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Psychiatric emergencies
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).
Common psychiatric emergencies are
•
•
•
•
•
•

Suicidal threat
Violent, aggressive behaviour and excitement
Panic attacks
Stupor and catatonic syndrome
Hysterical attacks
Transient situational disturbances
Organic psychiatric emergencies are
•
•
•
•

Delirium tremens
Epileptic furor
Acute drug induced extra pyramidal symptoms
Drug toxicity
Suicidal threat
• Suicide is a type of deliberate self-harm and is
defined as an intentional human act of killing
oneself.
Management
• Beware of suicidal signs.
• Monitor the patient’s safety needs.
• Encourage verbal communication of suicidal
ideas.
• Enhance self-esteem of the patient.
Violent behaviour
• This is a severe form of aggressiveness.
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.
Panic attacks
• Episode of acute anxiety or panic as a part of
psychotic or neurotic illness.
Management
• Give reassurance.
• Search for causes.
• Diazepam 10 mg or Lorazepam 2 mg
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.
Management
• Ensure patent airway.
• Administer IV fluids.
• Give care same as that of unconscious patient
Hysterical attacks
• A hysteric may mimic abnormality of any
function which is under voluntary control.
– Hysterical fits
– Hysterical ataxia
– Hysterical paraplegia
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.
Transient situational disturbances
• These are characterized by disturbed feelings
and behaviour occurring due to overwhelming
external stimuli.
Management
•
•
•
•

Reassurance.
Mild sedation
Promoting ventilation of feelings
Counseling
Delirium tremens
• It is an acute condition resulting from
withdrawal of alcohol.
Management
• Keep the patient in quiet and safe
environment.
• Sedation
• Fluid and electrolyte balance
• Reassure the patient and family
Epileptic furor
• Following epileptic attack patient may behave
in a strange manner and become excited or
violent.
Management
• Sedation
– Inj. Diazepam 10 mg IV
– Inj. Haloperidol 10 mg IV
Acute drug induced EPS
• Antipsychotics can cause a variety of
movement related side effects, collectively
known as EPS.

• Neuroleptic malignant syndrome is the
complication.
Management
•
•
•
•
•

Stop the causative drug.
Cool the patients body temperature
Maintain Fluid and electrolyte balance
Diazepam for muscle relaxation
Dantrolene to treat malignant hyperthermia
Drug toxicity
• It can be accidental or suicidal.
• Very common drug is Lithium
Management
•
•
•
•
•

Administer oxygen
Start IV line
Assess for cardiac arrhythmias
Refer for hemodialysis
Administer anticonvulsants
Thank you

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Psychiatric emergencies