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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
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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
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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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Copyright 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
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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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Copyright 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
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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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Copyright 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
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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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MentalStatusExamination
Emotionalstability Ispatientawareofhisorherenvironment? Canpatientdescribeorratehisorhermoodusingascaleof1to
10? Doespatientappearhappy,sad,depressed,orangry? Ispatientsmoodappropriateforthespecificsituation? Doespatientshowmoodswingsorbehaviorsthatindicate
anxiety,de
