Mental Health Emergencies

Mental Health Mental Health in the ED Mental Health in the ED Focused surveyFocused survey History of present illness & patient’s perception History of present illness & patient’s perception Medical history Medical history Medication history Medication history Physical exam Physical exam Diagnostic procedures Diagnostic procedures

Interventions Determine priorities Determine priorities ABC’sABC’s Maintain safetyMaintain safety Assess life threatening emergenciesAssess life threatening emergencies Provide appropriate environmental settingProvide appropriate environmental setting Implement therapeutic modalitiesImplement therapeutic modalities Educate patient and family/significant otherEducate patient and family/significant other

Age-Considerations Pediatric Pediatric Many disorders are age-specific onset relatedMany disorders are age-specific onset related Determine what behavior is abnormal vs adjustment to developmental changesDetermine what behavior is abnormal vs adjustment to developmental changes “acting-out” signifies a problem if the behaviors are socially or culturally unacceptable.“acting-out” signifies a problem if the behaviors are socially or culturally unacceptable.

Age-Considerations Geriatric Geriatric Most commonly – depression, suicidal, suspicious, anxiety, situational crisisMost commonly – depression, suicidal, suspicious, anxiety, situational crisis Assess for drug/alcohol abuseAssess for drug/alcohol abuse Look at all meds & scheduleLook at all meds & schedule Rule out organic causesRule out organic causes Personal losses and stressors can precipitate emotional disordersPersonal losses and stressors can precipitate emotional disorders

Anxiety Only 1 in 5 patients ever seek medical treatment Only 1 in 5 patients ever seek medical treatment Only 25% of all patients diagnosed with anxiety are ever treated Only 25% of all patients diagnosed with anxiety are ever treated Treatment is often indicated when symptoms produce physiological disruption Treatment is often indicated when symptoms produce physiological disruption Patients are often under treated due to fear patients will become addicted to medications Patients are often under treated due to fear patients will become addicted to medications

Depression Consists of specific alterations in mood, often accompanied by a negative self- concept and physical changes, along with changes in activity & interest levels. Consists of specific alterations in mood, often accompanied by a negative self- concept and physical changes, along with changes in activity & interest levels. Can be suspected when characteristics last >2 weeks. Can be suspected when characteristics last >2 weeks.

Characteristics Loss of interest in usual activities Loss of interest in usual activities Depressed mood Depressed mood Appetite increase or decrease Appetite increase or decrease Weight changes Weight changes Insomnia or hypersomnia Insomnia or hypersomnia

Characteristics Fatigue Fatigue Decreased ability to think Decreased ability to think Recurrent thoughts of death Recurrent thoughts of death Feelings of worthlessness Feelings of worthlessness Psychomotor agitation or retardation Psychomotor agitation or retardation 5 of these >2 weeks = clinical depression 5 of these >2 weeks = clinical depression

Suicidal Behavior Profile- adolescence or ≥45, male, white, separated, divorced, widowed, living alone, unemployed Profile- adolescence or ≥45, male, white, separated, divorced, widowed, living alone, unemployed Assessment Assessment Precipitating factorsPrecipitating factors Substance abuseSubstance abuse

Suicidal Behavior Treatment Treatment Orient to realityOrient to reality Provide safe environmentProvide safe environment Solutions to ineffective coping & fearSolutions to ineffective coping & fear

Homicidal or Violent Behavior “Acting out of the emotions of fear or anger to achieve desired goals.” Psychosis Psychosis Antisocial behavior Antisocial behavior Organic disease Organic disease

Planning & Interventions Ensure safety of self and others Ensure safety of self and others Encourage patient to identify feelings Encourage patient to identify feelings Help patient determine cause of feelings Help patient determine cause of feelings Orient patient to place and time Orient patient to place and time Administer medications as ordered Administer medications as ordered HaldolHaldol Facilitate communication Facilitate communication

Psychotic behaviors Schizophrenia Schizophrenia Mania Mania Psychotic depression Psychotic depression

Psychotic Behaviors The result of a pathological process that may be acute or chronic The result of a pathological process that may be acute or chronic Resultant behavior is distorted perceptions, disorganized thinking, impaired judgment, impaired decision- making, regressive behavior Resultant behavior is distorted perceptions, disorganized thinking, impaired judgment, impaired decision- making, regressive behavior May be functional or organic May be functional or organic

Treatment Diagnostics to R/O organic Diagnostics to R/O organic Orient to time, person, place Orient to time, person, place Reduce stimuli Reduce stimuli Antipsychotics Antipsychotics Reinforce reality Reinforce reality Keep safe Keep safe Family counseling 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 Behaviors- Behaviors- Flight of ideasFlight of ideas Impaired mentationImpaired mentation Hostile & paranoidHostile & paranoid Flamboyant actionsFlamboyant actions Impulsive behaviorImpulsive behavior Disorganized activityDisorganized activity Poor social judgmentPoor social judgment Inflated self-esteemInflated self-esteem

Treatment for Bipolar Orient to reality Orient to reality Remove from stimulating environment Remove from stimulating environment Remove objects of self-harm Remove objects of self-harm Medicate – Lithium Medicate – Lithium Work on family & social support Work on family & social support Observe closely Observe closely

Domestic Abuse Psychological or physiological Psychological or physiological Must be reported. Must be reported.

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