1. Psychiatric emergencies differ from medical emergencies in that they can harm patients and others due to severe danger to life or others. Immediate intervention is needed to safeguard lives and provide emotional support.
2. Triage of psychiatric patients involves assessing medical stability, legal status, safety, suicidality, aggression, underlying conditions, lethality, trauma, and substance use.
3. Nursing management of psychiatric emergencies includes creating a safe environment, monitoring patients, providing reassurance, and administering medications as needed.
Obsessive-compulsive disorder (OCD) is a chronic and relapsing anxiety disorder that is characterized by persistent obsessive thoughts and/or repetitive compulsive actions that impair daily functioning. The repetitive actions can be mental or physical acts, either of which is perceived by the individual as reducing anxiety. Individuals with OCD might recognize the irrationality of their anxiety-driven patterns, they feel helpless to resist the compulsive urges that serve as dysfunctional coping mechanisms to reduce anxiety. Many patients prefer to keep ritualistic compulsions such as repetitive checking of locks or repeated hand washing a secret because they are ashamed of their illogical behavior.
Definition:
Obsession: Repetitive thoughts, images and doubts which make a person absolutely senseless and irrational. Individual tries to resist but finds unable to do so because that restriction might increase the level of anxiety.
Compulsion: Repetitive actions are performed followed by obsession in order to avoid the marked distress even though the client knows that behavior is unrealistic, senseless and irrational.
Etiology/ Predisposing factors:
I. Biological Theories:
a) Neurotransmitters:
Studies have suggested that changes in brain serotonin(5-HT) function may contribute to anxiety symptoms and anxiety type behaviors. Among anxiety disorders, the most compelling evidence implicating 5-HT exists for OCD.
OCD patients were found to have higher plasma free 3-methoxy-4-hydroxy-phenylglycol and plasma norepinephrine levels. The maximum number of binding sites (Bmax) for tritiated clonidine was significantly greater in OCD patients than in normal people. There was a blunted growth hormone, cortisol and ACTH response to clonidine in OCD.
b) Genetics:
Family studies: 35% of first-degree relatives of OCD clients might suffer from this disorder.
Twin studies: Monozygotic twins are more prone to it as compared to dizygotic twins.
c) Electrophysiological Studies:
Electroencephalography: Many of the earlier reports suggested EEG abnormalities in OCD. Temporal lobe spikes and increased theta waves have been reported in sleep EEG or OCD subjects.
Evoked Potentials: Higher N60 amplitudes were found in somatosensory evoked patients in OCD. Obsessional patients are characterized by reduced amplitudes and decreased latencies of late EP component.
d) Brain Imaging:
Cranial CT and MRI scans: An increase in ventricular-brain ratio was found in cranial CT in OCD. Subsequent studies have shown similar results in caudate nuclei. Earlier reports found non-specific abnormalities on Magnetic Resonance Imaging of the brains in OCD.
Management:
IV. Psychosurgery:
There are various procedures that have been used in treatment of OCD. They are as follows;
• Prefrontal leucotomy
• Transorbital leucotomy
• Biomedical leucotomy
• Orbital leucotomy
• Rostral leucotomy
• Limbic leucotomy
• Subcaudate tractotomy
Almost all people affected by emergencies will experience psychological distress which for most people will improve over time.People with severe mental disorder are especially vulnerable during emergencies and need access to mental health care and other basic needs.
Electroconvulsive therapy (ECT) is a treatment for certain mental illnesses. During this therapy, electrical currents are sent through the brain to induce a seizure.
The procedure has been shown to help people with clinical depression. It’s most often used to treat people who don’t respond to medication.
Obsessive-compulsive disorder (OCD) is a chronic and relapsing anxiety disorder that is characterized by persistent obsessive thoughts and/or repetitive compulsive actions that impair daily functioning. The repetitive actions can be mental or physical acts, either of which is perceived by the individual as reducing anxiety. Individuals with OCD might recognize the irrationality of their anxiety-driven patterns, they feel helpless to resist the compulsive urges that serve as dysfunctional coping mechanisms to reduce anxiety. Many patients prefer to keep ritualistic compulsions such as repetitive checking of locks or repeated hand washing a secret because they are ashamed of their illogical behavior.
