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Psych Emergencies Latest Updates 2024/2025
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Psych Emergencies Latest Updates 2024/2025
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Psych Emergencies Latest Updates2024/2025
A 25 year old male is brought to the emergency department by his family, with a complaint of feeling
depressed for the past week. In obtaining the history, which of the following statements regarding this
patient would support a diagnosis of major depression?
A. The patient has no history of medical illness
B. The patient has a history of Crohn's disease
C. There is no family history of depression
D. The screening mnemonic in SAD CAGES is negative ANS✔✔ The answer is B. In SAD CAGES is a
screening mnemonic for symptoms, not causes, of major depression. Depression is more common in
patients with history of other medical illnesses, some of which may actually cause depressive symptoms.
As compared with major depression, dysthymic disorder is a more chronic, and less severe, form of
depressive illness.
A 42 year old male with end stage liver disease due to chronic hepatitis C infection arrives to the
emergency department in stable condition after an unsuccessful suicide attempt by bilateral wrist
laceration. He reports no history of depression or psychiatric disorder. Aside from his liver disease, for
which he takes interferon alpha and ribavirin, he reports that he is in good health and takes no other
medications. Which of the following factors increased this patient's risk of new-onset suicidal ideation?
A. chronic hepatitis C infection
B. end-stage liver disease
C. interferon alfa therapy
D. ribavirin therapy ANS✔✔ The answer is C. Interferon alfa, an important cytokine in the early immune
response to viral infection, has both antiproliferative and antiviral properties. It is the only therapy
approved by the Food and Drug Administration for hepatitis C infection. Interferon alfa has been
associated with high rates of central nervous system side effects, including anhedonia, fatigue, anorexia,
impaired concentration, sleep disturbance, and suicidal ideation. Clinicians should always look up the
, side effects of their patients' medications, especially unfamiliar drugs. This can both expedite diagnosis
of drug-induced complications and prevent them with appropriate pretreatment. Pretreatment with a
selective serotonin reuptake inhibitor appears to be an effective strategy to minimize depression
induced by interferon alfa. Chronic hepatitis C infection and end-stage liver disease can both be difficult
diseases to live with, however, these conditions are not known to significantly increase a patients' risk
for new suicidal ideation. Depression is not a known side effect of ribavirin treatment. Although males
have a higher percentage of successful suicide attempt than females, females have a much higher
incidence of suicide attempt and ideation than males overall.
A 35 year old female is brought to the emergency department after family members called the police to
say she was threatening to kill herself by jumping out a window. She has a long history of depression.
Regarding suicide, which of the following statements is FALSE?
A. All states have laws giving law enforcement the right to place into custody any individual suspected
of being a danger to themselves or others.
B. Family sitters provide the best option for close observation of suicidal patients since they often have
a calming influence on the patient.
C. The patient's room needs to be cleared of all potentially dangerous objects such as blunt instruments,
glass objects, and the patient's belongings.
D. The majority of suicide attempts involve minor injuries or drug overdoses. ANS✔✔ The answer is B.
For any patient presenting with suicidal ideation, the emergency department physician must first
stabilize medical condition as most attempts involve minor injury or drug overdoses treatable by
emergency room staff. Secondly, all objects and substances should be kept strictly out of reach of the
suicidal patient. Once stabilized these patients may be kept under direct supervision. It is not
recommended that family members provide the direct supervision because of a possibility of
collaboration between family and patient to leave the hospital. In this event, or even before coming into
the hospital, all law enforcement has the right to bring into custody any patient at risk of harming self or
others.
Suicide rates are consistent with the average population in this population:
A. Females with breast implants
B. Men with AIDS
C. African-American males
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