Behavioural/Psych

Question 1

Agitated Patient in ED:

List Medical & Psych causes

Answer 1

Medical:

• Intox
• Withdrawal
• Encephelitis
• Thyroid
• TBI
• Hypoglycemia
• Epilepsy: temporal lobe

Psych:

• Psychosis/Scz
• Bipolar
• Depression
• Adjustment
• PTSD
• Conduct Disorder

Question 2

Eating Disorder: AN

Reasons for hospitalization

Answer 2

• Wt loss /Malnutrition
  
  • Wt< 75% of avg body wt , BMI <15
• Cardiac:
  
  • Bradycardia <50 awake <45 asleep
  • Postural Changes: >30 BP >20 HR
  • Prlonged QT on ECG
• Fluids/Lytes:
  
  • Lyte AbN: Phosphate , kalemia
  • Dehydration
• Hypothermia <35.5
• Behavioural:
  
  • Acute Food refusal /uncontrolled binging
  • SI
  • Failure of OP management

Question 3

Eating Disorder/AN:

Invx to order

Answer 3

• Lytes + ext lytes + Gluc + Ur Creat
• ECG
• Postural VS
• Liver enzymes
• Beta HCG
• UA
• CBC anemia
• ESR – rule oit other things

Question 4

SI/SA in ED:

Reasons for hospitalization

Answer 4

1. Failure of rapport among physician, child, and family
2. Serious SA (lethality and intent)
3. Continuing active suicidality
4. Inability to engage in safety planning
5. Psychosis of child
6. Divisive/disturbed family, incapable of support and supervision
7. Denial of significance of SA

Fleischers

Question 5

SI/SA:

risk factors

Answer 5

• Positive family history
• Hopelessness
• Low self-esteem
• Active desire to die
• Depression
• Anger/desire for revenge

(Fleischers)

CPS June 2015

• 1. History of mental illness (especially depression but also conduct disorder + others)
• 2. Prior deliberate self harm or previous suicide attempt
• 3. Bullying
• 4. Sexual orientation disclosure, gender identity
• 5. Family conflict or poor child-parent communication
• 6. Impulsivity (physical aggression, risk-taking behaviour)
• 7. Substance abuse
• 8. Parental mental illness or family history of suicide
• 9. Lack of psychosocial support or follow up

Question 6

Signs of Impending Violence

list 4

Answer 6

• Recent acts of violence, including property violence
• Verbal or physical threats
• Carrying weapons or other objects that may be used as weapons (e.g., forks, ashtrays)
• Progressive psychomotor agitation
• Alcohol or other substance intoxication
• Paranoid features in a psychotic patient
• Command violent auditory hallucinations—some but not all patients are at high risk
• Catatonic excitement
• Certain manic episodes
• Certain agitated depressive episodes
• Personality disorders (rage, violence, or impulsivity)

(Fleischers)

Question 8

Adverse effects/events from AntiPsychotic

+ Rx

Answer 8

• EMS:
  
  • Acute dystonic reaction –> Benadryl
  • Tardive dyskinesia –> Benadryl or Benztropine
  • Akathsia –> Ativan
• NMS:
  
  • AMS + HTN/Tachy+ fever + Rigidity –> Dantrolene /cooling

Question 9

Indications for use of restraints

Answer 9

• Prevent Imminent harm to pt
• Prevent imminent harm to others
• prevent serious disruption to treatment
• prevent significan damage to envitonment