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Dr. Linny G.

M Liando, SpKJ
Definition
Any disturbance
in thoughts, feelings, or actions
for which
immediate therapeutic
intervention
is necessary
Treatment setting
General medical or psychiatry ER?
Staff and other personnel, setting ruangan
Children/young or adult?
Security (pts condition)
Evaluation (1)
Goal : sesegera mungkin melakukan penilaian pada
pasien sehingga dapat diberi tata laksana
Need modification
Triage : emergent, urgent, non-urgent (false
emergency)
Evaluation (2)
General strategy :
Self protection
Prevent harm : suicidal, homicidal, patient safety, self-
care
Organic or functional?
Psychotic?
Consider ORGANIC!!!
ACUTE onset (within hours or minutes, w/ prevailing
symp.)
FIRST episode
Geriatric AGE
Current medical illness or injury
Significant SUBSTANCE abuse
Non-auditory disturbances of perception
NEUROLOGICAL symptoms (loss of consciousness,
seizures, head injury, change in headache pattern,
change in vision)
Classic mental status signs (diminished alertness,
disorientation, memory impairment, impairment in
concentration and attention, dyscalculia, concreteness)
Other mental status signs (speech, movement, or gait
disorders)
Constructional apraxia (difficulties in drawing clock,
cube, intersecting pentagons)
Evaluation (3)
Physical Examination
Emergency Psychiatric Interview
Specific setting : psychosis, suicidal, violent, rape/
sexual abuse
Mental Status Examination
SUICIDAL RISK

Previous attempt or fantasized suicide


Anxiety, depression, exhaustion
Availability of means of suicide
Concern for effect of suicide on family members
Verbalized suicidal ideation
Preparation of a will, resignation after agitated depression
Proximal life crisis, such as mourning or impending surgery
Family history of suicide
Pervasive pessimism or hopelessness
Violent Behavior
Signs of impending violence
Very recent acts of violence, including property violence
Verbal or physical threats (menacing)
Carrying weapons or objects that may be used as weapons (forks, ashtrays)
Progressive psychomotor agitation
Alcohol or drug intoxication
Paranoid features in a psychotic patient
Command violent auditory hallucinations (may be high risk)
Organic mental disorders, global or with frontal lobe findings; less commonly with
temporal lobe findings (controversial)
Patients with catatonic excitement
Certain patients with mania
Certain patients with agitated depression
Personality disorder patients prone to rage, violence, or impulse dyscontrol
Assess the risk of violence
Consider violent ideation, wish, intention, plan, availability of means, implementation of
plan, wish for help.
Consider demographics : male, age 15-24, low socioeconomic status, no social supports
Consider past history: violence, nonviolent antisocial acts, impulse dyscontrol (e.g.,
gambling, substance abuse, suicide or self-injury, psychosis).
Consider overt stressors (e.g., marital conflict, real or symbolic loss).
DIAGNOSTIC AND TREATMENT
CONSIDERATION
Common Psychiatric emergency
Treatment
Max tranq, min sedation
!!! : overmedication, undermedication, premature
switching of the medication
Restraints
Disposition (in-, out-, extended observation