Download Mental Health Emergencies

Mental Health Emergencies
Mental Health
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Mental Health in the ED
• Focused survey
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History of present illness & patient’s perception
Medical history
Medication history
Physical exam
Diagnostic procedures
Interventions
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Determine priorities
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ABC’s
Maintain safety
Assess life threatening emergencies
Provide appropriate environmental setting
Implement therapeutic modalities
Educate patient and family/significant other
Age-Considerations
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Pediatric
• Many disorders are age-specific onset related
• Determine what behavior is abnormal vs
adjustment to developmental changes
• “acting-out” signifies a problem if the
behaviors are socially or culturally
unacceptable.
Age-Considerations
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Geriatric
• Most commonly – depression,
suicidal, suspicious, anxiety,
situational crisis
• Assess for drug/alcohol abuse
• Look at all meds & schedule
• Rule out organic causes
• Personal losses and stressors
can precipitate emotional
disorders
Anxiety
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Only 1 in 5 patients ever seek
medical treatment
Only 25% of all patients diagnosed with
anxiety are ever treated
Treatment is often indicated when symptoms
produce physiological disruption
Patients are often under treated due to fear
patients will become addicted to medications
Depression
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Consists of specific alterations in mood,
often accompanied by a negative selfconcept and physical changes, along with
changes in activity & interest levels.
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Can be suspected when
characteristics last >2 weeks.
Characteristics
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Loss of interest in usual activities
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Depressed mood
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Appetite increase or decrease
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Weight changes
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Insomnia or hypersomnia
Characteristics
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Fatigue
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Decreased ability to think
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Recurrent thoughts of death
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Feelings of worthlessness
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Psychomotor agitation or retardation
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5 of these >2 weeks = clinical depression
Suicidal Behavior
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Profile- adolescence or ≥45, male, white,
separated, divorced, widowed, living
alone, unemployed
Assessment
• Precipitating factors
• Substance abuse
Suicidal Behavior
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Treatment
• Orient to reality
• Provide safe environment
• Solutions to ineffective
fear
coping &
Homicidal or Violent Behavior
“Acting out of the emotions of fear or anger
to achieve desired goals.”
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Psychosis
Antisocial behavior
Organic disease
Planning & Interventions
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Ensure safety of self and others
Encourage patient to identify feelings
Help patient determine cause of feelings
Orient patient to place and time
Administer medications as ordered
• Haldol
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Facilitate communication
Psychotic behaviors
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Schizophrenia
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Mania
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Psychotic
depression
Psychotic Behaviors
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The result of a pathological process that
may be acute or chronic
Resultant behavior is distorted
perceptions, disorganized thinking,
impaired judgment, impaired decisionmaking, regressive behavior
May be functional or organic
Treatment
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Diagnostics to R/O organic
Orient to time, person, place
Reduce stimuli
Antipsychotics
Reinforce reality
Keep safe
Family counseling
Bipolar Disorder
“Manic-depressive illness that is
characterized by alternating euphoria &
depressed mood periods”
Mood changes can occur
over minutes, hours, or
days & may be lengthy
periods of stability
between episodes.
Bipolar Disorder
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Behaviors•
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Flight of ideas
Impaired mentation
Hostile & paranoid
Flamboyant actions
Impulsive behavior
Disorganized activity
Poor social judgment
Inflated self-esteem
Treatment for Bipolar
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Orient to reality
Remove from stimulating environment
Remove objects of self-harm
Medicate – Lithium
Work on family & social support
Observe closely
Questions
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