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  • Cognitive Disorders have organic causes such as injury or disease

Transcript

  • 1. Psychiatric andBehavioral Disorders
  • 2. Sections Behavioral Emergencies Pathophysiology of Psychiatric Disorders Assessment of Behavioral Emergency Patients Specific Psychiatric Disorders Management of Behavioral Emergencies Violent Patients and Restraint
  • 3. Behavioral Emergencies Behavior  Normal versus Abnormal Behavior  Indications of a Behavioral or Psychiatric Condition  Behavior that interferes with core life functions  Behavior that poses a threat to the life or well-being of the patient or others  Behavior that deviates significantly from society’s expectations or norms
  • 4. Pathophysiology of Psychiatric Disorders Mental Health Problems  Role of Medication Noncompliance Causes of Disorders  Biological (Organic)  Cause related to disease process or structural changes  Psychosocial  Cause related to the patient’s personality style, unresolved conflicts, or crisis management methods  Sociocultural  Cause related to the patient’s actions and interactions with society
  • 5. Assessment of Behavioral Emergency Patients Scene Size-up  Ensure Personal Safety Initial Assessment  Suspect Life-Threatening Emergencies  Assess and Manage ABCs  General Impression  Consider posturing, hand gestures, and signs of aggression.  Observe the patient’s awareness, orientation, cognitive abilities, and affect.  Consider the patient’s emotional state.  Control the Scene
  • 6. Assessment of Behavioral Emergency Patients Focused History and Physical Exam  Obtain the Patient’s History  Listen.  Spend time.  Be assured.  Do not threaten.  Do not fear silence.  Place yourself at the patient’s level.  Keep a safe and proper distance.  Appear comfortable.  Avoid appearing judgmental.  Never lie to the patient.
  • 7. Assessment of Behavioral Emergency Patients Mental Status Examination  General Appearance  Mood and Affect  Behavioral  Intelligence Observations  Thought Processes  Orientation  Insight  Memory  Judgment  Sensorium  Perceptual  Psychomotor Processes
  • 8. Assessment of Behavioral Emergency Patients Psychiatric Medications  Determine Presence and Type  Compliance  Identify Mental Health Professional
  • 9. Specific Psychiatric Disorders Cognitive Disorders  Delirium  Rapid onset of widespread, disorganized thought  Dementia  Gradual development of memory impairment and cognitive disturbances • Aphasia, apraxia, agnosia, disturbance in executive functioning
  • 10. Specific Psychiatric Disorders Schizophrenia  Symptoms  Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, flat affect  Types  Paranoid  Disorganized  Catatonic  Undifferentiated  Management
  • 11. Specific Psychiatric Disorders Anxiety and Related Disorders  Panic Attack  Differentiating the panic attack from medical conditions  Four symptoms peaking within 10 minutes • Palpitatations, sweating, trembling or shaking, shortness of breath or smothering, feelings of choking, chest pain or discomfort, nausea, abdominal distress, paresthesias, chill, hot flashes, derealization or depersonalization, dizziness, unsteadiness, or lightheadedness • Fear of losing control, going crazy, or dying
  • 12. Specific Psychiatric Disorders Phobias  Excessive fear that interferes with functioning Posttraumatic Stress Syndrome  Reaction to an extreme, life-threatening stressor  Characteristics • Recurrent, intrusive thoughts • Sleep disorders and nightmares • Survivor’s guilt • Often complicated by substance abuse
  • 13. Specific Psychiatric Disorders Mood Disorders  Depression  Major Depressive Episodes • Depressed mood lasting all day, nearly every day • Diminished interest in pleasure and daily activities • Significant weight change • Insomnia or hypersomnia • Psychomotor agitation or retardation • Feelings of worthlessness or excessive guilt • Diminished ability to think; indecisiveness • Recurrent thoughts of death
  • 14. Specific Psychiatric Disorders Major Depressive Disorder • Requires 5 or more symptoms present during the same 14 day period. • Depression cannot be accounted for by other problems. • In Interest S Sleep A Appetite D Depressed Mood C Concentration A Activity G Guilt E Energy S Suicide
  • 15. Specific Psychiatric Disorders Bipolar Disorder  Manic episodes • Inflated self-esteem or grandiosity • Decreased need for sleep • More talkative than usual or pressure to keep talking • Flight of ideas or subjective experience that thoughts are racing • Distractibility • Increase in goal-directed activity • Excessive involvement in pleasurable activities • Delusional thoughts  May alternate with depressed episodes.  Lithium is used.
