Psychiatric emergencies

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Psychiatric emergencies

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Psychiatric emergencies

  1. 1. Psychiatric emergencies
  2. 2. Psychiatric emergency • Is a condition wherein the patient has disturbances of thought, affect and psychomotor activity leading to a threat to his existence (suicide), or threat to the people in the environment (homicide).
  3. 3. Common psychiatric emergencies are • • • • • • Suicidal threat Violent, aggressive behaviour and excitement Panic attacks Stupor and catatonic syndrome Hysterical attacks Transient situational disturbances
  4. 4. Organic psychiatric emergencies are • • • • Delirium tremens Epileptic furor Acute drug induced extra pyramidal symptoms Drug toxicity
  5. 5. Suicidal threat • Suicide is a type of deliberate self-harm and is defined as an intentional human act of killing oneself.
  6. 6. Management • Beware of suicidal signs. • Monitor the patient’s safety needs. • Encourage verbal communication of suicidal ideas. • Enhance self-esteem of the patient.
  7. 7. Violent behaviour • This is a severe form of aggressiveness.
  8. 8. Management • Restrain the patient. – Physical – Chemical • Encourage the patient to ventilate the aggressive feelings. • Remove hazardous objects from patients area. • Protect yourself and others from violent patient.
  9. 9. Panic attacks • Episode of acute anxiety or panic as a part of psychotic or neurotic illness.
  10. 10. Management • Give reassurance. • Search for causes. • Diazepam 10 mg or Lorazepam 2 mg
  11. 11. Catatonic stupor • Stupor is a clinical syndrome of akinesis and mutism. • Catatonic signs are : mutism, negativism, stupor, ambitendency, echolalia, echopraxia, automatic obedience, posturing, mannerisms, stereotypies, etc.
  12. 12. Management • Ensure patent airway. • Administer IV fluids. • Give care same as that of unconscious patient
  13. 13. Hysterical attacks • A hysteric may mimic abnormality of any function which is under voluntary control. – Hysterical fits – Hysterical ataxia – Hysterical paraplegia
  14. 14. Management • Help the patient to realize the meaning of the symptoms, and help him find alternative ways of coping with stress. • IV Pentothal is useful • Relieve the anxiety among family members.
  15. 15. Transient situational disturbances • These are characterized by disturbed feelings and behaviour occurring due to overwhelming external stimuli.
  16. 16. Management • • • • Reassurance. Mild sedation Promoting ventilation of feelings Counseling
  17. 17. Delirium tremens • It is an acute condition resulting from withdrawal of alcohol.
  18. 18. Management • Keep the patient in quiet and safe environment. • Sedation • Fluid and electrolyte balance • Reassure the patient and family
  19. 19. Epileptic furor • Following epileptic attack patient may behave in a strange manner and become excited or violent.
  20. 20. Management • Sedation – Inj. Diazepam 10 mg IV – Inj. Haloperidol 10 mg IV
  21. 21. Acute drug induced EPS • Antipsychotics can cause a variety of movement related side effects, collectively known as EPS. • Neuroleptic malignant syndrome is the complication.
  22. 22. Management • • • • • Stop the causative drug. Cool the patients body temperature Maintain Fluid and electrolyte balance Diazepam for muscle relaxation Dantrolene to treat malignant hyperthermia
  23. 23. Drug toxicity • It can be accidental or suicidal. • Very common drug is Lithium
  24. 24. Management • • • • • Administer oxygen Start IV line Assess for cardiac arrhythmias Refer for hemodialysis Administer anticonvulsants
  25. 25. Thank you

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