PSYCHOBEHAVIORAL DISORDERS■ Schizophreniform disorder: Symptoms present for <6 months.
■ Schizoid personality disorder: Voluntary social withdrawal with no signs
of psychosis
■ Schizotypal personality disorder: Odd, magical thinking with no signs of
psychosis
DIAGNOSIS/TREATMENT
See above.
COMPLICATIONS
■ Ten percent risk of suicide(there is an increased risk for those with
recent hospital discharge or in the postpsychotic period)
■ Forty percent risk of concurrent substance abuse
■ Long-term use of antipsychotics can cause extrapyramidal symptoms, dys-
tonia. Decrease doses and administer diphenhdyramine, benztropine.
■ Tardive dyskinesia (TD) may also be seen with use of antipsychotics. Con-
sider switching to atypical antipsychotics (which have lower incidences of
TD when compared to typical antipsychotics).
■ Watch out for neuroleptic malignant syndrome (NMS). (See “Neuroleptic
Malignant Syndrome.”)
A 45-year-old Caucasian man with a history of diabetes and coronary
artery disease presents to the ED with suicidal ideation. He is married with
two children, has no personal history of mental illness but has a sister with
a depression and previous suicide attempts. He reports that he lost his job
recently and is feeling hopeless that he’ll be able to provide for his family. What is
his risk for suicidality?
High! (He has 7 of 11 risk factors.)Major Depression and Suicide
Affects about 10–25% of womenand 5–12% of men. Lifetime risk of suicide
is 15%.
RISKFACTORS FORSUICIDE
■ Age (adolescent and elderly)
■ Male gender
■ Poor physical health
■ History of mental illness
■ Caucasian
■ Feeling of hopelessness, helplessness
■ Isolation
■ Unemployment or stressful work situation
■ Poor financial situation
■ Previous suicide attempt
■ Family history of completed or attempted suicide