psychiatric emergency, gnm psychiatric emergency

1. Psychiatric emergency
Psychiatricemergencyisaconditionwhereinthe patienthasdisturbancesof thought,affectand
psychomotoractivityleadingtoa threatto his existence (suicide),orthreattothe people inthe
environment(homicide).This conditionneeds immediateinterventiontosafeguardthe life of
the patient,bringdownthe anxietyof the family membersandenhance emotional securityto
othersinthe environment.
COMMONPSYCHIATRIC EMERGENCIES
1. Suicidal threat
2. Violentoraggressive behaviororexcitement
3. Panicattacks
4. Catatonicstupor
5. Hysterical attacks
6. Transientsituational disturbances
SUICIDAL THREAT
In psychiatryasuicidal attemptisconsideredto
be one ofthe commonestemergencies.
Definition
Suicide isatype of deliberateself-harmandis
definedasanintentionalhumanactof killing
oneself.
Etiology
1. Psychiatric Disorders
a. Major depression
b. Schizophrenia
c. Drug or alcohol abuse
d. Dementia

2. e. Delirium
f. Personalitydisorder
2. PhysicalDisorders
• Patientswithincurable orpainfulphysical
disorderslike,cancerandAIDS.
3. Psychosocial Factors
a. Failure inexamination
b. Dowrydifficulties
c. Marital difficulties
d. Loss oflovedobject
e. Isolationandalienationfromsocial groups
f. Financial andoccupational difficulties
Risk Factors for Suicide
• Age
• malesabove 40yearsof age
• femalesabove 55yearsof age
• Sex
• menhave greaterriskofcompletedsuicide.
• suicide is3 timesmore commoninmenbthaninwomen.
womenhave higherrate of attempted suicide
• Beingunmarried,divorced,widowedor separated
• Havinga definite suicidalplan
• Historyof previoussuicidal attempts
• Recentlosses
Suicidal TendencyinPsychiatricWards
Certainpsychiatricdisorderswhere the patient maydevelopsuicidal tendenciesinclude:
• Major depression:Thisisone ofthecommonest conditionsassociatedwithahighriskof
suicide.Suicideinamajordepressive episode isdue topervasiveandpersistentsadness;

3. pessimisticcognitionsconcerningthe past, presentandfuture; delusionsof guilt,help-
lessness,hopelessnessandworthlessness; andderogatoryvoicesurginghimtotake his
life.The riskofsuicide ismore whenthe acute phase haspassedandthe characteristic
psychomotorretardationhasimproved.This issobecause the patienthasmore energyto
carry out hissuicidal plansnow,thoughhe mighthave beenharboringthemforquite some
time.
• Schizophrenia:The majorriskfactorsamong schizophrenicsinclude the presence of
associateddepression,youngage andhigh levelsof premorbidfunctioning(especially
duringcollege education).People inthisrisk grouparemore likelytorealizethedevastating
significance of theirillnessmore thanother groupsof schizophrenicpatientsdo,andsee
suicide asa reasonable alternative.
• Mania: Manic patientsmayoccasionally commitsuicide.Thisisusuallythe resultof
grandiose ideation:the patientmaybelieve thathe isa greatperson,or wishtoprove his
supernatural powers.Withthisintentinmind, he maycarry outsome dangerousactivitythat
can cost himhislife.
• Drug or alcoholabuse:Suicideamongalcoholics canbe due to depressioninthe withdrawal
phase.Also,the lossof friendsandfamily, self-respect,status,andageneral realization ofthe havoc
alcohol hascreatedin hislife can cause the individual towishtodie.
• Personalitydisorder: Individualswithhistrionicandborderline traitsmayoccasionally
attemptsuicide.
• Organicconditions:Conditionssuchas deliriumanddementiadue tochangesof
moodlike anxietyanddepressionmayalso induce suicidaltendency.
Management
1. Beaware of certainsignswhichmayindicate thatthe individual maycommitsuicide,such
as:
i. suicidal threat
ii. writingfarewell letters
iii. givingawaytreasured articles

4. iv. makinga will
v. closingbankaccounts
vi. appearingpeaceful andhappyafter periodof depression
vii. refusingtoeator drink,maintainpersonal hygiene.
2. Monitoringthe patient'ssafetyneeds:
• take all suicidal threatsorattempts seriouslyandnotifypsychiatrist
• searchfor toxicagentssuchas drugs/ alcohol
• donot leave the drugtray withinreachof the patient,make sure thatthe daily
medicationisswallowed
• remove sharpinstrumentssuchasrazor blades,knives,glassbottlesfromhis
environment.
• remove strapsandclothingsuchas belts, neckties
• donot allowthe patienttobolthisdoor on the inside,make sure thatsomebody
accompanieshimtothe bathroom
• patientshouldbe keptinconstant observationandshouldneverbe leftalone
• have goodvigilance especiallyduring morninghours
• spendtimewithhim,talktohim, andallow himtoventilate hisfeelings
• encourage himtotalkabout hissuicidal plansImethods
• if suicidal tendenciesare verysevere, sedationshouldbe givenasprescribed
3. Encourage verbal communicationofsuicidal ideasaswell ashis/herfearanddepressive
thoughts.A 'no suicidal'pactmay be signed, whichisa writtenagreementbetweenthe
clientandthe nurse,that clientwill notacton suicidal impulses,butwill approachthe nurse
to talkabout them.
4. Enhance self-esteemofthe patientbyfocusing onhisstrengthsratherthanweaknesses.His
positive qualitiesshouldbe emphasizedwith realisticpraise andappreciation.Thisfosters
a sense of self-worthandenableshimtotake control of hislife situation.