Download PSYCHIATRIC EMERGENCY

PSYCHIATRIC
EMERGENCY
PSYCHIATRIC
EMERGENCY
Conditions need immediate interventions
&any
Delay increase risk for patients and others
 One of the most Pitfall in Psychiatric
Emergency is NEGLECT &IGNORE of
ORGANIC CAUSALITY in Emotional
Disorders

PSYCHIATRIC




EMERGENCY
SUICIDE & HOMICIDE
AGGRESSION & VIOLENCE
CATATONIA
NMS (Neuroleptic Malignant Syndrome)
PSYCHIATRIC
EMERGENCY
Prevalence:
%20 of referrals; Suicidal
%10 of referrals; Aggressive or Violency Behavior
%40 of ALL Referrals need Hospitalization
 Male= Female
 Single> Married
 Often Night Time

PSYCHIATRIC
EMERGENCY
Clinical Evaluation:
FIRST : Emergency Interventions
THEN: Diagnosis & Treatment of Major
Disease

SUICIDE




Suicidal Thought
Suicidal Threat
Suicidal Attempt: F >M
Committed Suicide: M>F
SUICIDE
Psychiatric Disorder:
MDD, Dysthymia, BMD
Schizophrenia,Schizophreniform,Brief
Psychotic Disorder
PTSD,OCD,GAD
Personality Disorders

SUICIDE
Medical Problems:
CNS Disease (Epilepsy, MS, AIDS,
Dementia, Hantington)
Endocrine (Cushing Disease, Anorexia
Nervosa, Kleinfelter)
GI (Peptic Ulcer, Cirrhosis)

Immobility , Disfigurement , Persistent
Chronic Pain
SUICIDE
ETIOLOGY
 Biologic
Serotonergic Hypofunction, Platlet MAO decrease
,Genetic
 Psychologic
Hoplessness, Depression, Impulsivity, Aggressivity
 Social
Family Discord ,Divorce, Single, Lack of Support
SUICIDE
HIGH RISK SUICIDE:
 Male
 >45 Yrs old
 Single & Divorce
 Unemployment
 Unstable Family & Interpersonal
Relationship
 Severe Depression, Psychosis, Personality
Disorder, Substance Use (Alcohol)
SUICIDE
HIGH RISK SUICIDE
 Hopelessness
 Prolonged & Severe Suicidal Thought
 HX of Several Attempts, with Plan, Low
Rescue, Use of Fatal Methods
SUICIDE

TREATMENT OF SUICIDAL PATIENTS:
AGGRESSION
& VIOLENCE
AGGRESSION
 Goal directed Behavior (verbal or
nonverbal) for Hurt
VIOLENCE
 Severe & Sudden Goal directed Behavior
to Destruction of property OR Hurt OR Kill
others
AGGRESSION & VIOLENCE




BMD
Schizophrenia, Schizophreniform, Brief
Psychotic Disorder
MDD
Personality Disorders
AGGRESSION & VIOLENCE
RISK EVALUATION:
 Demographic Characteristics:Male ,15-24
Yrs, Low SES &Social Support
 Evaluation of Thought, Attempt, Plan for
Violence, Weapons Availability
 Past HX of: Violence, Antisocial Behaviors
,Impulse Control Disorder (Substance,….)
 HX of Major Stressor: Loss, Family
Discord…
AGGRESSION & VIOLENCE
Impending Violence:
 Verbal or Physical Threatening
 Progressive Restlessness
 Weapons Carrier
 Substance or Alcohol Abuser
 Excited Catatonia
 Paranoid (Psychosis)
 Personality Disorder
AGGRESSION & VIOLENCE

TREATMENT ALGORYTHM:
CATATONIA

TREATMENT ALGORYTHM
NOROLEPTIC MALIGNANT
SYNDROM(NMS)







Fatal Complication due to Antipsychotics
Abrupt Discontinuation Levodopa in
Parkinsonism
Anytime in Treatment Course
Prevalence:%/02- 2.4
Mortality Rate:%10-20
Male>Female
Young>Geriatrics
NOROLEPTIC MALIGNANT
SYNDROM(NMS)
Major Symptoms:
 Muscle Rigidity
 Increase in Body Temperature
AND 2 Symptoms of:
Diaphoresis/ Tremor/ Dysphagia/ Mutism/
Urinary
Incontinency/Tachycardia/Alteration in
Consciousness level/Leucocytosis/HTN/
Muscle Injury (CPK)
NEUOROLEPTIC MALIGNANT
SYNDROM(NMS)
Treatment (Conservative)
 FIRST: Discontinuation of AP
 Decrease Body Temperature
 Monitoring of Vital Signs, Hydratation,
Electrolyte, I/O
 Muscle Relaxant
(Bromocriptine,Amantadine, Dantrolene)
FOR 5-10 DAYS
NEUOROLEPTIC MALIGNANT
SYNDROM(NMS)
Prevention
 Use of AP in Appropriate Indications
 Use of AP in Minimum Effective Dose
 Use of AP with Cholinergic Properties