Chapter 29
Psychiatric
Disorders
Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
29-1
Objectives
29-2
Behavior
• The way in which a person acts or performs
29-3
Abnormal Behavior
• A way of acting or conducting oneself that:
– Is not consistent with society’s norms and
expectations
– Interferes with the individual’s well-being
and ability to function
– May be harmful to the individual or others
29-4
Behavioral Emergency
• A psychiatric disorder is a disorder of
behavior or personality without
obvious brain damage.
• A behavioral emergency is a situation
in which a patient displays abnormal
behavior that is unacceptable to the
patient, family members, or
community.
29-5
Factors That May Cause Changes in Behavior
Mind-altering substances
• Alcohol
• Drugs
29-6
Factors That May Cause Changes in Behavior
Situational Stressors
• Rape
• Loss of a job
• Physical or
psychological abuse
• Death of a loved one
• Natural disasters
(tornado, flood,
earthquake, hurricane)
• Marital stress or
divorce
• Man-made disasters
(war, explosion)
• Career change
29-7
Factors That May Cause Changes in Behavior
Medical Illnesses
• Toxic exposure
• Low blood sugar
• Central nervous system
infection
• Inadequate blood flow
to the brain
• Head trauma
• Seizure disorder
• Extremes of
temperature (excessive
cold or heat)
• Lack of oxygen
(hypoxia)
• Drug or alcohol
withdrawal
29-8
Factors That May Cause Changes in Behavior
Psychological Crises
• Panic
• Agitation
• Self-destructive behavior,
suicidal gesture
– Danger to self
• Bizarre thinking and
behavior
• Threatening behavior,
violence
– Danger to others
29-9
Anxiety
• State of worry and
agitation
• Usually triggered by a
vague or imagined
situation
29-10
Anxiety
• Some anxiety is good
– Can increase awareness and
performance
• As anxiety increases:
– Drains energy
– Shortens attention span
– Interferes with thinking and
problem-solving
29-11
Conditions Associated with Anxiety
•
•
•
•
•
•
Asthma
Diabetes
Heart problems
Thyroid disorder
Seizure disorder
Inner ear
disturbances
• Premenstrual
syndrome (PMS)
• Autism spectrum
disorders
• Withdrawal from
alcohol, sedatives,
or tranquilizers
• Reaction to
–
–
–
–
–
Cocaine
Amphetamines
Caffeine
Aspartame
Other stimulants
29-12
Anxiety Disorder
• Common signs and
symptoms
– Tiredness
– Trembling
– Headaches
– Twitching
– Muscle tension
– Irritability
– Muscle aches
– Sweating
– Difficulty swallowing
– Hot flashes
29-13
Fear
• Usually triggered by a specific object or
situation
– Fear of losing a job
– Fear of being unable to pay the bills
29-14
Panic Attack
• An intense fear that occurs for no apparent
reason
• Can build gradually over several minutes or
hours or occur suddenly
29-15
Panic Attack
• Common signs and
symptoms
– Numbness or tingling
sensations
– Shortness of breath or a
smothering sensation
– Heart palpitations
– Fear of going crazy or
being out of control
– Nausea or abdominal
distress
– Choking
– Sweating
– Hot flashes or chills
– Feeling of detachment or
being out of touch with
oneself
– Trembling or shaking
– Dizziness or faintness
– Fear of becoming
seriously ill or dying
29-16
Obsessive-Compulsive Disorder (OCD)
• Type of anxiety disorder
• Obsessions
– Recurring thoughts, impulses, or
images that cause the person anxiety
• Compulsions
– Recurring behaviors or rituals
29-17
Phobias
• An irrational and constant fear of a specific
activity, object, or situation (other than a
social situation)
• Social phobia
29-18
Common Phobias
Specific phobias
Social phobias
• Fear of animals
• Thunder and/or
lightning
• Doctors or dentists
• Germs, bacteria
• Being alone
• Blood, injection, or
injury
• Fear of heights
• Fear of airplane travel
•
•
•
•
Public speaking
Eating in public
Using public restrooms
Writing while others are
looking on
• Performing publicly
29-19
Phobic Reaction
• Resembles a panic attack
• Signs and symptoms may include:
– Panic
– Sweating
– Difficulty breathing
– Increased heart rate
29-20
Depression
• A state of mind characterized by feelings
of sadness, worthlessness, and
discouragement
• Signs of depression vary with age
29-21
Depression
• Common signs and
symptoms
– Loss of appetite
– Diarrhea or constipation
– Significant weight loss or
gain
– Tiredness
– Loss of interest in usual
activities or hobbies
– Difficulty sleeping or
sleeping too much
– Crying spells
– Muscle aches
– Vague pains
– Constant feelings of
sadness, irritability, or
tension
– Inability to make decisions
or concentrate
– Feelings of anger,
helplessness, guilt,
loneliness
– Thoughts of suicide or
death
29-22
Bipolar Disorder
• Alternating episodes of mood
elevation (mania) and
depression
• When manic:
– Easily distracted
– Requires little sleep
– Extremely energetic and
enthusiastic
• When depressed:
– Feels worthless
– May consider suicide
29-23
Paranoia
• A mental disorder characterized by
excessive suspiciousness or delusions
