Mental Health Emergencies Study Guide for the CEN

Thought Disorders

Thought disorders are mental health conditions that affect the patient’s ability to think and communicate in a clear and organized manner. It is one of the primary symptoms of schizophrenia but can also occur in mania or depression. Psychosis occurs when the patient loses touch with reality altogether and becomes unsure of what is real and what is fake.

Assessment

Symptoms of schizophrenia and other thought disorders include delusions, paranoia, hallucinations, disordered or illogical thinking, disorganized or nonsensical writings, poor personal hygiene, lack of emotion and facial expressions, and withdrawal from daily life. There is no definitive diagnostic test for thought disorders. A mental health professional will diagnose the patient after an extensive examination and evaluation of the patient.

Treatment

Thought disorders are most commonly treated with antipsychotic medications and intense psychotherapy. Patients may need to be admitted into an inpatient mental health facility until their condition has stabilized. The disorganized nature of the disorder makes it very challenging for patients to remember to take medications regularly and attend therapy appointments, which is crucial to treating the disorder effectively.

Situational Crises

Situational crises occur when the patient experiences a sudden major stressor. Examples include a terminal diagnosis or serious illness, job loss, relationship issues, birth of a new baby, unexpected death in the family, or traumatic accident. These stressors can cause the patient to experience sudden onset depression or anxiety.

Assessment

Assess the patient’s physical and emotional status carefully. Watch for signs of suicidal ideation, especially if the patient has lost a loved one and is grieving. Ask the patient how they are doing and provide emotional support. The patient may have some insomnia or difficulty sleeping and appear fatigued. They may be withdrawn or avoid talking about their situational crisis.

Treatment

Treatment varies depending on how the patient responds to their situational crisis. For some patients, lifestyle changes such as exercise, ensuring adequate sleep, eating healthy food, and practices such as meditation and breathwork are enough to manage stress.

Other patients may benefit from the use of an SSRI or atypical antidepressant. The patient may be prescribed benzodiazepines to temporarily help with their anxiety until the SSRI or atypical antidepressant takes effect. Psychotherapy is also helpful and teaches the patient healthy coping strategies to adjust to the situational crisis.

Intentional Overdose and Ingestions

Intentional overdose or ingestion is any deliberate overconsumption of a potentially harmful substance. This can be prescription medication, over-the-counter medication, or medication that has been obtained illegally. Overdoses can occur with substances that are taken orally, nasally, rectally, intravenously, or intramuscularly.

Assessment

Immediately assess the patient’s physical condition using the following ABCDE guidelines:

• airway—Ensure the patient’s airway is patent and provide assistance if needed. An oropharyngeal airway (OPA) is appropriate for an unconscious patient with no gag reflex, while a nasopharyngeal airway (NPA) can be inserted in a patient who is arousable or awake. A jaw thrust or chin lift can be added in if necessary.

• breathing—Monitor the adequacy of ventilation and oxygenation. Apply oxygen or use a bag valve mask, if necessary, to maintain oxygenation and assist in ventilation/respirations.

• circulation—Monitor cardiac rhythms, obtain IV access, and use defibrillation if necessary.

• disability—Evaluate the patient’s neurological status and level of responsiveness.

• exposure—Ensure that all clothing is removed to perform a comprehensive visual assessment.

A serum toxicology screen will be drawn to check for specific substances. Use the SAMPLE mnemonic (signs and symptoms, allergies, medications, past medical history, last oral intake, and events leading up to the current situation) to perform a secondary assessment. This helps to narrow down the potential causes of the patient’s condition while waiting on the results of the toxicology screen.

Treatment

The specific treatment for a drug overdose varies depending on what substance was taken. If the patient has a suspected narcotic overdose, they will receive naloxone. If a benzodiazepine overdose is suspected, they will receive flumazenil. A Tylenol overdose can be treated with acetylcysteine. Activated charcoal can be used to slow the absorption of any ingested toxins. If the substance is more unusual, Poison Control can be consulted for specific treatment options. After the patient’s condition has stabilized, they may receive a referral to a counselor to educate them about local resources to treat substance use disorder.