FOR BSC. NURSING 3RD YR.AND GNM 2ND YR.

1. VIDYAKIRANA COLLEGE OF
NURSING BANGLORE
SUB- MENTAL HEALTH NURSING
TOPIC- PSYCHIATRIC EMERGENCIES
PRESENTED BY- MRS. SULEKHA DESHMUKH

2. Psychiatric emergency

3. Introduction
• Psychiatric emergency is an acute disturbance of behavior,
thought or mood of a patient, which if untreated may lead
to harm, either to the individual or to other in the
environment .

4. Definition
• Psychiatric emergency differs from other medical
emergencies in that danger of harm to the society is
also taken into account .it may arise due to patient’s
mental state, patient’s relatives or due to
environmental cause.

5. 2- definition
• It is a condition in which there is alteration in
behaviors, emotion or though, presenting in an acute
form, psychiatric emergency need immediate attention
and care

6. classification
Suicide
stress
Crisis
Violence
Stupor
Panic attach

7. Suicide

8. • Suicide is commonest psychiatric emergency .suicide word
is derived from a Latin word “one’s own to kill”
• The conscious act of intentionally causing “one’s own
death” suicide is a type of deliberate self harm.

9. Method used for suicide
• Ingestion of poison

10. • Hanging

11. • Burning

12. • Drowning

13. • Jumping in front of train and vehicle

14. • Wrist cutting

15. • firearms

16. Warning sign
of suicide
• Change in eating habits
• Changes in sleeping habits
• Drug and alcohol use
• Neglect of personal care
• Reduced attention and
concentration
• Violent action
• Anti social behavior
• Decline in school work

17. Causes of suicide
• Psychiatric disorder
• Major depression
• Drug and alcohol abuse
• Schizophrenia
• Personality disorder

18. • 2- physical disorder
• Chronic and incurable
disorder like cancer, aids

19. • 3 -PSYCHOSOCIAL FACTORS
• Failure in examination
• Dowry harassment
• Marital problem
• Loss of loved object
• Isolation and alienation from social group
• Financial and occupational difficulties

20. Common misconception about suicide
• People who talk about suicide do not complete suicide
• Suicide happen without any waring
• Once people decide to die by suicide there is noting you can
do to stop them
• All suicidal individual are mentally ill.
• Once a person is suicidal, he is suicidal forever

21. Management of suicide
•Be aware of the warning sign
•Provide a safe environment remove all suicidal
object like – sharp items, medicine, chemical ect
•Counselling and guidance
•Treatment of disorder
•Follow up care

22. • Do not leave person alone
• Spent time with person
• Encourage to talk about his /her problem
• Acute psychiatric emergency

23. Nursing management
• Safety of patient is nursing priority
• Patient should be under the observation
• Patient should not left alone patient should not allow to
take bath alone
• All psychiatric drug, lotion, chemical should be kept under
lock and key
• Nurse should spend more time with the person who
attempted suicide
• Encourage patient to express feels

24. Stress

25. DEFINITION
• Stress can be defined as a state of worry or mental tension
caused by a difficult situation. Stress is a natural human
response that prompts us to address challenges and threats
in our lives. Everyone experiences stress to some degree.

26. Causes
• Death of love one
• War and violence
• Divorce
• Change of house
• Marital problem
• Natural disaster
• Serious health problem
• pregnancy

27. Reaction of stress
• Alarm reaction
• Stage of resistance
• Stage of exhaustion

28. Alarm reaction
• It is an emergency situation that arise due to stress.
In this phase the sympathetic nerve system of person
become ready for fight or flight situation.

29. Stage of resistance
• If the stressor remain continue for a long time, the
body secrete opposing hormones like adrenocortical
trophic hormone. If a person confront again any
stressor in this stage there is no alarm reaction due
to resistance.

30. Stage of exhaustion
• Regular continuous presence of stress factors reduce the
resistance capacity of person toward old or new stress. A
person may be physically or mentally ill during this stage or
he may have both, that irreversible damage to tissues or to
the individual occurs and this is sometimes followed by
illness and death.

31. Sign and symptoms of stress
• Headache
• Body aches
• Chest pain or palpitation
• Difficulty in breathing
• Increase smoking or alcohol use
• Insomnia
• Weight gain or loss

32. • Frequent urination
• Constipation, diarrhea, nausea, vomiting
• Cold or sweaty hand or feet
• Social withdrawal or isolation

33. Management
• Focusing on problem
• Self monitoring
• Be realistic
• Use sense of homer
• Use supporting relationship
• Use relaxation and deep breathing
• Time management
• Express out the emotion by talking

34. • Positive thinking and adopt positive attitude.

35. Crisis
intervention

36. Definition
• The term crisis was described by “CAPLON”
• when people face problem which they are unable to resolve
by well tried defense mechanism, the great need for an
individual in this situation is to find some significant person
who will support him at least for some time
• A time of intense difficulty or danger [ FINANCIAL CRISIS,
mental crisis]

37. Features of crisis
Crisis occurs in all individual at one time or another
Crisis precipitates from specific events
Crisis are personal by nature
Crisis are acute not chronic
It is self limiting last for 4 to 6 weeks
Universal experience

38. Type of crisis
Developmental
crisis
Situational
crisis

39. Developmental crisis
• It is also known as maturation crisis Erikson divided the
whole life into eight developmental stage according to
Erikson, when a person enters into next phase from one
phase he goes through many emotional and psychological
changes. This transitional phase may work as a crisis for
that person. It is maximum influence is seen over
adolescent phase.

