Psychiatric Emergencies Dr. Khalid

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/herReassure 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 othersthe 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 symptomsCognitive dysfunction-

INVESTIGATIONS .CBC, ElectrolytesRenal function test, liver function test, and .thyroid function test .Toxicology screening.EEGIn case of fever, urine and blood culture (and(.possibly CSF culture .Radiological testsOther tests should be done based onpresentation, 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