Definition:
Obsession: Repetitive thoughts, images and doubts which make a person absolutely senseless and irrational. Individual tries to resist but finds unable to do so because that restriction might increase the level of anxiety.
Compulsion: Repetitive actions are performed followed by obsession in order to avoid the marked distress even though the client knows that behavior is unrealistic, senseless and irrational.
Etiology/ Predisposing factors:
I. Biological Theories:
a) Neurotransmitters:
Studies have suggested that changes in brain serotonin(5-HT) function may contribute to anxiety symptoms and anxiety type behaviors. Among anxiety disorders, the most compelling evidence implicating 5-HT exists for OCD.
OCD patients were found to have higher plasma free 3-methoxy-4-hydroxy-phenylglycol and plasma norepinephrine levels. The maximum number of binding sites (Bmax) for tritiated clonidine was significantly greater in OCD patients than in normal people. There was a blunted growth hormone, cortisol and ACTH response to clonidine in OCD.
b) Genetics:
Family studies: 35% of first-degree relatives of OCD clients might suffer from this disorder.
Twin studies: Monozygotic twins are more prone to it as compared to dizygotic twins.
c) Electrophysiological Studies:
Electroencephalography: Many of the earlier reports suggested EEG abnormalities in OCD. Temporal lobe spikes and increased theta waves have been reported in sleep EEG or OCD subjects.
Evoked Potentials: Higher N60 amplitudes were found in somatosensory evoked patients in OCD. Obsessional patients are characterized by reduced amplitudes and decreased latencies of late EP component.
d) Brain Imaging:
Cranial CT and MRI scans: An increase in ventricular-brain ratio was found in cranial CT in OCD. Subsequent studies have shown similar results in caudate nuclei. Earlier reports found non-specific abnormalities on Magnetic Resonance Imaging of the brains in OCD.
Management:
IV. Psychosurgery:
There are various procedures that have been used in treatment of OCD. They are as follows;
• Prefrontal leucotomy
• Transorbital leucotomy
• Biomedical leucotomy
• Orbital leucotomy
• Rostral leucotomy
• Limbic leucotomy
• Subcaudate tractotomy
Almost all people affected by emergencies will experience psychological distress which for most people will improve over time.People with severe mental disorder are especially vulnerable during emergencies and need access to mental health care and other basic needs.
Electroconvulsive therapy (ECT) is a treatment for certain mental illnesses. During this therapy, electrical currents are sent through the brain to induce a seizure.
The procedure has been shown to help people with clinical depression. It’s most often used to treat people who don’t respond to medication.
These slides,describes the general and possible causes of mental disorders.
These slides can be used by Psychiatric students,mental health nurses,Doctors and clinical officer students including whoever interested in mental disorders etiology.
Crisis is a state of disequilibrium resulting from the interaction of an event. it includes crisis and crisis intervention or its management.
it includes crisis types, characteristics , phases etc.
Behavior therapy is a type of psychotherapy which is based on theories of learning and aims at changing maladaptive behavior and substituting it with adaptive behavior.
Psychiatric emergency is a condition where in 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).
These slides,describes the general and possible causes of mental disorders.
These slides can be used by Psychiatric students,mental health nurses,Doctors and clinical officer students including whoever interested in mental disorders etiology.
Crisis is a state of disequilibrium resulting from the interaction of an event. it includes crisis and crisis intervention or its management.
it includes crisis types, characteristics , phases etc.
Behavior therapy is a type of psychotherapy which is based on theories of learning and aims at changing maladaptive behavior and substituting it with adaptive behavior.
Psychiatric emergency is a condition where in 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).