  • 16. Specific Psychiatric Disorders Substance-Related Disorders  Physiological and Psychological Dependence Somatoform Disorders  Symptoms without Cause  Somatization disorder  Conversion disorder  Hypochondriasis  Body dysmorphic disorder  Pain disorder
  • 17. Specific Psychiatric Disorders Factitious Disorders  Characteristics  Intentional production of physical or psychological signs or symptoms  Motivation for the behavior is to assume the “sick” role  External incentives for the behavior • Avoiding police or work
  • 18. Specific Psychiatric Disorders Dissociative Disorders  Psychogenic Amnesia  Fugue State  Multiple Personality Disorder  Depersonalization Eating Disorders  Anorexia Nervosa  Bulimia Nervosa
  • 19. Specific Psychiatric Disorders Personality Disorders  Cluster A  Paranoid personality disorder  Schizoid personality disorder  Schizotypal personality disorder  Cluster B  Antisocial personality disorder  Borderline personality disorder  Histrionic personality disorder  Narcissistic personality disorder
  • 20. Specific Psychiatric Disorders  Cluster C  Avoidant personality disorder  Dependent personality disorder  Obsessive–compulsive disorder Impulse Control Disorders  Kleptomania  Pyromania  Pathological Gambling  Trichotillomania  Intermittent Explosive Disorder
  • 21. Specific Psychiatric Disorders Suicide  Assessing Potentially Suicidal Patients  Document observations about the scene that may be valuable to mental health professionals.  Document any notes, plans, or statements made by the patient.  Treat traumatic or medical complaints.
  • 22. Suicide Risk Factors Previous attempts  Major separation Depression trauma Age  Major physical  15–24 or over 40 stresses Alcohol or drug abuse  Loss of independence Divorced or widowed  Lack of goals and Giving away plan for the future belongings  Suicide of same- Living alone or in sexed parent isolation  Expression of a plan Presence of psychosis with depression for suicide Homosexuality  Possession of the  HIV status mechanism for suicide
  • 23. Specific Psychiatric Disorders Crisis in the Geriatric Patient  Assess the patient’s ability to communicate.  Provide continual reassurance.  Compensate for the patient’s loss of sight and hearing with reassuring physical contact.  Treat the patient with respect.  Avoid administering medication.  Describe what you are going to do before you do it.  Take your time.  Allow family and friends to remain with the patient whenever possible.
  • 24. Specific Psychiatric Disorders Crisis in Pediatric Patients  Avoid separating young children from their parent.  Prevent children from seeing things that will increase their distress.  Make all explanations brief and simple.  Be calm and speak slowly.  Identify yourself.  Be truthful with children.  Encourage children to help with their care.
  • 25. Specific Psychiatric Disorders Reassure children by carrying out all interventions gently. Do not discourage children from crying or showing emotions. If you will be separated from children, introduce the next person who will assume their care. Allow children to keep a favorite blanket or toy. Do not leave children alone.
  • 26. Management of Behavioral Emergencies General Management  Ensure scene safety and BSI precautions.  Provide a supportive and calm environment.  Treat any existing medical conditions.  Do not allow the suicidal patient to be alone.  Do not confront or argue with the patient.  Provide realistic reassurance.  Respond to the patient in a simple, direct manner.  Transport to an appropriate receiving facility.
  • 27. Management of Behavioral Emergencies Medical  Treat Underlying Problems. Psychological  Build Trust.  Use interviewing Skills.  “Talk Down” the Patient.
  • 28. Management of Behavioral Emergencies
  • 29. Violent Patients and Restraint Violent Patients  EMS Safety  Laws of Consent  Authority to determine competence  Determining Threat  Threat to self  Threat to others
  • 30. Violent Patients and Restraint Methods of Restraint  Guidelines  Use the minimum force needed.  Use appropriate devices to perform restraint.  Restraint is not punitive.  Patients who have been restrained require careful monitoring.  Materials for Restraint
  • 31. Restraining the Unarmed Patient Ensure you have adequate assistance and prepare the stretcher and restraints. Encircle the patient and give him or her one last opportunity to cooperate.
  • 32. Restraining the Unarmed Patient Assign one person to each limb and approach at the same time. Keep communicating with the patient.
  • 33. Restraining the Unarmed Patient Once patient is restrained, move patient to a prone or laterally recumbent position on the stretcher and secure. Keep the patient restrained throughout transport.
  • 34. Positioning and Restraining Patients for Transport Positioning the patient prone reduces resistance and allows continued airway maintenance. Keep the stretcher in its lowest position.
  • 35. Positioning and Restraining Patients for Transport Continually reassess the patient’s airway, breathing, and circulation.  Be alert for signs of positional asphyxia.  Never hog-tie or use hobble restraints. Chemical restraint
  • 36. Psychiatric and Behavioral Disorders Behavioral Emergencies Pathophysiology of Psychiatric Disorders Assessment of Behavioral Emergency Patients Specific Psychiatric Disorders Management of Behavioral Emergencies Violent Patients and Restraint