PSYCHIATRIC EMERGENCIES

A psychiatric emergency is any disturbance in

thoughts, feelings, or actions for which
immediate therapeutic intervention is
.necessary
Nonspecialists are often the first care
providers, but whenever possible, such cases
.should be evaluated by a psychiatrist
EPIDEMIOLOGY
:In psychiatric emergency room
.are suicidal 20%-
.are violent 10%-
.Most common diagnoses are mood disorders-
AGITATION
PSYCHOMOTOR RESTLESSNESS IS
CALLED AGITATION

Agitation is a common presentation in

. psychiatric emergency room
Aggressive, violent patients are often psychotic
and have diagnoses such as schizophrenia,
delusional disorder, delirium, acute mania,
and dementia. Such behavior can also result
from intoxication with alcohol or other
.substances
:The best predictors of violent behavior are
.Excessive alcohol intake-
.History of aggressive behavior-
.History of childhood abuse-
GENERAL GUIDELINES IN ASSESSING
AGGRESSIVE PATIENT
.Ask for help
Ensure sufficient number of staff members
Remain calm -
Avoid confrontation- -
Keep good distance from patient and avoid -
.touching him/her
.Try to distract him/her-
Reassure the patient (e.g. you are safe here ..-
(.We will help you
.
MANAGEMENT
Ensure patients’/others’ safety

Do no harm to the patient

Rapid tranquilize
Physically restraint
 RAPID TRANQUILIZATION
.A
Give I/M Lorazepam 2mg + haloperidol 5mg
Give together in same syringe
Repeat hourly till patient is calm

.B
I/V diazepam 10mg given slowly is another
alternative
Repeat hourly up to 30mg
PHYSICAL RESTRAINTS
Restraints are used to prevent
clear, imminent harm to the patient or others-
the patient's treatment from being-
; significantly disrupted
damage to physical surroundings; and to-
. decrease sensory overstimulation

Contraindications include use in patients with

extremely unstable physical and mental
.conditions
FEATURES THAT POINT TO A MEDICAL
CAUSE OF AGITATION
.Acute onset-
.First episode-
.Geriatric age-
.Current medical illness or injury-
.Substance abuse-
.Nonauditory hallucinations-
.Neurological symptoms-
Cognitive dysfunction-
INVESTIGATIONS
.CBC, Electrolytes-
Renal function test, liver function test, and -
.thyroid function test
.Toxicology screening-
.EEG-
In case of fever, urine and blood culture (and-
(.possibly CSF culture
.Radiological tests-
Other tests should be done based on-
presentation, history given and physical
. examination
RAPE AND SEXUAL ABUSE
Rape is a life threatening experience in which
the victim has almost always been
threatened with physical harm, often with a
.weapon

In addition of rape, other forms of sexual abuse

include genital manipulation with foreign
objects, infliction of pain and forced sexual
. activity
Typical reactions to both rape and sexual
abuse victims include shame, humiliation,
.anxiety, confusion, and outrage
Many victims wonder whether they are
responsible, and somehow invited the
.assault
Clinicians should be reassuring, supportive and
.nonjudgmental

Female victim almost always prefers female

.doctor
 SUICIDE
Suicidal behavior/ideation is a common psychiatric
emergency. It usually requires detailed assessment
by specialized physician. Assessment usually include
.emotional validation and reassurance

Patients presenting with suicidal gestures usually get

admitted to psychiatric hospital. They are put under
.close observation for few days

.Will be discussed during teaching OSCE session