Psychiatric EmErgEnciEs By Dr. Ahmed Albehairy, M.DConsultant Psychiatry, MOH
Definition:A Psychiatric emergency isa disturbance in thoughts, feelings,or actions that requireimmediate treatment .
Item to be discussed- Set and situation of intervention.- Categories and clinical pictures.- Management ( assessment in psychiatric and non psychiatric wards, investigations, treatment )
Sets and situations of intervention. Disasters. survivors.
Disaster intervention- Coordination.- Protection and human rights standards.- Human resources.- Community mobilization and support.- Health services.- Education.- Disseminated information.- Food security and nutrition.- Shelter and site planning.- Water and sanitation.
Emotional response to disaster• Impact phase. numbness.• Crisis phase: denial and intrusive symptoms with hyper arousal. somatic symptoms (e.g., fatigue, dizziness, headaches, nausea) as well as anger, irritability, apathy, and social withdrawal. Individuals may be angry with caregivers who fail to solve problems or who are unable• Resolution phase: Grief, guilt, and depression are often prominent during the first year as individuals continue to cope with• Reconstruction phase: During this phase, reappraisal, assignment of meaning, and the integration of the event into a new self-concept
Potential outcomes of traumatic events• Severe persistent problematic symptoms - Marked depression, marked hyperarrousal, Intrusive reexperiencing.• ASD,PTSD.• Dissociative symptoms.• Exacerbation and reoccurrence of psychiatric disorders.• Substance abuse.• Aggression.• Grief.• In children, aggression, risk taking, sexual acting out.
Risk factors for ASD and PTSD• Persons who lost a loved one• Individuals who experienced an injury• Persons who witnessed horrendous images• Persons who had dissociation at the time of the event• Those who experience serious depressive symptoms within a week and lasting for a month or more• Individuals with numbness, depersonalization, sense of reliving the trauma, and motor restlessness after the event• Those with preexisting psychiatric problems• Persons with prior trauma
Basic Principles of Intervention After Emotional Trauma• Reduce stress., safe environment, Promote contact with loved ones .• Support self-esteem. to understand that their reaction to the trauma is a normal reaction.• Help the person to focus on immediate needs, such as rest, food, shelter, social supports, or sense of community• Promote coping mechanisms.• Help individuals to reframe any destructive cognitions, such as he or she acted terribly and is a terrible person or is• Administer medication (eg, propranolol, alpha-agonists, benzodiazepines, nonactivating selective serotonin reuptake• inhibitors [SSRIs]), if needed, to decrease arousal.• Avoid increasing stress.• Avoid prompting discussion of issues that cannot be resolved.• Avoid abreaction in groups .
Therapeutic intervention in disasterDebriefing:• (1) introduction (purpose of the session),• (2) describing the traumatic event,• (3) appraisal of the event,• (4) exploring the participants emotional reactions during and after the event,• (5) discussion of the normal nature of symptoms after traumatic events,• (6) outlining ways of dealing with further consequences of the event, and (7) discussion of the session and practical conclusions.
CBT IN Disaster• Seeing that people are concerned about them.• Learning about the range of normal responses to trauma and hearing that their emotional reactions are normal responses to an abnormal event (rather than a sign of weakness or pathology).• Being reminded to take care of concrete needs (eg, food, fluids, rest).• Cognitive restructuring (changing destructive schema, such as "having fun is a betrayal of the injured," "the world is totally unsafe," "I am responsible for the disaster," or "life is without meaning," to more constructive ones).• Learning relaxation techniques.• Undergoing exposure to avoided situations either via guided imagery and imagination or in vivo
Medications in disaster• Propranolol (as well as clonidine) may limit hyperarousal.• atypical neuroleptic.• mood stabilizer .• Diphenhydramine and other medications may be helpful for sleep.• Benzodiazepines may limit hyperarousal and foster sleep follow-up treatment is in short supply.• SSRIs .