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· PDF fileChapter 35 Behavioral and Psychiatric Disorders 2 Learning Objectives • Define what constitutes a behavioral

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  • 9/11/2012

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    Chapter35

    BehavioralandPsychiatricDisorders

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    LearningObjectives

    Definewhatconstitutesabehavioralemergency.

    Identifypotentialcausesforbehavioralandpsychiatricillnesses.

    Listthreecriticalprinciplesthatshouldbeconsideredintheprehospitalcareofanypatientwithabehavioralemergency.

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    Copyright 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company

  • 9/11/2012

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    LearningObjectives

    Outlinekeyelementsintheprehospitalpatientexaminationduringabehavioralemergency.

    Describeeffectivetechniquesforinterviewingapatientduringabehavioralemergency.

    Distinguishbetweenkeysymptomsandmanagementtechniquesforselectedbehavioralandpsychiatricdisorders.

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    LearningObjectives

    Identifyfactorsthatmustbeconsideredwhenassessingsuiciderisk.

    Formulateappropriateinterviewquestionstodeterminesuicidalintent.

    Explainprehospitalmanagementtechniquesforthepatientwhohasattemptedsuicide.

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    LearningObjectives

    Describeassessmentofthepotentiallyviolentpatient.

    Outlinemeasuresthatmaybeusedinanattempttosafelydiffuseapotentiallyviolentpatientsituation.

    Listsituationswhenpatientrestraintscanbeused.

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    Copyright 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company

  • 9/11/2012

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    LearningObjectives

    Discusskeyprinciplesinpatientrestraint. Describesafetymeasurestakenwhenpatientviolenceisanticipated.

    Explainvariationsinapproachtobehavioralemergenciesinchildren.

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    UnderstandingBehavioralEmergencies

    Anestimated26.2percentofAmericansage18andoldersufferfromdiagnosablementaldisorderingivenyear About57.7millionpeople

    NationalInstituteofMentalHealthhasestimatedthat1in7individualswillneedtreatmentatsomepointinlifeforemotionaldisturbance MentalhealthproblemsareleadingcauseofdisabilityinU.S.andCanadaforpeople15to44yearsofage

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    Noclearagreementoridealmodelfornormalbehavior

    Consideredtobeadaptivebehavioracceptedbysociety Canvarybycultureandethnicgroup Conceptofabnormal(maladaptive)behavioralsoisdefinedbysocietywhenbehavior

    Deviatesfromsocietysnormsandexpectations Interfereswithwellbeingandabilitytofunction Harmsindividualorgroup

    UnderstandingBehavioralEmergencies

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    Canyouthinkofatimeinyourlifewhenyou,afamilymember,oraclosefriendhadabehaviorthatfitthisdefinition?Howdiditmakeyou

    feel?

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    Behavioralemergency Changeinmoodorbehaviorthatcannotbetoleratedbyinvolvedpersonorothers

    Requiresimmediateattention Mayrangefrombriefinabilitytocopewithstressoranxietytosituationsinwhichpatientsmaybedangeroustothemselvesandothers

    Mostpeoplewithmentalillnessfunctionwellondailybasis

    UnderstandingBehavioralEmergencies

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    Depression,anxietydisorders,mildpersonalitydisordersoftenareeffectivelymanagedwithmedicationandcounselinginoutpatientmentalhealthcenters

    Mostbehavioralemergencieshaveabiological/organic,psychosocial,orsociocultural cause

    UnderstandingBehavioralEmergencies

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    Copyright 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company

  • 9/11/2012

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    BiologicalCauses

    Physicalorbiochemicaldisturbancesinbraincanresultinsignificantchangesinbehavior

    Biologicaldisturbances Mentaldisordersthatresultfromphysicalratherthanapurelypsychologicalcause

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    BiologicalCauses

    Examplesofbiologicalcauses Geneticfactors Prenatalandpostnatalfactors

    Infection Endocrine,metabolic,vasculardisorders

    Imbalanceinbrainchemistry(mayhaveheritablecomponent)

    Alterationsinneurotransmission

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    Copyright 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company

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    BiologicalCauses Specificgenesthatmayinfluencebalanceofchemicalsinbrain Neurotransmittersareresponsibleforcommunicationamongbraincells

    Predominantneurotransmittersinbrain Glutamate,aminobutyric acid(GABA) Serotonin Dopamine Norepinephrine

    Mostscientistsbelievethatmentalillnessesresultfromproblemswithcommunicationbetweentheseneurotransmittersandneuronsinbrain

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    BiologicalCauses

    Organiccauses Substanceabuse Trauma Illness Infections Tumors Dementia

    Considerpossibilityofthesemedicalconditionsaspartofdifferentialdiagnosisinallbehavioralemergencies

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    PsychosocialCauses

    Psychosocialmentalillness Oftenrelatedtoindividualspersonalitytype Mayberelatedtopersonsabilitytoresolvesituationalconflictinlife

