Mental Health EmergenciesMental Health Emergencies

Mental HealthMental Health

Mental Health in the EDMental Health in the ED• Focused surveyFocused survey

History of present illness & patient’s perceptionHistory of present illness & patient’s perception Medical historyMedical history Medication historyMedication history Physical examPhysical exam Diagnostic proceduresDiagnostic procedures

InterventionsInterventions

Determine prioritiesDetermine 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-ConsiderationsAge-Considerations

PediatricPediatric• Many disorders are age-specific onset relatedMany disorders are age-specific onset related• Determine what behavior is abnormal vs Determine what behavior is abnormal vs

adjustment to developmental changesadjustment to developmental changes• ““acting-out” signifies a problem if the acting-out” signifies a problem if the

behaviors are socially or culturally behaviors are socially or culturally unacceptable.unacceptable.

Age-ConsiderationsAge-Considerations

GeriatricGeriatric• Most commonly – depression, Most commonly – depression,

suicidal, suspicious, anxiety, suicidal, suspicious, anxiety, situational crisissituational 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 Personal losses and stressors

can precipitate emotional can precipitate emotional disordersdisorders

AnxietyAnxiety

Only 1 in 5 patients ever seek Only 1 in 5 patients ever seek medical treatmentmedical treatment

Only 25% of all patients diagnosed with Only 25% of all patients diagnosed with anxiety are ever treatedanxiety are ever treated

Treatment is often indicated when symptoms Treatment is often indicated when symptoms produce physiological disruptionproduce physiological disruption

Patients are often under treated due to fear Patients are often under treated due to fear patients will become addicted to medicationspatients will become addicted to medications

DepressionDepression

Consists of specific alterations in mood, Consists of specific alterations in mood, often accompanied by a negative self-often accompanied by a negative self-concept and physical changes, along with concept and physical changes, along with changes in activity & interest levels.changes in activity & interest levels.

Can be suspected when Can be suspected when characteristics last >2 weeks.characteristics last >2 weeks.

CharacteristicsCharacteristics

Loss of interest in usual activitiesLoss of interest in usual activities

Depressed moodDepressed mood

Appetite increase or decreaseAppetite increase or decrease

Weight changesWeight changes

Insomnia or hypersomniaInsomnia or hypersomnia

CharacteristicsCharacteristics

FatigueFatigue

Decreased ability to thinkDecreased ability to think

Recurrent thoughts of deathRecurrent thoughts of death

Feelings of worthlessnessFeelings of worthlessness

Psychomotor agitation or retardation Psychomotor agitation or retardation

5 of these >2 weeks = clinical depression5 of these >2 weeks = clinical depression

Suicidal BehaviorSuicidal Behavior Profile- adolescence or Profile- adolescence or ≥≥45, male, white, 45, male, white,

separated, divorced, widowed, living separated, divorced, widowed, living alone, unemployedalone, unemployed

AssessmentAssessment• Precipitating factorsPrecipitating factors• Substance abuseSubstance abuse

Suicidal BehaviorSuicidal Behavior

TreatmentTreatment• Orient to realityOrient to reality• Provide safe environmentProvide safe environment• Solutions to ineffective coping & Solutions to ineffective coping &

fearfear

Homicidal or Violent BehaviorHomicidal or Violent Behavior

““Acting out of the emotions of fear or anger Acting out of the emotions of fear or anger to achieve desired goals.”to achieve desired goals.”

PsychosisPsychosis Antisocial behaviorAntisocial behavior Organic diseaseOrganic disease

Planning & InterventionsPlanning & Interventions

Ensure safety of self and othersEnsure safety of self and others Encourage patient to identify feelingsEncourage patient to identify feelings Help patient determine cause of feelingsHelp patient determine cause of feelings Orient patient to place and timeOrient patient to place and time Administer medications as orderedAdminister medications as ordered

• HaldolHaldol

Facilitate communicationFacilitate communication

Psychotic behaviorsPsychotic behaviors

SchizophreniaSchizophrenia

ManiaMania

Psychotic Psychotic depressiondepression

Psychotic BehaviorsPsychotic Behaviors

The result of a pathological process that The result of a pathological process that may be acute or chronicmay be acute or chronic

Resultant behavior is distorted Resultant behavior is distorted perceptions, disorganized thinking, perceptions, disorganized thinking, impaired judgment, impaired decision-impaired judgment, impaired decision-making, regressive behaviormaking, regressive behavior

May be functional or organicMay be functional or organic

TreatmentTreatment

Diagnostics to R/O organicDiagnostics to R/O organic Orient to time, person, placeOrient to time, person, place Reduce stimuliReduce stimuli AntipsychoticsAntipsychotics Reinforce realityReinforce reality Keep safeKeep safe Family counselingFamily counseling

Bipolar DisorderBipolar Disorder““Manic-depressive illness that is Manic-depressive illness that is

characterized by alternating euphoria & characterized by alternating euphoria & depressed mood periods”depressed mood periods”

Mood changes can occur Mood changes can occur over minutes, hours, or over minutes, hours, or days & may be lengthy days & may be lengthy periods of stability periods of stability between episodes.between episodes.

Bipolar DisorderBipolar 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 BipolarTreatment for Bipolar

Orient to realityOrient to reality Remove from stimulating environmentRemove from stimulating environment Remove objects of self-harmRemove objects of self-harm Medicate – LithiumMedicate – Lithium Work on family & social supportWork on family & social support Observe closelyObserve closely

QuestionQuestionss

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