This slide contains information regarding Psychiatric Emergencies (Anger, Aggression and violence, Stupor and Catatonia) . This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated. Thank you!
hii guys this is my ongoing presentation from my speciality class i hope u guys lije that please so i hope it is been useful for u in ur specialities by getting little help with that
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
2. Although we all know when to take our loved ones to the
hospital when we see signs of physical illness, the majority
of us are entirely unaware of psychiatric conditions. This
can be a grave problem in case it is a psychiatric
emergency. As compared to a medical emergency, major
psychiatric emergencies are different because they can
harm the patient and others around them. Situations with
significant and severe danger to the patient’s life, to a
minor, or to others around them.
3. An emergency is defined as an unforeseen combination of
circumstances which calls for an immediate action.
A medical emergency is defined as a medical condition
which endangers life and/or causes great suffering to the
individual.
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). This
condition needs immediate intervention to safeguard the
life of the patient, bring down the anxiety of the family
members and enhance emotional security to others in the
environment.
4. Psychiatric emergency might be defined as: A sudden,
serious, psychological or psycho-social disturbance which
renders the individual unable to cope effectively with his life
situation, his interpersonal relationships, and/ or his
intrapsychic conflicts.
• W.J. Cassidy(1967)
5. • The initial approach to the patient should be warm, direct and
concerned.
• A quick evaluation to identify the nature of the condition and to
institute care on the basis of seriousness is essential.
• The emergency staff should have basic knowledge of handling
psychiatric emergencies.
• Medico legal cases need to be registered separately and
informed to the concerned officer.
• Hospital security must be adequate to control violent and
dangerous patients.
• History and clinical findings should be recorded clearly in the
emergency file.
• Patient’s condition and plans of management should be
explained in simple language to the patient and family
members.
6. • To safeguard the life of patient
• To reduce the anxiety
• To provide the emotional security
• To educate the client and family members
7. 1. Triage
• includes assessing the immediate needs of individuals
presenting across a variety of priority concerns.
• two factors must be considered first when triaging the
psychiatric patient: medical stability and legal status.
• The acronym ASSAULTS can assist the nurse to
systematically address critical components of an all-
encompassing triage evaluation.
• A - assess for all the areas
• S – safety
• S – suicidality
• A - aggressive/assaultive behavior,
• U - underlying medical conditions,
• L - lethality,
• T - trauma, and
• S - substance use/abuse,
8. • TITLE - Care of Psychiatric Patients: The Challenge to
Emergency Physicians
• AUTHOR - Leslie Zun, MD, MBA
• JOURNAL NAME – Western Journal of Emergency Medicine
• CURRENT ISSUE: VOLUME 17 ISSUE 2
• PUBLISHED: MARCH 2, 2016
• The purpose of this article is to discuss disparity and challenges
in caring for psychiatric patients. EDs do a good job of
determining how to improve the care of the medical patient but
they have done little addressing the unique needs of the
psychiatric patients. Patient care surveys focus on evaluating
the patient care experience of non-psychiatric patients in the
ED. These customer service surveys have identified many
priorities for patient care and satisfaction in the ED, need for
improvement, hence The triage process in the ED is skewed to
patients with medical problems over those with psychiatric
9.
10. RESULT - The author suggests that better treatments protocols are
needed for psychiatric patients in crisis in the ED. However, best
practices in evaluation and treatment of agitation (BETA) expert
guidance recommends that medication be determined by the most
probable etiology. Treatment of psychiatric illness should be similarly
tailored to the patient and situation.
CONCLUSION - It is time to advocate for the psychiatrically ill patient
in the ED. We need to push for more training, establishment of
standards of care, reduced wait times and find alternatives to
boarding.
11. 2. Safe environment for emergency evaluation
• Weapon screening
• Rooms in which the examiner cannot be easily trapped
• Method to call for help
• Adequate personnel to respond if help is needed
including trained security personnel
18. • DEFINITION
Suicidal behaviour includes suicidal ideation (frequent thoughts
of ending one's life), suicide attempts (the actual event of trying
to kill one's self), and completed suicide (death occurs). Suicidal
behavior is most often accompanied by intense feelings of
hopelessness, depression, or self‐destructive behaviors
(parasuicidal behaviors).