    Childhoodtrauma Childabuseorneglect Dysfunctionalfamilystructurethataffectsrelationshipswithparentsandsiblings

    Biologicaldisordersmaycontributetopsychosocialcausesofmentalillness

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    Copyright 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company

  • 9/11/2012

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    Sociocultural Causes

    Relatedtowayapersonbalancesemotions,thoughts,andinteractionsinsociety Whenbalanceshiftsrapidly,personmayexperienceemotionalturmoilthatresultsincrisis

    Factors Personalrelationships Familystability Economicstatus Socialcohesion Workenvironment Personalbeliefsystemsandvalues

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    Sociocultural Causes

    Changesinbehaviorcausedbypersonalorsituationalstressoftenlinkedtospecificeventorseriesofevents Environmentalviolencerelatedtosociety

    War Terrorism Riots

    Personalviolence Ongoingdiscriminationorprejudice Economicandemploymentproblems

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    AssessmentandManagement

    Initialassessmentandmanagement Ensurescenesafety Containcrisis Provideproperemergencymedicalcare Transportpatienttoappropriatehealthcarefacility

    MostEMSserviceshaveprotocolsthatcallforlawenforcementtoevaluatesceneforpossibledangerandtocontrolanyactsofaggressionbypatient

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    Assessment

    Beginassessmentbycreatingrapportwithpatient Dothiswhilegatheringinformationneededforimmediatemanagementoflifethreateningconditions

    Onarrival,surveysceneforanyrelevantdetails Evidenceofsubstanceabuse Suicideattempt Othercluesthatmayshedlightonpatientsstate

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    Assessment

    Beginassessmentbycreatingrapportwithpatient Observepatientforemotionalresponse

    Fear Anger Confusion Hostility

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    Assessment

    Whileprovidingpatientcare,focusevaluationonpatientslevelofcognitivefunctioning Alertness Orientation Speechpatterns Affect Wayinwhichpatientinteractswithfriends,lovedones,familymembers

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    Assessment

    Whenpossible,numberofpeoplearoundpatientshouldbelimited Helpscontrolscene Anyonewhointerfereswithsceneorpatientassessmentorwhoadverselyaffectspatientsconditionshouldberemovedfromarea

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    Assessment

    Otherinformationcanbe Volunteeredbypatient Obtainedfrompatientinterview Providedbyfamilymembers,bystanders,firstresponders

    Interviewpatientsfamilyorcaregiverabout Patientsusualleveloffunctioning Recentstressinpatientslife Approachesthatmayhelpgainpatientstrustandcooperation

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    Assessment

    Informationneededforfullbackgroundandhistoryofevent Pastmedicalhistory Medications Pastpsychiatricproblems Precipitatingfactors

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    InterviewTechniques

    Aftermanaginganylifethreateningillnessorinjury,interviewpatientifpossible Donotaskformoredetailsthanneeded Limitedandsupportiveinterviewstrengthensrapportwithpatient

    Helpsestablishandmaintainrelationshipduringpatientcare

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    InterviewTechniques

    Effectiveinterviewtechniques Activelistening Showingsupportandempathy Preventinginterruptions Respectingpatientspersonalspacebylimitingphysicaltouch

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    MentalStatusExamination

    Mentalstatusexamination(MSE) Appearanceandbehavior Speechandlanguage Cognitiveabilities Emotionalstability

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    MentalStatusExamination Appearanceandbehavior

    Howdoespatientlook? Ispatientneatlydressedandwellgroomed?

    Ispatientpleasantandcooperativeoragitated? Ispatientsbehaviorappropriateforparticularsituation?

    Whatispatientsbodylanguage? Dobodymovementsorposturesuggesttension,anxiety,hostility,oraggression?

    Doespatientmaintaineyecontactduringpatientinterview?

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    MentalStatusExamination

    Speechandlanguage Ispatientsspeechintelligibleandnormalintone,volume,andrate?

    Doestoneofpatientsvoicechange? Isspeechspontaneous,witheaseofexpression? Dopatientswordsandsentencesproceedinanorderlyfashion?

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    MentalStatusExamination Cognitiveabilities

    Ispatientorientedtoperson,time,andplace? Doespatientknowwhoandwhereheorsheis? Doespatientknowwhoyouare? Canpatientremainfocusedonyourquestionsandconversation?

    Whatispatientsattentionspan? Canpatientfollowaseriesofshortcommands? Doespatientrespondtodirectionsappropriately? Arepatientscommentslogicalandpresentedinorganizedfashion?

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    Copyright 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company

  • 9/11/2012

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    MentalStatusExamination

    Emotionalstability Ispatientawareofhisorherenvironment? Canpatientdescribeorratehisorhermoodusingascaleof1to

    10? Doespatientappearhappy,sad,depressed,orangry? Ispatientsmoodappropriateforthespecificsituation? Doespatientshowmoodswingsorbehaviorsthatindicate

    anxiety,de

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