Chapter twelve other psychiatric considerations
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Chapter Twelve: Other Psychiatric Considerations. points to consider. Suicide evaluation and prevention Mental status examination Categories of psychiatric illness Psychotropic medications. suicide. More common in alcoholics More common when drinking 65% involve drinking

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Chapter Twelve: Other Psychiatric Considerations

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Chapter twelve other psychiatric considerations

Chapter Twelve: Other Psychiatric Considerations


Points to consider

points to consider

  • Suicide evaluation and prevention

  • Mental status examination

  • Categories of psychiatric illness

  • Psychotropic medications


Suicide

suicide

  • More common in alcoholics

  • More common when drinking

    • 65% involve drinking

    • alcoholics and non-alcoholics

    • alcohol effects judgment


Suicide types

suicide: types

Completers

 isolated secretive

lonely violent methods

 calculated  lonely teens or

white males 50+

Attempters

 impulsive  pills

 women  die by mistake


Suicide types cont

suicide: types (cont.)

Threateners

 as “weapon” in relationships

 usually don’t follow through

Parasuicide

 a different class

 to relieve emotional pain

 die through miscalculation


Suicide high risk factors

suicide: high-risk factors

Recent loss

Single, widowed, childless

Emotional constellations

anger + hopelessness

poor family communications

isolation in a relationship

Chronic illness

Entering or leaving depression


Suicide clinical tips

suicide: clinical tips

Ask all clients

Be explicit

If suicidal thoughts . . .

What was going on then?

Is there a plan?


Responding to suicidal patients

responding to suicidal patients

  • Diffuse psychologically and concretely

  • Offer alternatives

  • Reinforce reasons to live

  • Make a referral

  • Get weapons

  • Assure not leaving office to go home alone


Emergency situations

emergency situations

  • Someone threatening to jump or shoot themselves

  • Police departments have trained emergency personnel

  • In the meantime . . .

    • keep voice down

    • non-threatening topics

    • ask practical questions


Mental status exam

mental status exam

  • Purpose

    • secure information on mental functioning

  • Three components

    • mood and affect

    • thought processes

    • cognitive functioning


Major categories of of psychiatric illness

major categories of of psychiatric illness

  • Substance use, most common psychiatric disorder

  • Alcoholism, the great mimicker

    • can mask other disorders

  • Need to assess contribution of alcohol and other psychiatric disorders to problems

  • Substance use problem  another psychiatric condition termed “co-morbidity” or “co- occurring disorders”


Mood disorders

mood disorders

  • Depression

  • Mania

  • Bipolar

  • Relation to alcohol use

    • can worsen depression

    • can contribute to suicide attempts

    • possible use to self-medicate in mania


Mood disorders cont

mood disorders (cont.)

  • Relationship to alcohol dependence

    • depression common in alcoholism

    • diagnosis of depressionin sober stateby history, depression prior to alcohol


Disorders with psychosis

disorders with psychosis

  • Disturbed thought and perceptions

  • Schizophrenia

    • debilitating

    • positive symptoms additions to usual behavior delusions, hallucinations

    • negative symptoms loss of usual functions withdrawal, difficulty communicating,

      depressed mood


Disorders with psychosis cont

disorders with psychosis (cont.)

  • Alcohol-induced conditions can mimic schizophrenia

    • Wernicke-Korsakoff syndrome

    • alcoholic hallucinosis

  • Alcohol use in schizophrenia

    • modest use can cause problems


Anxiety disorders

anxiety disorders

  • Steady or episodic

  • Different types

    • fear of places/situations (agoraphobia)

    • fear of specific object (simple phobia)

    • unrelenting thoughts (obsessions)

    • repetitive acts (compulsions)

  • Physical symptoms

  • No alteration of mood , thought, or judgment


Anxiety disorders cont

anxiety disorders (cont.)

  • Diagnose in abstinent state

  • Benzodiazepines used to treat

    • high abuse potential

    • other medications available

  • Primary or secondary to alcohol problems


Personality disorders

personality disorders

  • Ten different types

  • Types common with alcohol

    • Antisocial Personality Disorder

      • interpersonal problems problems with authority con others for personal benefit

      • risk factor for alcohol disorders

      • drinking can induce antisocial behaviors


Personality disorders cont

personality disorders (cont.)

  • Borderline Personality Disorder

    • inappropriate emotions

    • feelings of boredom, emptiness

    • chaotic life situations

    • impulsive

    • evoke negative feelings in helpers

    • diagnose in sober state


Attention deficit hyperactivity disorder

attention deficit hyperactivity disorder

  • First seen in childhood

  • 3% to 5% of children

  • Increased risk for alcohol/drug use problem

  • Diagnosis difficult in alcoholism

    • Consider when a series of treatment failures

    • By history, childhood


Attention deficit cont hyperactivity disorder

attention deficit (cont.) hyperactivity disorder

  • Treatment with medication

    • Stimulants common

    • Stimulants paradoxical action

    • Suggests brain anomalies

  • Implications for prevention

    • children with ADHD


Medical illness causing psychiatric illness

medical illness causing psychiatric illness

  • Variable causes examples: brain tumor, stroke, infections

  • Permanent or reversiblereversible = deliriumirreversible = dementia

  • Treatment of underlying condition

  • Elderly especially susceptible


Alcohol problems and homelessness

alcohol problems and homelessness

  • Every evening, 600,000 people without shelter

  • 2/5ths of homeless have alcohol problems

  • Multiply disadvantaged

    • medical problems  psychiatric illness

    • social isolated  victims of crime

    • transient  Tx revolving door


Other addictive behaviors

other addictive behaviors

  • Non-alcohol/drug addictions

    • seen as disorders of impulse-control

    • gambling

    • eating disorders

    • computer/internet

  • Alcohol often part, non-substance addictions


Psychotropic medications

psychotropic medications

  • Different types of psychotropic medications

  • Different properties

  • Differ in abuse potential

  • Four major classes

    • anti-psychotic  mood stabilizers

    • anti-depressants  anti-anxiety


Psychotropic medications anti psychotic agents

psychotropic medications: anti-psychotic agents

  • Used to treat severe mental illness

  • In addition to anti-psychotic effects also sedating

  • Little likelihood of abuse

  • Effects not considered “pleasurable”

  • Two different types of anti-psychotic drugs


Psychotropic medications anti depressants

psychotropic medications: anti-depressants

  • For biological component of depression

  • Take for 2 or more weeks before full effects

  • Different types of anti-depressants

  • Rarely subject to abuse

  • But overdose can be lethal


Psychotropic medications mood stabilizers

psychotropic medications: mood stabilizers

  • Used to treat bipolar disorder, mania, and depression

  • Different types of drugs in category

  • Alcohol contraindicated additive effects and possible liver damage

  • Little likelihood of abuse


Psychotropic medications anti anxiety agents

psychotropic medications: anti-anxiety agents

  • Effects similar to alcohol

    • invite abuse and dangerous with alcohol

  • Uses: treat anxiety disorders managing alcohol withdrawal

  • Two different types

    • benzodiazepines

    • “non-benzodiazepines”less abuse (e.g. Atarax, Buspar)

  • Associated with abuse

    • Librium Valium Xanax

      Rohypnol(not available in U.S.)


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