Psychiatric Emergencies

• Crises can happen anytime and it is important that

we recognize that these may lead to psychiatric
emergencies.

• It is important that psychiatric emergencies, like

any medical emergency, be handled properly and
immediately. Otherwise, complications such as
death or the onset of a disabling psychiatric illness
may result.

• Manifestations of these emergencies in a person

are usually overt that they can easily be
recognized.

• The psychiatric emergencies are identified through

a person's way of behaving, thinking and feeling.
Identifying a psychiatric
emergency
Panic Reactions

• These are characterized by extreme anxiety

and fear, often in response to realistic
situations such his as earthquakes, fires and
military encounters, discovery of serious
illness, death of a loved one, and others.
• However, it is possible that the cause of
anxiety which can lead to panic may not be
readily clear to the patient.
Panic reaction
• usually unable to describe his feelings
• he would appear to be experiencing an intense
sense of apprehension and fear
• he cannot stay in one position
• he oftentimes shows a terrified look and may point
to his chest because of pain, shortness of breath or
palpitations
• at times, he may show rapid shallow breathing or
hyperventilation
• at other times, he may point to his abdomen
because of severe stomachache, cramps, or
gurgling in his stomach
• he may point to his head because of dizziness, a
feeling of lightheadedness muddled and sometimes
confused thoughts
Acute Psychosis

• characterized by a sudden onset of

highly disturbed behavior which may
be agitated, aggressive and/or bizarre.
• A chemical imbalance in the brain
causes the state called psychosis.
• When the imbalance is triggered
suddenly by a stressful event or a
physical disturbance in the brain, the
state is called an acute psychosis.
 Acute Psychosis
1. Disturbances in behavior
•mainly characterized by a loss of
control over one's impulses.
 Disturbances in
behavior
• The patient is constantly on his
feet, restless, talkative and
unable to stop. He insists on
doing anything that he may
think of doing.
• He may suddenly run, laugh,
cry, insult, say vulgar words or
perform vulgar or bizarre acts
• He may wander around
aimlessly, not responding or
paying attention to those
around him.
• He may become even more
agitated, violent and
destructive when someone
tries to control him.
• His acts have neither reason
nor purpose.
 Acute Psychosis
2. Disturbances in thinking
•The patient is unable to organize his
thoughts.
•His ideas are unconnected and he gets
easily distracted.
 Disturbances in thinking
• He uses words he alone can understand.
• He may express false beliefs (delusions)
and be suspicious --- insisting that a plan
exists to kill him (paranoid delusion).
• He may say that he is the Son of God
bringing a special message to the world
(grandiose delusion).
• He may claim to hear voices not heard by
others telling him of a plot to kill him
(auditory hallucinations).
• He sees things which others do not see.
• He may or may not be able to tell the right
time or recognize a familiar place or
person.
• His memory may or may not be impaired.
• His suspiciousness and confusion may
lead to his inability to trust anyone,
including the health worker who attends to
him.
Acute Psychosis
3. Disturbances in mood and emotional
expression
•The emotions shown by the patient do not
correspond to what he says.
•He may be expressionless (blunt or flat affect)
while relating something very tragic or may laugh
or cry without cause.
•He may stare sharply at nothing in particular, or
blankly, seemingly out of touch with those around
him.
Acute psychosis due to GMC

• The following are symptoms in

addition to those previously
mentioned:
– Disorientation
– Disturbances in memory
– Definite signs of other medical
problems arising from the cause of the
disturbance in the brain
• Possible causes are:
– intoxication by alcohol or drugs;
– dehydration or states of fluid and electrolyte
imbalance as in severe acute diarrhea;
– complications of prolonged kidney or liver
diseases like uremia or hepatic coma states;
– brain infections, hemorrhage, anoxia, or
injury.

***It is important that these are recognized because they

are medical emergencies that need immediate attention.
 Self-harm or
Suicide
• The wish or action taken by the individual to
harm or destroy himself.
• For some individuals, these may lead to
depression of a serious degree that thoughts
of suicide occur.
• If there is any suspicion at all that a person is
capable of self-harm suicide precaution
 Self-harm or Suicide

• Alertness to preoccupation of self-harm may lead to early

detection of suicidal intent. More common situations include:
– Recent loss of a loved one, a possession, an opportunity
or reputation which the person cannot accept; and
feelings that one can no longer go on after these losses.
– Intense stress which causes tiredness, exhaustion and
long-standing fatigue leading to physical, mental and
emotional exhaustion.
– Feelings of being lost and unsure, unwanted, lonely alone.
– Feelings of futility and of wondering "What's the use?"
Management of Psychiatric
Emergencies
Acute Psychosis
1. Dealing with the patient
•Allow the patient to tell you in his own way how he feels and
thinks about himself and situations around him.
•During this time, try to be silent and listen, assuming a calm
and unhurried attitude.
– A person who is disturbed and confused responds positively to
questions that lead to such feelings.
– You may say, "Can you tell me more about these feelings?" Most
patients, no matter how disturbed they are, recognize a sincere
desire to understand them and may become more cooperative to
discuss their situations and feelings.
• Important goals are:
1. Establish empathy and rapport
2. Allow the patient to express himself in his own
way.
 This will be facilitated by the interviewer remaining silent
at the appropriate times, listening with interest and
interrupting only when necessary.
3. Stop the interviews if patient is too disturbed.
 If the patient is too disturbed, agitated, violent or
disoriented, stop the interview and bring him to a hospital

*** An antipsychotic medication can be given by the physician in

the form of injections to control his restlessness. If the patient is
not hospitalized, he will need to be given anti-psychotic
medications to be taken orally.
2. Dealing with the patient's family
•The family should be involved in treatment as soon
as possible.
•The family can help in:
– giving further information about the patient and his
illness
– controlling the patient
– decision-making about management (including
decision about hospitalization)
•If the patient is not hospitalized, the family's role
becomes crucial in making sure that the
medications prescribed to control the restlessness
and agitation are strictly complied with.
2. Dealing with the patient's family
•Emphasize to them that the illness, although
seemingly a response to identifiable crisis,
indicates a chemical imbalance in the brain that
can be restored through the use of medications.
•Be sure that at least one member is clearly
identified to give the medications, and knows
how to do so.
•Schedule regular follow-up appointments with
the patient.
– At least one family member should
accompany the patient.
3. Dealing with the community
•There may be a need to bring an acutely psychotic
patient to the hospital. A means of transportation
may have to be provided for by a member of the
community.
•Relatives should be asked to accompany the patient
so that he can be controlled.
•Mainly, however, the health worker has to educate
the community that acute psychosis is treatable, and
that the patient, having been sick, should not be
ridiculed, avoided, nor feared when he returns to the
community.
Self-harm/Suicidal Attempt
1. Dealing with the patient
•must try to establish rapport with the patient
•try to make the patient feel that he or she
accepts and understands that through this
suicidal act he (the patient) is expressing
some difficult feelings and is asking for help
•The patient can be encouraged to talk of his
intentions to commit suicide, the feeling he
finds difficult to deal with, or the thoughts he
cannot accept.
 Self-harm/Suicidal Attempt
1. Dealing with the patient
•When listening to the patient, try not to be
critical or disapproving of him.
•Refer the patient to a psychiatrist if he/she
is available or the physician in health center.
•Suicidal intent/attempt is associated with the
entire range of psychiatric disorders. The
opinion of the specialist is therefore crucial to
further management.