RISK FACTORS
• Age- adolescent and middle age
• Gender - women
• Marital status - unmarried
• Socio-economic status
• Occupations – lawyers, dentist, musicians, physicians with F/H
19. PSYCHIATRIC DISORDERS
Major depression
Schizophrenia
Drug/ alcohol abuse
Dementia
Delirium
Personality disorder
PHYSICAL DISORDERS
Cancer
Arthritis
AIDS
PSYCHOSOCIAL FACTORS
Failure in examination
Dowry harassment
Marital problem, Loss of loved
Isolation
Alienation from social groups
Financial and occupational
difficulties
20. • Assessing suicidal risk
• MSE
• Psychopharmacological Treatment
NURSING MANAGEMENT
Assessing the suicidal risk/potential.
Mental status examination.
Monitor the patient’s safety needs-
Search for toxic agents such as drugs or alcohol.
Do not leave the drug tray within the reach of the patient. Make
sure that daily medication is swallowed.
remove sharp instruments, straps, belts etc.
Do not allow the patient to bolt the door on inside, make sure
that somebody accompanies him to the bathroom.
21. Patient should be kept in constant observation and
should be never left alone.
Spend time with him, talk to him, and allow him to
ventilate his feelings.
Encourage him to talk about his suicidal
• plans/methods.
If suicidal tendency are very severe, sedate the patient.
A ‘no suicidal’ pact may besigned.
Enhance self esteem of the patient by focusing on his
• strengths rather than weaknesses.
22. • One to one relationship
• Assess suicidal risk daily
• Remove hazardous objects
• Window locked
• Monitor patient
• Be alert of verbal and non-verbal clues
• Verbal and written contracts
• Problem solving techniques
• Place near nurses station
• Do not allow to bolt the door
23. • Do not panic/ raise an alarm
• Act with speed and coordination
• Emergency medical measures-check pulse, respiration
and airway
• -if overdose of medicine- gastric lavage
• -Turn head to one side
• -pulse- inj. Decadron 4mg IV
• Plan intervention to control future attempts.
24. DEFINITION
• Social psychologists define aggression as behavior that
is intended to harm another individual who does not wish
to be harmed. (Baron & Richardson, 1994)
• Violence is defined as “a physical act of force intended to
cause harm to a person or an object and to convey the
message that the perpetrator’s point of view is correct
and not the victim’s.” (Harper-Jaques and Reimer, 1992)
26. • IN TRIGGERING
PHASE-
• Restlessness
• Anxiety
• Irritability
• Muscle tension
• Rapid breathing
• Perspiration
• Loud voice.
• IN ESCALATION
PHASE-
• Pale or flushed face
• Yelling
• Agitated
• Threatening
• Demanding
• Clenched fists
• Hostility, loss of ability
to solve problems.
IN CRISIS PHASE-
Loss of emotional and
physical control
Throwing objects
Kicking, Hitting
Spitting
Biting, scratching
Screaming
Inability to
communicate clearly.
IN RECOVERY
PHASE-
Lowering of voice
Decreased muscle
tension
Clearer
More rational
communication and
IN POST
CRISIS
PHASE-
Remorse
Apologies
Crying
Quiet
Withdrawn
behavior.
27. • Talk
• Food
• Medications
• Physical restraints
• Support
• NURSING INTERVENTION
• Decreased environmental stimuli
• Limit interaction with others
• Stay with patient
• Gentle approach
• Create safe environment
• Maintain clear exit
• Do not keep provocative members
• Redirect violent behaviour
• Talk out rather acting out
28. DEFINITION
Panic attack:
Is a brief period of extreme distress, anxiety, or fear that begins
suddenly and is accompanied by physical and/or emotional
symptoms. •
Panic disorder:
Is involves spontaneous panic attacks that occur repeatedly,
worry about future attacks, and changes in behavior to avoid
situations that are associated with an attack.
