicidal
gesture must be assessed and taken very seriously. Don’t be afraid to talk with
patients about their suicidal thoughts.
Personality disorders are exaggerations in how people think about or perceive
their environment and surroundings. They are classified into three categories: odd
or eccentric behaviors; dramatic, emotional, or erratic behaviors; and anxious or
fearful behaviors.
In somatoform disorders, such as factitious disorders and hypochondriasis,
patients are overly concerned with their physical health or appearance to the point
that this concern dominates their lives.
Eating disorders, such as anorexia nervosa and bulimia nervosa, are disorders of
personal control related to eating. They can result in acute and chronic problems.
Impulse control disorders include impulsive gambling, kleptomania, and
pyromania. They reflect the inability to resist temptation.
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Substance-related disorders are associated with the use of alcohol and drugs. A
variety of social, biological, cultural, and physiologic dimensions define
substance-related disorders.
Psychosis is a state of delusion in which individuals are out of touch with reality.
Causes include psychiatric problems (eg, schizophrenia), drug-induced psychotic
states, and intense stress.
Individuals with schizophrenia may display positive symptoms (hallucinations
and delusions), negative symptoms (apathy and a flat affect), or disorganized
symptoms (erratic speech or motor function). Dealing with psychotic patients is
difficult because their behavior may be dangerous.
Disorganization and disorientation describe how conditions may present
themselves. Disorganized patients have uncontrolled and disconnected thoughts.
They need structure, explanations, and directions. Disoriented patients may not
know where they are, what day it is, or even who they are. These patients need
continuous orienting.
Dealing with hostile, combative, and violent patients can be emotionally and
physically demanding for emergency responders. Be cautious when approaching
these individuals and evaluating situations where violent or potentially violent
patients may be. Know the specific risk factors and signs of hostile situations.
Combative patients may need to be restrained. In such cases, make sure you have
enough experienced people and work quickly. Follow the legal guidelines for
restraining patients.