rgb said:
I'm a writer currently writing a novel that partly centers around the Crisis Triage Unit of a psychiatric hospital. While artistic license is a given, I would also like to be as accurate as possible.
I'm interested to know:
1. When and how a PET responds to a psychiatric emergency.
A pet...as in a cat or bird? You capitalized PET, which makes me think of Positron Emission Tomography (PET), which is a type of brain scan. Is that what you meant?
I've seen on television how pets sometimes take the moods of their owners, becoming dysphoric or less active when the owner is depressed, for example. Some patients of mine have said how their dog or cat has seemed to give them more love when they're crying or seemingly upset.
PETs, however, respond in a completely different manner. In one study, 5-HT1A receptors were decreased by about a third in panic disordered patients, some of whom were depressed. Most of the receptors were decreased in the anterior and posterior cingulate, and raphe nucleus.
I have a feeling you were talking about birds, cats, and dogs, though.
2. The basic procedures for involuntary admittance to a crisis unit.
In NY:
1. Interview the patient. Find that patient to be a danger to self, danger to others, or gravely disabled (unable to care for self).
Assuming the patient doesn't sign in voluntarily, the physician will complete a 9.39 form from the ER called "Involuntary Application for admission." The form has a front and back which must be completed by the psychiatrist detailing the presenting problem, psychiatric and/or medical findings, and reason for involuntary admission. A copy of a form called "status and rights" is given to the patient, detailing their rights as an involuntarily committed patient.
Depending on the circumstance, there is also a 2-PC form (2 Physician Certificate) which allows two doctors (with a third applicant doctor) to involuntarliy commit someone as well. From the ER, however, a 9.39 is performed.
3. The steps a doctor goes through when first examining a potentially dangerous and/or hostile patient.
Depending on the acuity of the situation, the doctor will observe, then attempt to interview the patient. Often this is done with security close by, in case the patient becomes violent. If this does occur, the patient is usually placed in restraints and medicated with an IM injection.
If the patient is calm enough to be interviewed, the psychiatrist will perform a standard yet focused psychiatric interview, focusing on the immediate cause of the patient's anger, paying special attention to any medical causes that may be contributing to the patient's agitated state. Many medical problems can masquerade as agitation. For this reason, the ER will attempt to draw blood, get a drug uring screen, a fingerstick glucose and other measures helpful in making a diagnosis.
Details on the psychiatric interview can be found by doing a quick google search.
Here is a basic article from a psychiatry journal/magazine to get you started.
4. The role of a psychiatric nurse, including limitations of that role.
The psychiatric nurse, depending on the setting, may obtain blood samples, assist in restraining the patient, or administer medication. They do not conduct the psychiatric interview or make clinical decisions in most cases.
They will record their observations of the patient for the doctor to review, when considering the discontinuation of restraints, watch for adverse medication effects and relay their findings to the doctor, who will remedy the complications, if they arise.
I'd also like to know if there's a specific drug that can imediately cause someone to act irrationally and possibly violent.
There are quite a few, including those in the steroidal class (prednisone, cortisone), amphetamines and amphetamine like drugs (Ritalin, Cylert, Dexadrine, Adderal and other amphetamine salts), and illegal drugs such as PCP and cocaine to name a few. Alcohol of course is another common culprit.