Episodes of acute anxiety and panic can occur as a part of
psychotic or neurotic illness. The patient will experience
palpitations, sweating tremors, feelings of choking, chest pain,
nausea. abdominal distress, fear of dying, parasthesia, chills or
hot flushes
30. • Signs and symptoms
• Palpitation
• sweating
• Tremors
• Feeling of choking
• Chest pain
• Nausea
• Abdominal pain
• Chills
• Fear of dying
31. • Give reassurance
• Search for causes
• Diazepam 10mg/ lorazepam 2mg
NURSING MANAGEMENT
• Develop trust relationship through communicating core
communication values(caring, acceptance, empathy)
• Stay with the client and offer reassurance of safety and
security
• Maintain a calm non threatening environment
• Help client recognize early signs
32. DEFINITION
Stupor is a clinical syndrome of akinesis and mutism but with
relative preservation of conscious awareness.
Stupor is often associated with catatonic
signs and symptoms .
The various catatonic signs include mutism, negativism,
stupor, ambitendency, echolalia, echopraxia, automatic
obedience, posturing, mannerisms, stenotypes, etc.,
34. • Maintain hydration
• Check vitals
• Keep airway patent
• Ventilator support
• Personal hygiene
• Identify specific cause and threat
• NURSING MANAGEMENT
Collect history and perform physical examination.
Ensure patent airway.
Administer iv fluids.
Draw blood for investigations before starting any
treatment.
Care of skin, nutrition and personal hygiene.
35. Excitement is a general psychomotor over activity i.e.
excessive motor and psychic activity leading to behavior
disorder, where the behavior disorder, where the patient
may hurt himself and/or others.
• Etiology
• 1. Psychosocial disorder
• 2. organic disorder – Delirium, Dementia
• 3. Substance abuse – intake of stimulant eg. Cocain,
alcohol or during the withdrawal period
36. • Remove chains and restrains
• Talk
• Sedate
• Take history
• Physical examination
• Send blood for Hb ,WBC,ESR,RBC etc
• Treat hydration
• Retain limited furniture
• Provide safe environment
37. Collect history and perform physical examination
Administer IV fluids
Ensure patent airway
Draw blood for investigations before starting my
treatment
Other care is same as that for an unconscious patient.
38. DEFINITION
An uncontrollable outburst of emotions or fear, often
characterized by irrationality, laughter, weeping etc.
A hysteric may mimic abnormality of any function, which is
under voluntary control. The common modes of
presentation may be:
Hysterical fits
Hysterical ataxia
Hysterical paraplegia
Marked by dramatic
Quality & sadness of mood
39. • It is a attention seeking behavior, repressed anxiety,
tranformation of an unconscious conflict in to physical
symptoms, such as paralysis, blindness, loss of
sensation etc.
• MANAGEMENT
• Hysterical fits are distinguish from true / genuine fits •
Explain the psychological nature of disease to the
relatives of the patient • Reassure the family members
that no harm would come to pt. • Help the pt to recognize
the meaning of symptoms & identify suitable alternative
coping mechanism • Observe the patient continuously •
Suggestion therapy with IV pentothal, helpful in some
cases.
40. Identify primary and secondary gains.
Do not focus on the disability; encourage the patient to perform self
care activities as independently as possible. Intervene only when
patient requires assistance.
Do not allow the patient to use the disability as a manipulative
tool to avoid participation in therapeutic activities.
Withdraw attention if patient continues to focus on physical
limitations.
Encourage patient to verbalize fears and anxieties.
Identify specific conflicts that remain unresolved and assist patient
to identify possible solutions.
Assist the patient to set realistic goals for the future.
Help the patient to identify the areas of life situation that are not
within his ability to control.
41. • An idiopathic reaction to major transquilizers and related
drugs such as phenothiazanes( compazine,
prochlorperazine), Haloperidol, metaclopramide etc.
consisting of abnormal muscle contractions.
• Can occur after single, first time dose or in patients who
have had the same medicine before without problem.