41. Situational
crisis
• Situational crisis arise due to the
failure to fulfil the daily needs and
negative result for ex.
• Loss of employment
• Change in living place
• Severe suicidal ideation
• Marital dispute
• Loss of ability to work
• Death of love person

42. Crisis
intervention
• Crisis intervention refers to the
method used to offer
immediate short term help to
individual who experience an
event that produces emotion
mental, physical and
behavioural distress or
problem.

43. Crisis intervention
• Assessment of the individual and problem
• Planning and therapeutic intervention
• Implementing the intervention
• Evaluation the crisis

44. Goals of crisis intervention
• To decrease emotional stress and protect the crisis victim
from additional stress.
• Reduction in disequilibrium / relief of symptoms of crisis.
• Identification of other support systems.

45. Technique of
crisis
intervention
Sedative
Suggestion
Environmental modification
Behaviour modification
Mental ventilation
Clarification
Providing support

46. Violence/excitement/aggressive behavior

47. Introduction
• Physical aggression by one person on another
• During this stage patient will be irrational[not based on
clear thought] uncooperative, delusional and assaultive[a
sudden attach on somebody or someone].

48. Etiology
• Organic psychiatric disorder
• Delirium
• Dementia[a serious mental problem caused by brain
disease or injury]

49. • Other psychiatric disorder
• Schizophrenia
• Mania
• Withdrawal from alcohol and drug
• Panic disorder
• Acute stress
• Personality disorder

50. Do’s
• Protect yourself
• Unarm the patient
• Keep the doors open
• Keep others near you
• Do restrain if necessary

51. •Unarm the patient

52. Dont’s
• Do not keep potential weapon near the patient
• Do not sit with back to patient
• Do not wear neck tie or jewellery
• Do not keep any provocative [plan to make somebody
angry] family member in the room
• Do not confront [to stand in front of somebody because
you want to fight him/her]
• Do not close to the patient

53. Management
• Untie the patient if tie up
• Talk to the patient softly
• Firm and kind approach is essential
• Ask direct and concise question[giving a lot of
information in a few words]
• Assist the patient in defining the problem

54. Sedation drug
• Diazepam – 5-10 mg
slow IV.
• Haloperidol 2-10
mg IM.IV.
• Chlorpromazine 50-
100mg IM.

55. CONT……
• Collect detailed history and explore the cause
• Catty out complete physical examination
• Check hydration status if severe dehydration
• Have less furniture in the room, remove all sharp
instrument
• Stay with the patient to reduce anxiety
• Encourage the patient to talk out the aggressive feeling
rather than acting them out

56. Guideline for self protection while handling an
aggressive patient
• Never see the patient alone
• Keep a comfortable distance away from patient
• Be prepared to move
• Maintain a clear exit route
• Be sure that the patient has no weapons with him
• If patient is having a weapon, ask him to keep it down
rather than fighting with him

57. • Keep something between you and weapon like pillow,
mattress, blanket.
• Distract the patient to remove the weapon e.g. – throwing
water on the face
• Give prescribed antipsychotic .

58. Stupor and catatonic syndrome
• 1-Stupor – is a clinical syndrome of akinesis[ absence, loss or
impairment of the power of voluntary movement] and mutism
but with relative preservation of conscious awareness
• 2-Catatonic syndrome – any disorder which presents with at
least two catatonic signs.
• Catatonia – either excited or withdrawn [very quite ]
• Catatonic sign – negativism, mutism, stupor, excitement and
impulsiveness[ likely to act suddenly and without thinking]

59. Management
Stuporous patient
• Check vital sign
• Maintain hydration
• History and physical examination
• Draw blood for investigation before starting any treatment
• Identify the specific cause and treatment

60. • Care of skin, nutrition, elimination and personal hygiene is
required
• Give ventilatory support if needed

61. Panic attacks
• Panic attack is a brief period of extreme distress, anxiety, or
fear that begins suddenly and accompanied by physical and
emotional symptoms.

62. Risk factors
• Adolescence and early adulthood
• Graduating from college, getting married, having a first
child
• Genetics

63. Manifestation
•Palpitations
•Sweating

64. • Tremors
• Chest pain

65. • Nausea
• Abdominal distress

66. • Fear of dying
• Paresthesia [ tingling or pricking pins because damage of
peripheral nerves]

67. Management
• Search for causes
• Inj. Diazepam 10 mg or lorazepam 2mg
• Counsel the patient and relatives
• Use behavior modification techniques.

68. Victims of disaster
• People who have survived a sudden, unexpected,
overwhelming stress

69. features
• Anger
• Frustration
• Guilt
• Depression

70. Management
• Group therapy
• benzodiazepines to reduce anxiety
• Listen attentively
• Do not interrupt
• Console them- patting on the shoulder, touching,
holding their hands

71. Conn…
• Do not ask them to stop crying
• Use silence
• Provide accurate and responsible information
• Referral to mental health service if required