• Common delusions include believing:
– People are following her, harassing her
– People are plotting against her
– People are reading her mind or controlling
her thoughts
– She possesses great power or special
abilities
– She is a famous person
29-24
Hallucinations
• Patient sees, hears, or feels things others
cannot
– Visual
• Worms or snakes crawling on the floor
– Auditory
• Hearing voices
– Tactile
• Insects crawling on the skin
29-25
The Paranoid Patient
•
•
•
•
•
Suspicious
Distrustful
Argumentative
Excitable
Unpredictable
29-26
Schizophrenia
• A group of mental disorders
• Symptoms include:
– Hallucinations
– Delusions
– Disordered thinking
– Rambling speech
– Bizarre or disorganized behavior
• Prefer to be alone
• Can become combative
• High risk for suicidal and homicidal behavior
29-27
Suicide
• Suicide gesture
• Suicide attempt
• Completed suicide
29-28
Suicide Risk Factors
• Previous suicide
attempt
• History of mental
disorders, particularly
depression
• History of alcohol and
substance abuse
• Family history of
suicide
• Family history of child
maltreatment
• Feelings of
hopelessness
• Impulsive or aggressive
tendencies
• Loss
• Physical illness
• Easy access to lethal
methods
• Unwillingness to seek
help
• Cultural and religious
beliefs
• Local epidemics of
suicide
• Isolation
29-29
Suicide
• The more well thought
out the plan, the more
serious the suicide risk
29-30
Excited Delirium
• Abnormal behavior
characterized by elevated
temperature, agitation,
aggression, and
“superhuman” strength,
especially during attempts
to restrain the patient
29-31
Excited Delirium
• Fatal excited delirium consists of four
separate phases
1. Elevated temperature
2. Agitated delirium
3. Respiratory arrest
4. Death
29-32
Excited Delirium
• Scene safety
• Request the assistance of law enforcement
personnel
• Request advanced life support personnel to
the scene
• When it is safe to do so, approach the patient
calmly and cautiously.
• Continuously monitor the patient’s mental
status and ABCs
• Monitor the patient’s vital signs and oxygen
saturation
29-33
Assessment
• Take steps to ensure your safety
• Consider dispatch information
– Have you responded to this location
before?
• If so, how many times?
• Were those calls violent in nature?
– Are law enforcement personnel on the
scene?
• If not, ask that they respond to the scene
29-34
Scene Size-Up
• Carefully assess the scene for
possible dangers
[Insert figure 29-1]
29-35
Scene Size-Up
• Postures that may indicate potential
violence:
– Standing or sitting in a position that
threatens self or others
– Inability to sit still, nervous pacing
– Fists or jaw clenched
– Unsafe object in the patient’s hands
29-36
Scene Size-Up
• Movements that may indicate potential
violence:
– Moving toward rescuers
– Carrying heavy or threatening objects
– Tense muscles
– Quick, irregular movements
29-37
General Guidelines
• When called to the scene of a behavioral
emergency:
– Be prepared to spend time at the scene
– Limit the number of people around the
patient
– Take the time to calm the patient
– Approach the patient slowly and
purposefully
• Do not make any quick movements
29-38
Assessment
• Clearly identify yourself
• Assess mental status and ABCs
• Respect the patient’s personal space by
limiting physical touch
• Life-threatening illness or injury takes
priority over the patient’s behavioral problem
29-39
Assessment
• Face the patient
• Do not place the patient between yourself
and an exit
• Sit or stand at or below the patient’s level
• Maintain a comfortable distance from him
• Maintain eye contact
• Let him know what you expect and what he
can expect from you
29-40
Assessment
• Note appearance, speech, and mood
– Speech normal or garbled?
– Anxious, depressed, excited, agitated, angry,
hostile, fearful?
• Pay attention to patient’s thought process
– Disordered?
– Is he hearing or seeing things that are not
there?
– Does he have unusual worries or fears?
29-41
Methods to Calm the Patient
with a Psychiatric Disorder
•
•
•
•
Be polite and respectful
Do not talk down to the patient
Ask open-ended questions
Be aware of your own reactions
to the situation
• Do not allow your personal
feelings to get in the way of
your professional judgment
• Do not threaten, challenge, or
argue with disturbed patients
29-42
Methods to Calm
Behavioral Emergency Patients
• Answer questions honestly
– Do not lie to the patient
– Do not make promises you cannot keep
• If the patient is hearing or seeing things, do
not “play along”
29-43
Medical/Legal Considerations
• Documentation of the patient’s abnormal
behavior is very important
• When possible:
– Have witnesses present when providing
patient care
– Use attendants of the same gender
29-44
Medical/Legal Considerations
• To provide care against the patient’s will:
– Contact medical direction
– Law enforcement personnel should be
present
29-45
Questions?
29-46