42. • Promethazine 25-50 mg
• Diphenhydramine 25-50 IM/IV
• Biperdone 2-3 mg/IM
• Diazepam 5-10 mg IM/IV slowly
• No response after 3 doses-suspect other diseases.
NURSING MANAGEMENT
• Administer medication and assess for effectiveness.
43. These are characterized by disturbed feelings and
behaviour occurring due to overwhelming external
stimuli.
The symptoms include depression, fatigue, sadness, cruing
spills, anxiety, poor concentration, social withdrawal etc.
44. Management:
Reassurance
Mild sedation if necessary
Allowing the patient to ventilate his/her feelings
Counseling by an understanding professional
NURSING MANAGEMENT
Presence, support, reassurance as well as the bond with
the family are cornerstones of the nursing care.
45. Delirium tremens is a potential form of ethanol(alcohol)
withdrawal.
Symptoms:
• may begin a few hours after the cessation of ethanol, but
may not peak until 48 – 72 hours.
• Altered mental status – confusion, hallucinations, service
agitation or generalized seizures – 6 – 48 hours after last
drink.
• Tremors
• Irritability
• Insomnia
• Nausea/vomiting
• Hallucinations, delusions
46. • Safe environment
• Sedation
• Diazepam 10mg/ Lorazepam 4mg IV
• Fluid and electrolyte balance
• Reassurance
NURSING MANAGEMENT
Monitor vital signs, observe the patient carefully.
Decrease stimulation, provide a quiet and safe
environment.
Evaluate the patients hydration and serum electrolytes.
Maintain I/O chart. Administer IV fluids.
Carefully evaluate the patient for presence of other concomitant
medical or surgical problems like trauma, GI bleed etc.
47. Observe for the development of possible focal
neurological sign.
Institute high calorie and high carbohydrate diet.
Add thiamine 100 mg IM, then orally, folic acid 1 mg orally
daily for 7 – 10 days.
Infections, that is, aspiration pneumonia should be suspected
and treated.
Reassure patient and family.
48. Following epileptic attack patient may behave in a strange
manner and become excited and violent.
• After attack
• Patients becomes excited and violent
Management:
• Inj. Diazepam 10mg
• Haloperidol 10mg IV
• Inj. Luminal 10mg followed by oral
anticonvulsant
49. • Withdrawal from drugs and alcohol is a common psychiatric
emergencies and the substances such as
• Alcohol
• Opioids
• Barbiturates and Benzodiazepine
• Stimulants - Cocaine and amphetamines
• SIGNS AND SYMPTOMS
• More severe symptoms such as hallucinations, seizures,
delirium may also occur in some instances.
• Changes in appetite, Changes in mood, Congestion,
Fatigue, Irritability, Muscle pain, Nausea, Restlessness,
Runny nose, Shakiness, Sleeping difficulties, Sweating,
Tremors, Vomiting etc.
50. • Patients should be monitored regularly (3-4 times daily) for
symptoms and complications.
• Patients should drink at least 2-3 litres of water per day during
withdrawal to replace fluids lost through perspiration and
diarrhoea. Also provide vitamin B and vitamin C supplements.
• The dose must be reviewed on daily basis and adjusted based
upon how well the symptoms are controlled and the presence
of side effects
• Symptomatic medications should be offered as required for
aches, anxiety and other symptoms.
• psychological therapy that focuses on providing patients with
skills to reduce the risk of relapse.
• Patients in withdrawal should not be forced to do physical
exercis
51. • The response to stressful events has three components:
• 1. an emotional response, with somatic accompaniments
• 2. a coping strategy
• 3. a defence mechanism.
52. • This is a prolonged and abnormal response to exceptionally intense
stressful circumstances such as a natural disaster or a sexual or other
physical assault.
• MANAGEMENT
• Comfort and consolation
• • Protection from further threat and distress
• • Immediate physical care
• • Helping reunion with loved ones
• • Sharing the experience (but not forced)
• • Linking survivors with sources of support
• • Facilitating a sense of being in control
• • Identifying those who need further help (triage)
• • facts—the victim relates what happened
• • thoughts—they describe their thoughts immediately after the incident
• • feelings—they recall the emotions associated with the incident
• • assessment—they take stock of their responses
• • education—the counsellor offers information about stress responses and
how to manage them.
