Psychiatric Emergencies

Dr. Adel Ahmed Alzayed Kuwait university – Medical college Department of Psychiatry

 

    To

be able to describe the common types and causes of psychiatric emergencies. be able to describe acute management of common psychiatric emergencies.

 To


     History

 Collateral


◦ Is it a chronic problem? Crisis ? Why now? are the expectations?

General assessment

  Physical


◦ Uncooperative agitated inappropriate patients tend to aggravate staff and lead to inadequate medical care and not be examined properly.

General assessment

   Mental

state examination - Laboratory – screens- Imaging


General assessment

  Aims ◦ Engagement ◦ Assess future risk ◦ Identify risk factors for harm (especially modifiable maintaining factors ) ◦ Create management plan ◦ Understand the patients wish to die ◦ Diagnose psychiatric disorder if present

Assessment of the suicidal

   S ­ Sex  A ­ Age

 D­ Depression

 P ­ Psychiatric care

 E ­ Excessive drug use  S ­ Single

 R ­ Rational thinking absent  O ­ Organized attempt

 N ­ No supports (isolated)  S ­ States future intent

Risk factors for suicide


just psychiatric disorders (although commonest cause). “non-psychiatric” causes



full medical/psychiatric work up


dose benzodiazepines/ECT


   Agitation

is excessive motor or verbal activity. examples include:

 Common

◦ ◦ ◦ ◦ ◦

hyperactivity verbal abuse threatening gestures and language physical destructiveness vocal outbursts


 Commonest


psychiatric disorders that present with

◦ psychotic disorders (schizophrenia, mania, paranoid states,+/-hallucinations), ◦ drug abuse ◦ alcohol abuse

 Of

violent people with schizophrenia 71% are substance abusers (12 times risk violence). brain syndromes (7-28%)

 Organic

Violent Patient


safety of patient and staff.


determine if ideation or behavior stems from specific psychiatric illness. third parties of a serious threat of harm is present.



draw an effective and appropriate treatment plan.

Violent Patient


potential weapons e.g. keys, chairs.


other patients to safe place. patient in quiet setting, reduce stimulation.



- nonjudgmental, calm, helpful, slow, predictable. Speak softly, never turn back reassurance and support allow ventilation


Non pharmacological intervention

Preferred Verbal intervention Voluntary medication Show of force Emergency medication Offer food beverage or other assistance Alternate Restraints – physical , locked seclusion

Intervention for imminent violence

  Classical


 Novel

◦ Haloperidol(5-10mgs) ◦ ◦ ◦ Risperidone ◦ Olanzapine ◦ Quetiapine

 

 Benzodiazapines

◦ Lorazepam(1-4 mgs)

Oral options

 Haloperidol

(5-10 mgs) Accuphase


◦ Reduces injection frequency but it has a delayed onset of action 3-4 hours, effects last 2-3 days, including sedation, EPS


2-4 mgs


I.M. options

Flow chart for rapid tranquillisation of acutely disturbed patient

Atakan, Z. et al. BMJ 1997;314:1740


◦ ◦ ◦ ◦

consciousness alertness, awareness, sustain or shift attention.


Cognition - poor memory due to inattention and registration, thought disorganized, perceptual distortions, mood liability, fail recognize people Fluctuations, temporal course worse night , onset sudden

 


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