Transcript Adults – Differentiating Mental Health Urgencies and Emergencies

Differentiating mental health
urgencies and emergencies from
the ordinary pain of existence
Wilbur R. Dattilo MD
Assistant Clinical Professor
Department of Psychiatry
University of Utah
Life is suffering
• Everyone sometimes feels depressed, sad, lonely,
anxious, stressed out, bored, hopeless or any
other negative emotion you can imagine.
• Knowing that suffering IS normal can be helpful in
preventing us from “feeling bad about feeling
bad”
• A mentally “healthy” thing to do is to allow
ourselves to feel the way we are feeling and “lean
in” to hard emotions without trying to “get rid” of
them.
People are all different
• We all have a lot of different traits: Some of us
seem perfectly adapt to live in the world like it is
now, while others seems more adapt to a
different set of experiences.
• Some of us are “wired” to be more depressed,
anxious, neurotic, fat, thin, or like-alcohol more
than most.
• We could image a set of circumstances in which a
“negative” trait could actually help us survive.
• Nature doesn’t care if we are happy, only that
(some of us) survive and reproduce.
Getting Help
• Almost anyone could benefit from HELP
manage the stresses of life/ stop avoiding/ live
up to our potentials.
• All of us NEED help at some point in time.
• There are a lot of ways that people can get
help (family, community, church, service,
exercise, friends, and mental health
professionals)
When does someone need URGENT
help from a mental health
professional?
• Inability to work/love/ function in a relationship/ manage
responsibilities:
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Cant get out of bed
Cant take care of kids
Cant go to work
Cant maintain a job
Cant maintain a relationship
Frequent crying spells.
Cant leave the house.
Cant (do something else)
Cant stop drinking
• All Psychiatric Diagnoses require “Dysfunction”
When does someone need
EMERGENCY help?
• WHEN SOMEONE IS GOING TO GET (badly) HURT.
– Someone intends to or is planning to kill him or
herself.
– Someone intends to or is planning to kill someone else
– Someone is acting so recklessly that he or she or
someone else is going to get hurt.
– Someone so completely lacks the ability to care for
him or herself that he/she cannot act in a safe way
In a psychiatric emergency
• Act as if it is any other medical emergency:
– Take the person to any Emergency Room or to a
psychiatric hospital.
– Call the police or ambulance (911)
– Even if they don’t want help.
About Suicide
• Suicidal “ideation” can be passive or active.
– Passive = “I wish I was dead”
– Active = “I think I am going to kill myself”
• Everyone sometimes thinks about suicide
• Asking about suicide does not increase the chance that
it will happen
• When talking about suicide consider:
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Risk factors
Plan
Intent
Means
Suicide Risk Factors
• Some are static (there is nothing we can do about
them)
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Previous suicide attempt
Family history of suicide
Chronic pain, chronic medical condition, or recent loss
Older white men are demographically at the highest
risk of completing suicide
• Some can be modified
– Intoxication/ active substance abuse
– Access to a weapons (especially guns)
A few kids of psychiatric problems
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Depression
Bipolar disorder (mania)
Substance abuse problem
Psychosis (schizophrenia)
Personality Disorder (Borderline Personality
Disorder)
Depression
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Poor sleep
Lack of interest in activities
Excessive Guilt
Low Energy
Poor Concentration
Appetite changes
Psychomotor retardation
Suicidal ideation
Bipolar Mania
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High energy and excessive activity
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Overly good mood
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Irritability or impatience
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Fast, erratic talking
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Racing thoughts
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Inability to concentrate
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Little need for sleep
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Feelings of power
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Poor judgment
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Reckless spending
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High sex drive
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Alcohol or drug abuse
• Aggression
• Refusal to admit that there is a problem
Psychosis (schizophrenia)
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Delusions –
Hallucinations –
Grossly disorganized or catatonic behavior
Negative symptoms
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lack of emotion - the inability to enjoy acitivities as much as before
Low energy - the person sits around and sleeps much more than normal
lack of interest in life, low motivation
Affective flattening - a blank, blunted facial experession or less lively facial
movements or physical movements.
Alogia (difficulty or inability to speak)
Inappropriate social skills or lack of interest or ability to socialize with other
people
Inability to make friends or keep friends, or not caring to have friends
Social isolation - person spends most of the day alone or only with close family
Substance Use Disorder
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Taking the drug in larger amounts and for longer than intended
Wanting to cut down or quit but not being able to do it
Spending a lot of time obtaining the drug
Craving or a strong desire to use the drug
Repeatedly unable to carry out major obligations at work, school, or
home due to drug use
Continued use despite persistent or recurring social or
interpersonal problems caused or made worse by drug use
Stopping or reducing important social, occupational, or recreational
activities due to drug use
Recurrent use of drug in physically hazardous situations
Consistent use of drug despite acknowledgment of persistent or
recurrent physical or psychological difficulties from using opioids
Tolerance. Withdrawal
Personality Disorder (Borderline
Personality Disorder)
• Frantic efforts to avoid being abandoned by friends and family.
• Unstable personal relationships that alternate between idealization—“I’m
so in love!”—and devaluation—“I hate her.”
• Distorted and unstable self-image, which affects moods, values, opinions,
goals and relationships.
• Impulsive behaviors that can have dangerous outcomes, such as excessive
spending, unsafe sex, substance abuse or reckless driving.
• Suicidal and self-harming behavior.
• Periods of intense depressed mood, irritability or anxiety lasting a few
hours to a few days.
• Chronic feelings of boredom or emptiness.
• Inappropriate, intense or uncontrollable anger—often followed by shame
and guilt.
• Dissociative feelings
• Severe cases of stress can also lead to brief psychotic episodes.