Zes slides discribe mostly encountered psychiatric emergency disorders

1. By Elias
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2.  These are violence and suicide.
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3.  The most common cause of suicide is
depression.
 The most common cause of violence is
substance intoxication or withdrawal.
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5.  So, Always r/o substance intoxication or
withdrawal in patient with violence,
 Especially alcohol intoxication and
withdrawal
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6.  Before jumping to psychiatric diagnosis
and it is Always good to r/o medical
conditions.
 Like delirium secondary to hiv/AIDS,
hypoglycemia, seizure, etc…
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7.  You make Psychiatric diagnosis only after
exclusion of medical and substance
cause.
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8.  Some of the psychiatric disorder related
to violence and suicide are
1. Depression
2. Bipolar
3. Schizophrenia
4. Brief psychotic disorder
5. antisocial personality disorder
6. Postpartum psychosis
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9.  When ever you get violence patient
Safety is the first priority.
 to insure safety the patient should be
checked for weapons by hospital guard.
 You should have supportive staff around
which can help you in case if you need
help.
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10.  Any sign of violence should not be
tolerated like verbal aggression,
restlessness or attempt.
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11.  When ever your gut feeling tells you are
endanger you should stop the interview
ask for help and always have away to
escape.
 Don’t be heroes and never face a
violent patient alone.
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12.  to speak in eye level for e.g. if he seat
you seat if he stand you stand.
 To have safe distance b/n the patient
and you.
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13.  And if he is restrained don’t unchain him
during the interview time.
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14.  The second step in treatment of violence
patient is to use verbal descalation.
 To listen the patient and to validate his
concerns.
 To build trust and never to confront the
patient.
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15.  If this verbal descalation fail you can
use chemical restraint like haloperidol
and diazepam.
 If he is willing to take po give him
 Like 5mg haloperidol and 10mg diazepam
po.
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16.  If he is to violent you can give him im or
iv haloperidol 5mg and diazepam 10mg iv
only
 and don’t give diazepam im b/c it is
irritant to muscles.
 If no response you can repeat every 1
hour for 3 doses in 24 hours.
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17.  In cases of imminent suicidal and
homicidal patient; you can give
haloperidol injection every 2 hour until
the patient develop side effect.
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18.  Occasionally you may need to restrain
the patient for sometime but if you
restrain the patient you have to closely
follow him for bruises , vital sign and
unchain him when he is calm.
 Chained patient may need admission,
seclusion and closer follow up.
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19.  First, You should always ask patient if
they have suicidal wish or attempt;
 if say yes,
 You should ask risk factors and plan for
immediate attempt, and if he regret for
previous attempt.
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20.  Sex-being male 1, female0
 Age<20 or >45 1, if not 0
 Depression history 1, if not 0
 Previous suicide attempt 1, if not 0
 Ethanol or substance history 1, if not 0
 Rational thinking absence (psychosis) 1,
 No Spouse 1, if not 0
 Organized plan 1, if not 0
 No social support 1, if not 0
 Serious medical illness 1, if not 0
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21.  0-2 No real problems, keep watch.
 3-4 Send home, but check frequently.
 5-6 Consider hospitalization involuntary
or voluntary, depending on your level of
assurance patient with return for another
session.
 7-10 definitely hospitalize
involuntarily or voluntarily.
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22.  So those patient with high intent or
attempt to make suicide should be
admitted or referred to psychiatry for
further management.
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23.  For those with post partum psychosis
the risk of infanticide is high; so you
should always make sure the safety of
child.
 And the mother also should get
psychiatric treatment.
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24.  For alcohol intoxication you can give
supportive treatment like 40% dextrose,
rehydration…..etc.
 If they are aggressive you can give
haloperidol injection.
 But Don’t give diazepam
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25.  For alcohol withdrawal always r/o
delirium tremens if seizure give
diazepam.
 Always give thiamine before iv dextrose
to prevent Wernicke encephalopathy and
Korsakoff syndrome.
 Detox with diazepam.
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26.  kaplan
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