Psychiatric Emergencies
QUESTIONS
1. A 56-year-old male is brought to the emergency department (ED) by the emergency medical Services (EMS) from a methadone clinic. According to the methadone clinic nurse, the patient walked in with opiate withdrawal symptoms and mentioned that he has missed methadone for 3 days and that he usually takes 80 mg of methadone per day. The patient became drowsy and unarousable when he was given 80 mg of methadone. What should the methadone clinic have done prior to administering methadone?
A. Examine the patient, and make sure he is having opiate withdrawal.
B. Try to contact the methadone clinic from where he gets methadone and confirm the dose.
C. If not able to contact the program, give a low dose of methadone and titrate according to withdrawal symptoms.
D. Monitor the patient after he receives methadone.
E. All of the above
View Answer
1. Answer: E. When a patient not known to the service walks in with complaints of opiate withdrawal, it is important to make sure the patient is in fact having opiate withdrawal and not any other symptoms. Tolerance to opiates varies from one individual to the other, and the dose should be confirmed. If not, titrate the dose of methadone based on withdrawal symptoms and monitor the patient.
2. The number of suicides per 100,000 population per year in the United States is:
A. 100
B. 11
C. 21
D. 30
E. 1,000
View Answer
2. Answer: B. The number of suicides per 100,000 population per year in the United States is about 11. It is higher in the elderly (17 per 100,000 in the age group of 75+ years).
3. A 32-year-old female is brought to the ED by the EMS following a 911 call by her husband. He mentions to the ED physician that his wife delivered a healthy baby girl 3 weeks ago. She was sad and tearful and felt “gloomy” for the first few days after delivery. Over the past 2 weeks, however, she appears to be suspicious of visitors including her mother and sister who recently visited her. She has started “staring at the baby” and gets distressed. A urine toxicology screen is negative, and the patient has no past psychiatric history. She has no significant medical problems. When the ED physician asks her how she feels about the baby, she starts crying. What is the most important first step in the management of this patient?
A. Start the patient on antidepressant medication and discharge home.
B. Start the patient on antipsychotic medication and discharge home.
C. Give her clonazepam and discharge home.
D. Admit the patient immediately to the psychiatry inpatient unit.
E. The patient is just stressed; reassure and discharge her home.
View Answer
3. Answer: D. The history is suggestive of postpartum psychosis. The most important fist step in this situation is to safeguard the health of the mother and the baby. Ideally, she should be admitted to a mother-baby psychiatry unit that is specifically designed for postpartum depression and postpartum psychosis. The patient might require antipsychotics or other medicines depending on further assessment. Discharging a patient to home in this situation can be very dangerous.
4. Which of the following statements about suicide and gender is true?
A. Gunshots are the number one cause of death in suicide in both men and women.
B. Although women attempt suicide more often, men are four times more likely to complete suicide.
C. Women attempt suicide twice as often as men.
D. Most suicides are preventable.
E. All of the above
View Answer
4. Answer: E. A majority of suicides are preventable. The key is early recognition and treatment of mental illness, substance/alcohol abuse, and close follow-up.
5. All of the following statements about bipolar disorder and suicide are true except:
A. 25% to 50% of patients with bipolar disorder attempt suicide at least once
B. the suicide rate in the first year off lithium treatment is 20 times that during treatment
C. most bipolar patients who die by suicide do not communicate their suicidal state to others
D. lithium has shown to decrease the suicide behaviors associated with bipolar disorder
E. history of suicide attempt is a good predictor of a future suicide attempt
View Answer
5. Answer: C. Studies show that most bipolar patients who die by suicide actually communicate their suicidal thoughts/intent to others.
6. Alcohol is a factor in what percentage of suicides?
A. 10%
B. 30%
C. 50%
D. 5%
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