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34 Cards in this Set
- Front
- Back
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People with mental disorders are more likely to be violent (T/F?)
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True
But majority are not violent |
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Risk factors for violence with mental disorder
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- Hx violence
- Drug/alcohol intoxication or withdrawal - Demographic factors - Acute psychosis - delusions (persecution/control), command auditory hallucinations - Brain injury/disinhibitory condition - Personality disorder - Threats of violence |
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List strategies for approaching the room of a violent patient
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- Be mindful of attitudes and preconceived ideas
- Self-awareness - Take a deep breath, focus - Corroborative - use trusted relative/friend - Consider and plan approach |
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List considerations before entering the room of a violent patient
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- Staff presence
- Security/staff backup - Proximity to patient - Low stimulation environment - Alarms |
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List strategies used when entering the room of a violent patient
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- Safety most important
- Look for access to objects and weapons - Assess level of agitation - Use power of observation - Body position at level of patient - Shake hand if possible - Position close to door (but do not obstruct) - Beware of pride |
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List strategies to engage a violent patient
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- Use simple, clear language
- Explain role, actions, delays - Stay calm and empathetic - Listen to why angry or violent - Do not interrupt, argue, challenge - Use neutral themes, general chat - Offer a blanket, food, drink - Use medical problems as a way in - Consider eye contact, hand position, distance and angles - Do not drop guard - trust your gut - Don't make promises you can't keep - Depersonalise |
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Considerations in the history of a violent patient
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- Medical causes and comorbidities
- Contraindications for sedation - Mental health act |
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Approach to suicide assessment
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1. General opener (e.g. life not worth living)
2. Duration, intensity, frequency of thoughts, distress caused 3. Thoughts of methods 4. Specific plans, access 5. Preparations (wills, belongings) 6. What is stopping them, consequences 7. If post-attempt - how help was sought, expectations, current feeling, potential for change |
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Areas assessed for risk in suicide assessment
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Background - demographics, PMH, FHx, comorbidities
Future - access to harm, supports, changes to circumstances |
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Managing risk in suicide assessment
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- Engage
- Detain if threatening to leave - Assess mental state - intoxication, mood, psychosis - Specialist review - Discharge/admission |
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Cautions and adverse effects in rapid sedation
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- Cardiovascular collapse
- Respiratory depression - Brain injury - Hypotension - Bradycardia - Acute dystonic reaction - Interaction with other substances injected/ingested |
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Oral medications used for rapid sedation
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- Diazepam
- Olanzapine - Haloperidol |
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IMI medications used for rapid sedation
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- Lorazepam
- Midazolam - Haloperidol - Olanzapine |
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IV medications used for rapid sedation
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- Anaesthetics
- Benzodiazepines - Antipsychotics |
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Substances responsible for all substance-related deaths
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Tobacco - 75%
Alcohol - 25% Other drugs - 3% |
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Effects of high-dose methamphetamines
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- Hypertension
- Cardiac toxicity - Dehydration - Hyperthermia - Excessive water consumption - Seizures - Serotonin syndrome - Agitation, psychosis, delirium |
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Drugs with unknown makeup or unpredictable effects
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- Amphetamines
- PMA (amphetamine analogue) - Caffeine - Glucose - Bicarbonate Soda - Benzos - Ketamine - Agricultural chemicals, bleach |
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Mortality rates among opioid users
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1-2% per year
Usually when combining with other drugs |
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Signs and symptoms of opioid toxicity
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- Drowsy
- Slurred speech - Nausea and vomiting - Miosis - Flushed sweaty skin - Decreased RR, HR, BP - Seizures - Pulmonary oedema |
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Treatment for opioid toxicity
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Naloxone
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Dangerous consequences of IV drug use
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- Infection/sepsis
- Nerve trauma - Emboli/thrombosis - Endocarditis - Osteomyelitis |
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Sudden cardiac death in schizophrenia is a bigger risk than suicide (T/F?)
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True
Factors - sedantary lifestyle, diet, smoking, alcohol, substance abuse |
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Explain how antipsychotics can cause sudden cardiac death
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1. Postassium channels in cardiac conduction altered
2. Leads to long QT syndrome 3. Progresses to Torsades de Pointes (TdP) 4. Progresses to VF |
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Signs and symptoms of lithium toxicity
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- Decreased consciousness
- Dysarthria - Ataxia - Coarse tremor - Twitching - Vomiting - Increased tone - Myoclonus - Seizures |
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Lithium toxicity is more common in people with impaired renal function (T/F?)
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True
Renal function affected by: - Poor fluid intake - Fluid loss - Use of medications or diuretics |
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Incidence and mortality rate of neuroleptic malignancy syndrome
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Incidence 0.02-3%
10-20% mortality |
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Risk factors for neuroleptic malignancy syndrome
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- Typical antipsychotic use
- Rapid dose escalation - High doses - Switching neuroleptics - Parental administration - Extreme agitation - Catatonia |
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Signs and symptoms of neuroleptic malignancy syndrome
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- Muscle rigidity
- Mental state change - Hyperthermia - Autonomic instability |
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Investigations in neuroleptic malignancy syndrome
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- CK > 1000
- Elevated white cell count with left shift - Increased AST, ALT, ALP Increased LDH - Electrolyte imbalances - metabolic acidosis, low Na/Ca/Mg - Impaired renal function - Low Fe |
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Treatment for neuroleptic malignancy syndrome
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- Stop causative agent
- ICU - supportive care - Benzodiazepine for agitation |
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Prognosis for neuroleptic malignancy syndrome
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Most cases resolve in 2/52
Highest mortality in patients with renal impairment and organic brain disease |
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Drugs with potential to cause serotonin syndrome
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- SSRIs
- TCAs - Stimulants - Opiates - Anti-migraine agents |
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Signs and symptoms of serotonin syndrome
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- Cognitive - headache, agitation, hypomania, confusion, hallucinations
- Autonomic - shivering, hyperthermia, hypertension, tachycardia, nausea - Somatic - myoclonus, hyperreflexia, tremor |
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Causes of death in clozapine use
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- Neutropenia
- Arrhythmias - Myocarditis - Respiratory depression |
