Sunday, May 26, 2019 • 10:15 - 11:45
Track 5 - Psychiatry: Are Your Risk Assessments Borderline? Take it Easy!
Track Chair: Dr. Michael Howlett
Room: 109

Suicide Risk Assessment - Dr. Claude Botha

Description: The presentation gives a practical approach to the assessment, from a psychiatrist’s point of view, of the suicidal patients presenting in the Emergency Room.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Distinguish between self-harm and suicide behavior.
  2. Distinguish between para-suicide behavior and completed suicide behavior.
  3. Distinguish between suicidal ideation and suicide behavior with intent.

Pearls

  1. Deliberate self-harm are not synonymise with suicide behavior.
  2. ER physicians seldom see suicide completers (normally 92% at 1st or 8% at 2nd attempt), which are seen by the coroner. They are mostly, male pensioners, living alone.
  3. Suicide desire alone is insufficient to lead to a serious suicide attempt, fearlessness to die by suicide and the practical acquisition of means to do so is also needed.

Claude completed his undergraduate training at the University of Pretoria, South Africa and his specialist psychiatric training in London, UK. He then perused a postgraduate research degree in neuroscience at QMUL, UK focusing on the psycho-autonomic components of visceral pain regulation. Since then he has been working in the field of consultation liaison and emergency psychiatrist for the past decade.

Medical Clearance of the Mental Health Patient - Dr. Tracy Meyer

Description: Medical clearance can be performed quickly and safely. These patients can have a range of comorbid conditions and/or intoxications. Differentiating between an organic and a psychiatric cause can be challenging, and it’s easy to rely on laboratory tests. These tests can be time consuming, invasive to the patient and often misleading.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Know how to develop a safe and efficient protocol for medical clearance.
  2. Know when is it appropriate for a patient to be evaluated by the psychiatric team.
  3. Know when investigations are necessary in the medical clearance of the mental health patient.

Pearls

  1. Any protocol for medical clearance should be developed collaboratively with the Mental Health Department.
  2. Differentiating between a psychiatric cause and an organic cause can be complicated, however. Much of the evaluation is based on the physical exam.
  3. Many patients presenting for mental health assessment have some level of intoxication. Their blood alcohol level can give you misleading information. The Hack’s Impairment index is a tool that can help determine when an intoxicated patient is ready to be evaluated by the mental health team.

Dr. Tracy Meyer, MD FRCPC is an Emergency Physician in Saint John. She has an interest in marginalized populations and addiction medicine with a mixed practice of Emergency Medicine and a clinic for Opioid Use Disorder. She works with the psychiatry department for improved collaboration with the Emergency Department and is an advocate for harm reduction in New Brunswick.

Borderline Personality Disorder - Dr. Claude Botha

Description: The presentation gives a practical approach to improve efficacy in interacting, from a psychiatrist’s point of view, with the borderline personality disordered patient presenting in the Emergency Room.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Increase knowledge and understanding about borderline personality disordered as a condition.
  2. Look at a practical psychological approach in engaging with BPD patient in crisis.
  3. Improve understanding of the unconscious defence mechanisms and reciprocal roles negatively affecting ER interactions.

Pearls

  1. BPD patients frequently use the ER when in crises.
  2. ER physicians find the diagnosis and treatment of BPD patients challenging, with the eventual increase in stigma and development of a negative approach with poor outcomes.
  3. With increased personal awareness of transference, projection and reciprocal relationships, a ER physician could reduce splitting in the ER team, and improve a therapeutic corrective experience.

Claude completed his undergraduate training at the University of Pretoria, South Africa and his specialist psychiatric training in London, UK. He then perused a postgraduate research degree in neuroscience at QMUL, UK focusing on the psycho-autonomic components of visceral pain regulation. Since then he has been working in the field of consultation liaison and emergency psychiatrist for the past decade.