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Psychiatric
- 2. Behavior A person’s observable conduct and activity 20% of population has a mental health problem Anxiety, depression, eating disorders
- 3. Biological / Organic Tumors Drugs Infections Alterations in brain chemistry
- 4. Psychosocial Not attributed to medical conditions
- 5. Sociocultural Related to patient’s actions and interactions with society Childhood experiences, rape, assault, witnessing violence
- 6. Patient Assessment Look for: posture confusion fear rage anger mental status affect (visible indicators of mood)
- 7. Patient Assessment Listen Spend time (don’t rush) Be assured Do not threaten Do not fear silence Place yourself at patient’s level Keep a safe distance Appear comfortable Avoid appearing judgemental Don’t lie
- 8. Mental Status Examination (MSE) General appearance Behavioral observations Orientation Memory Sensorium Perceptual processes Mood and affect Intelligence Thought process Insight Judgement Psychomotor
- 10. Cognitive Disorders Delirium Dementia Aphasia Apraxia (impaired motor activities) Agnosia (failure to recognize objects or stimuli) Disturbance in executive functioning
- 11. Schizophrenia Hallucinations Delusions Depression Lives in ‘own world’ Catatonia (grossly disorganized) Flat affect (looks disinterested, lacking facial expression)
- 13. Anxiety A state of uneasiness, discomfort, apprehension, restlessness
- 15. Panic Attacks Palpitations, high heart rate Sweating Trembling or shaking Feeling of choking Chest pain or discomfort Nausea Dizzy, unsteady, faint Fear of losing control Fear of dying Paresthesia Chills
- 18. Post Traumatic Stress Disorder
- 19. Mood Disorders Pervasive and sustained emotion that colors a person’s perception of the world
- 20. Depression Profound sadness or feeling of melancholy
- 21. Depression Most of the day, nearly everyday Diminished interest in pleasure Weight loss or gain Insomnia or hypersomnia Agitation Feelings of worthlessness Inability to concentrate Recurrent thoughts of death
- 23. Bipolar Disorder One or more manic episodes
- 25. Bipolar Disorder Inflated self-esteem Decreased need for sleep More talkative than usual Flight of ideas ..racing thoughts Distractibility Increase in goal-directed activity Excessive involvement in pleasurable activities Delusional thoughts
- 26. Somatoform Disorders Physical conditions that have no apparent physiological cause
- 27. Somatoform Disorders Somatization - pt preoccupied by physical symptoms Conversion – loss of function (blindness or paralysis) unexplained Hypochondrias- exaggerated interpretation Body dysmorphic- body defect Pain – unexplained pain
- 29. Factitious Disorders The patient feigns illness to assume the sick role Intentional production of physiological signs and symptoms Economic gain, avoiding work, avoiding police Munchausen Syndrome
- 30. Dissociative Disorders Avoids stressful situations while gratifying needs Avoids stress by dissociating from his core personality
- 32. Dissociative Disorders Psychogenic Amnesia- failure to recall Fugue State- flees as a defense mechanism Multiple personalilty Depersonalization-loss of the sense of oneself
- 33. Eating Disorders Anorexia Nervosa Anorexia Athletica Bulimia Nervosa
- 34. Personality Disorders Persistently maladaptive behavior Cluster A, B, C
- 37. Cluster A Paranoid personality – distrust or suspicious Schizoid-detachment from social relationships Schizotypal peronality disorder- acute discomfort in close relationships
- 38. Cluster B Antisocial personality disorder Borderline personality disorder Histrionic personality disorder Narcissistic personality disorder
- 39. Cluster C Avoidant personality disorder Dependant personality disorder Obsessive-compulsive disorder
- 40. Impulse-Control Disorder Kleptomania Pyromania Pathological gambling Trichotillomania Intermittent explosive disorder
- 41. Suicide Risk Factors Previous attempts Depression Age Alcohol or drug abuse Divorced or widowed Giving away personal belongings Living alone or in isolation Psychosis Major separation trauma Stress
- 42. More Risk Factors Loss of independence Lack of goals Suicide of same-sexed parent Expression of a plan Possession of the mechanism
- 43. Excited Delirium Also called agitated delirium Drug intoxication or psychiatric illness Cocaine
- 44. Excited Delirium Have unexpected strength and endurance Tolerance of pain Feel hot to touch Agitated Sweat profusely Hostile Bizarre behavior and speech
- 45. Taser Deployment
- 46. Management of Behavioral Emergencies Scene safety Supportive and calm environment Treat medical conditions Do not allow to be alone Do not confront or argue Realistic reassurance Be direct and simple Transport to appropriate facility
- 47. Methods of Restraint Verbal De-escalation Physical Restraint Chemical
- 48. Physical Restraint 5 people 4 point restraint Avoid prone position Don’t hog-tie
- 49. Chemical Restraint Haldol Valium Versed Ativan Don’t use neuromuscular blocking medications