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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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points to consider
points to consider
  • Suicide evaluation and prevention
  • Mental status examination
  • Categories of psychiatric illness
  • Psychotropic medications
  • More common in alcoholics
  • More common when drinking
    • 65% involve drinking
    • alcoholics and non-alcoholics
    • alcohol effects judgment
suicide types
suicide: types


 isolated secretive

lonely violent methods

 calculated  lonely teens or

white males 50+


 impulsive  pills

 women  die by mistake

suicide types cont
suicide: types (cont.)


 as “weapon” in relationships

 usually don’t follow through


 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 depression in sober state by 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 reversible reversible = delirium irreversible = 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.)