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1. Distinguish between the symptoms from each major mental health disorder.
2. Select effective interventions for each symptom, including medication and physical interventions.
3. Analyze solutions to work effectively during a variety of psychiatric emergencies.
4. Choose a protocol/procedure to manage agitated and assaultive patients.
5. Design education/training for your unit to more effectively intervene during psychiatric emergencies.
6. Plan for safety, and the most therapeutic outcome, for your patient during a psychiatric emergency.
7. Assess the effects of trending issues in our communities, including: the opioid epidemic, increased suicide rates, utilization of ED and med-surg beds for psych patients, and the latest applicable legal risks.

Psychopharmacology Updates: Know Your Patient's Medications

• Choose antipsychotics, antidepressants, antianxiety (Benzodiazepines), sedatives, mood regulators
• Anticipate and treat side effects
• Contraindications
• Design medication protocols for different disorders
• Solve legal implications related to psychopharmacology

Keep Your Patients and Your License Safe: Tips to Decrease Risk

• Medication - voluntary vs. involuntary
• Physician orders and unit protocols
• Seclusion and/or restraints
• Commitment
• Licensed and unlicensed staff: Utilization, training, comfort
• Specific training for seclusion/restraint and suicide prevention
• Screening and searching of patients and visitors
• Decreasing liability through charting, staffing & supervision

Trending Issues: Your Changing Responsibilities

• Opioid Epidemic
  • Intoxication vs. withdrawal
  • Drug seeking
  • Narcotic and benzodiazepine antagonists
• Increase of Suicides
  • Approved assessment tools
  • Interventions including safety plans
  • Prevention utilizing 1:1 supervision
• A BH/Psychiatric Bed is Not Available
  • Commitment process
  • Standards against jailing psychiatric patients
  • Scarcity of psychiatric beds

New Skills to Address Your Patient's Acute Psychiatric Symptoms

• Scenario 1 - The patient is suspicious, resistant to treatment, fluctuates between anger and fearfulness
  • Determine whether delusions or hallucinations are influencing thoughts and response to staff
  • Distinguish between intoxication, mental illness or organic impairment
  • Try out effective use of simple directions, presenting reality and giving choices
  • Choose intervention and/or medication based on presenting symptoms
  • Decide when/if restraints or seclusion become necessary
• Scenario 2 - The patient is hyperactive, impulsive, hypersexual or assaultive, becomes angry about staff intervention, refuses meds, is not eating or sleeping
  • Distinguish behaviors due to mania, delirium, intoxication, or organic impairment
  • Modify environment and decrease stimulation to increase safety and decrease behavior
• Scenario 3 - Patient is anxious to a panic level, fight or flight behaviors, manifesting high blood pressure, pulse, sweating, and increased respirations
  • Distinguish behaviors due to anxiety disorder, delirium, dementia, or intoxication/withdrawal
  • Modify environment, decrease stimulation, 1:1 supervision, toxicology/drug and other lab screens
  • Keep verbal to minimum but explain procedures, give choices and observe/supervise
  • Choose appropriate medication
  • Decide if/when restraints and or seclusion necessary
• Scenario 4 - Patient fluctuates between calm, manipulative, passive behavior and demanding, angry, physically threatening (drug seeking)
  • Assess for personality disorder such as antisocial personality, borderline personality or narcissistic
  • Set and keep limits
  • Assign same staff and keep consistency between staff and shifts
  • Avoid medication but increase personnel or security

Susan D. Rich, MD, MPH, is an adult and child/adolescent psychiatrist specializing in diagnosis and treatment of patients with neuropsychiatric and trauma histories. As a clinician in private practice in a home office since 2006, Dr. Rich has learned to rapidly assess emergency psychiatric situations, de-escalate patients who are emotionally dysregulated, and intervene in heated disputes between family members and patients. She earned a Doctorate of Medicine from the University of North Carolina, completed residency training in psychiatry at Georgetown University Medical Center, and a 2-year child/adolescent psychiatry fellowship at Children’s National Medical Center. Additionally, Susan is founder of a nonprofit, author of several journal articles, a book, and a blog as well as being an international speaker at professional psychiatric conferences and medical center grand rounds.

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CE Information Coming Soon
Continuing education credit information is coming soon for this non-interactive self-study package.

CEs may be available for select professions, as listed in the target audience. Hours will be dependent on the actual recording time. Please check with your state licensing board or organization for specific requirements.

There may be an additional fee for CE certificates. Please contact our Customer Service at 1-800-844-8260 for more details.

**Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of mental health professionals. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your professions standards.

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners. For speaker disclosures, please see the faculty biography.

• Nurses
• Nurse Practitioners
• Case Managers
• Psychologists
• Security Officers
• Risk Management
• Legal Nurse Consultants