Assignment: Psychiatric Emergencies

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Assignment: Psychiatric Emergencies

Assignment: Psychiatric Emergencies

Discussion: Treatment of Psychiatric Emergencies in Children versus Adults

In this week’s Discussion, you compare treatment of adult psychiatric emergency clients to child or adolescent psychiatric emergency clients.

Post answers to the three questions below:

1. Briefly describe the case you selected (make up one).

2. Explain how you would treat the client differently if he or she were a child or adolescent.

3. Explain any legal or ethical issues you would have to consider when working with a child or adolescent emergency case.

References (also outside references welcomed)

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

· Chapter 23, “Emergency Psychiatric Medicine” (pp. 785–790)

· Chapter 31, “Child Psychiatry” (pp. 1226–1253)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

· “Bipolar and Related Disorders”

Note: You will access this book from the Walden Library databases.

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

 

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.

· Chapter 50, “Provision of Intensive Treatment: Intensive Outreach, Day Units, and In-Patient Units” (pp. 648–664)

· Chapter 64, “Suicidal Behavior and Self-Harm” (pp. 893–912)

mental emergency is sudden change in patient’s behavior, thinking, or mood that, if left untreated, could cause harm to the patient or those in the surroundings. 
As result, unlike other medical emergencies, the danger of harm to society is also considered when defining psychiatric emergency.

 

Major emergencies provide threat to the patient’s life or the lives of others in his environment, while mild emergencies pose no threat to life but inflict significant incapacitation. 
Only the most serious crises will be discussed.

 

In 2002, the suicide rate in India was 11.2 per 100,000. 
Suicide rates differ across the country, with Kerala having the highest rate of 30.8 per lakh in 2002. 
Army, Air Force, and Naval personnel had suicide rates of 0.04, 0.11, and 0.12 per thousand, respectively. 
In metropolitan areas, rates are higher than in rural areas. 
According to studies of completed suicides, 90-94 percent of the patients were mentally unwell at the time of the act. 
Depression is responsible for about half of all suicides, followed by alcohol abuse (34 percent) and schizophrenia (13 percent) [1]. 
meta-analysis of 249 suicide studies conducted between 1966 and 1993 found that, with the exception of mental retardation and dementia, practically all mental diseases increase the probability of suicide. 
The risk of suicide is highest for primary mental diseases and lowest for organic disorders, with substance use disorders being somewhere in the middle [2]. 
According to Indian studies, the majority of people who attempt suicide are between the ages of 15 and 30, and this number is expected to rise in the coming years [3, 4]. 
Suicide is very common among unmarried people (in the married the loss of spouse increases the risk during the first year of the loss). 
Unemployed people and those with concurrent medical ailment have the highest rates. 
Men commit suicide at higher rate than women, despite the fact that women attempt suicide at higher rate. 
Chaotic home environments, abrupt loss (death, divorce, job, finances), recent humiliating life event, unfaithful relationship, HIV, and legal troubles are all psychosocial factors that predispose to suicide. 
Suicides among the young are widespread following the announcement of board exam results. 
The conviction that no action will save the patient from the trauma that he or she is experiencing is the most common symptom among patients. 
The majority of people try suicide to get out of an intolerable circumstance (56 percent), 13% to influence others or the environment (13 percent), and the rest have mix of escape and manipulative intentions. 
Between 50 and 80 percent of suicide attempters have told their family or their treating psychiatrist about their plans.

 

Suicidal ideation should be asked about in all psychiatric patients as part of standard examination. 
The most powerful indicators of future suicidal attempt are self-destructive behaviors and past attempts. 
It must be noted that inquiring about suicidal attempt does not create or instill the desire to commit suicide in the patient. 
When patients are queried about suicidal ideation and told that their thoughts are symptom of their condition, they often feel relieved.

 

If patient arrives in the emergency room with history of attempting suicide, the patient’s medical state must first be reviewed for risk to life before being sent to the ICU under escort until the medical condition stabilizes. 
He is referred to psychiatrist for evaluation as soon as possible.

 

Electro-convulsive treatment should be used to treat severely suicidal and depressed people (ECT). 
The technique has 75-85 percent overall response rate [5]. 
Apart from ECT, atypical antipsychotics such as clozapine have been reported to have an unique antidepressant and anti-suicidal impact in schizophrenia.

 

In most cities around the world, crisis intervention centers and helplines are available. 
They give the person contemplating suicide safe place to talk about his issues, allowing the counsellor to urge the patient to seek professional help. 
However, there is currently dearth of scientific evidence for their effectiveness.

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