1. Chapter 24

2.   Situation in which a person exhibits “abnormal” behavior  Behavior that is unacceptable or intolerable to the patient, family, or community  Patients may exhibit  Anxiety  Panic  Agitation  Bizarre thinking & actions  Can pose a danger to themselves through suicidal or self- injurious acts, or to others through violent acts or actions whose consequences they may be incapable of understanding Behavioral Problem

3.   Common reasons why behavior changes  Low blood sugar  Hypoxia  Inadequate blood flow to the brain  Head trauma  Mind altering substances  Psychogenic substances  Excessive cold or heat  Infections of the brain or its coverings  Seizure disorder  Toxic ingestion  Drug or alcohol overdose Behavioral Change

4.   Make sure it is a behavior not a physical emergency  Pay Attention to:  General appearance  Speech  Skin  Posture or gain  Orientation  Memory  Awareness  Body language  Perception  Mood  Judgment Assessment

5.   Onset of symptoms relatively sudden or has been developing over time  Hallucinations are visual not auditory  Memory loss or impairment in most behavior problems  Pupils are dilated, constricted, or unequal  Excessive salivation  Incontinent  Unusual odors on breath How to tell physical/behavior

6.   State of painful uneasiness about impending problems  Characterized by agitation & restlessness  Most common emotion  Panic Attack  Show intense fear, tension or restlessness  Hyperventilate  Dizziness  Tingling around mouth & fingers  Spasms of hands & feet (carpel pedal spasms)  Tremors  Irregular heartbeat  Palpitations  Diarrhea  Feeling of choking Anxiety

7.   Closely related to anxiety  Irrational fears of things, places, or situations  Tense & restless  Wring their hands & pace  Tremors  Tachycardia  Irregular heartbeat  Dyspnea  Sweating  Diarrhea Phobias

8.  Depression  Most common psychiatric condition  Characterized by:  Deep feelings of sadness, worthlessness, & discouragement  Factor in 50% of suicides  May cause other psychological disorders  Sad appearance  Crying spells  Listless  Apathetic  Helpless  Hopeless  Withdrawn  Pessimistic  Appetite loss  Sleeplessness  Fatigue  Despondence  Severe restlessness  “No one understands” “problems can’t be solved”  Want to be left alone

9.   Manic depressive disorder  Swing to opposite sides of the mood spectrum Bipolar Disorder

10.   Highly exaggerated of unwarranted mistrust or suspicion  Hostile & uncooperative  “out to get them” Paranoia

11.   Out of touch with reality  Lives within his own world  Angry or belligerent or withdrawn  May only talk to voices inside of head  Mind altering drugs common cause Psychosis

12.   Group of mental disorders  Debilitating distortions of speech, & thoughts  Bizarre delusions  Hallucinations  Social withdrawal  Lack of emotional expressiveness  Rarely goes to multiple personality disorder Schizophrenia

13.   Willful act designed to end one’s life  Males are 4X more likely to die, but women make 3X more attempts  55% done with firearms  Unsuccessful attempts: drug ingestion, wrist slashing  8 th leading cause of death in US in males  3 rd leading cause in ages of 15-24  ½ that succeed have tried before Suicide

14.   Common ways  Gunshot  Hanging  Poisoning by ingestion  Carbon monoxide poisoning  Many victims make last minute attempt to communicate their intentions  Every suicidal act or gesture should be taken seriously, & the patient should be transported for evaluation

15.  Risk Factors  History of depression  Previous attempts  Family history of child abuse  Feelings of hopelessness  Unwillingness to seek help  Feeling of being isolated  History of impulsive  Inability to access mental health care  Recent loss of loved one  15-24 years old  Alcohol or drug use  Divorced or widowed  Gives away personal belongings  Psychosis with depression  Homosexuality  Major physical stress  Suicide of same-sex partner  Expression of clear plan  Availability of mechanism to carry out plan

16.   Excited delirium  Mental & physiological response  Unusual strength & endurance  Tolerance of pain  Agitation  Hostility  Frenzied & bizarre behavior  Hot & diaphoretic skin  Unusual speech Agitated Delirium

17.   May be associated with drug use  Difficult to determine between violence & agitated delirium

18.   Wants to fight with others  Signs  Nervous pacing  Shouting  Threatening  Cursing  Throwing objects  Clenched teeth and/or fists Violence to others

19.  Basic Principles  Every person has limitations  Right to his feelings  Has more ability to cope with crisis than he might think  Emotional disturbance when disaster or injury strikes  Emotional injury hurts just as much as physical  Don’t just “get better”  Culture differences have meaning

20.  Techniques  Approach slowly & with caution  Engage in active listening  Be supportive & empathetic  Limit interruptions  Respect pt’s space  Limit physical touch  Avoid any action that may be interpreted as threatening  Avoid questions or statements that may be taken as threatening

21.  Techniques  Speak calmly  Maintain distance  Seek cooperation  Maintain eye contact  No quick movements  Respond honestly  Don’t threaten or belittle  Plan escape route  Don’t play along  Involve trusted family members  Be prepared to spend lots of time  Never leave alone  Avoid restraints  Don’t force to make decisions  Encourage the patients  Get rid of gawkers

22.   Scene size up  Primary assessment  Secondary assessment  treatment  Reassessment

23.   Should be avoided  May require police authorization  Doctors orders  Don’t restrain in prone position  Guidelines (pg 872) Restraints

24.   Consent  Refusal of care  Using unreasonable force  Size & strength of patient  Type of behavior  Mental state  Method of restraint  Document & have a witness Legal considerations