53. Victims of disaster are people, who have survived a sudden,
unexpected, overwhelming stress.
This is beyond normally what is expected in life, like in and
earthquake, flood, riots and terrorism, Anger, frustration,
guilt,
numbness and confusion are common features in these
people.
Management:
• Treatment for life threatening physical problems
• Critical Incident Debriefing (CID) is a special technique,
which is used to lessen the discomfort of the disaster
victims.
54.
55. Critical incident debriefing includes five phases:
Fact, thought, reaction, reaching and Re-entry
• In the fact phase, each participant is involved to share his or
her perception of the incident.The group members describe
the incident, new information and pieces of information are
integrated into a more understandable whole.
• The thought phase, builds on this information by asking
participants to reflect the incident and to share what they
were feeling personally during different times of the crisis.
56. • In the reaction phase, participants are asked to evaluate the
impact of the emotional aspects of the incident (for example,
what was the worst part of the incident for you). Knowing that
other people are experiencing the same feelings makes them
realize that these feelings are normal behavioural responses
to abnormal circumstances, and this brings a lot of relief to
people who are under intense stress. Participants discuss
stress related symptoms they had during the incident or are
experiencing currently.
• The teaching phase, focuses on specific cognitive, emotional
and spiritual strategies to reduce stress and ways to enhance
group support.
• In the final re-entry phase, the facilitator encourages
questions and summarizes the process, Finally individuals
are referred to further counseling if needed.
57. Rape is a perpetuation of an act of sexual inter- course with a
female against her will and consent.
SIGNS & SYMPTOMS:
Acute disorganization characterized by self blame, fear of
being killed, feeling of degradation and loss of self esteem,
feelings of depersonalization and derealisation
recurrent intrusive thoughts, anxiety and depression are
commonly seen.
Long term psychological effects like post traumatic stress
disorders (PTSD) can occur in some cases.
58. Be Supportive, reassuring and non – judgmental.
Physical examination for any injuries.
Give morning after pill to prevent possible pregnancy.
Send samples for STD & HIV infection.
Explain to the patient the possibility of PTSD, sexual
problems like vaginismus and anorgasmia which may
appear later
59. • TITLE - Psychiatric Illness in the Emergency Department
• AUTHOR – Ali Madeeh, kim – lan, qammar, samia
• JOURNAL NAME – Psychiatric annals
• Psychiatric Illness in the Emergency Department
• PUBLISHED – January 2018
• VOLUME – 48(1):21-27 ISSUE NO - 1
60. • A substantial number of patients with mental illness present
to emergency departments (EDs) for treatment, and their
numbers are continuing to rise. Patients with substance use
disorders are the most common, but there are also patients
with suicidal ideation or those who have al-ready attempted
suicide, as well as patients with psychosis, altered mental
status, and acute anxiety disorders. Among patients with
substance use disorders, “traditional” drugs of abuse (ie,
alcohol, marijuana, cocaine) continue to predominate, but
there is an increasing number of patients who present with
intoxication caused by “designer” drugs, which are much
harder to detect. Suicide attempts remain a leading cause of
ED presentation and require ED personnel to not just do
triage and in-depth assessment, but also to make
recommendations for adequate follow-up.
61. Substance use disorders including newer “designer” drugs
that are hard to detect continue to pose a challenge to ED
physicians. ED physicians, including psychiatrists and mental
health workers who work in EDs, need to be vigilant for
patients who may present to EDs with these disorders.
Appropriate triage, rapid but comprehensive evaluation,
appropriate management, and timely referrals for after care
ensure the best possible outcomes.
62. A psychiatric emergency is any unusual behavior, mood, or
thought, which if not rapidly attended to may result in harm to a
patient or others. The incidence of alcohol and substance
abuse in our country as well as the rise in levels of unipolar
depression, have led to an increased number of patients
reporting to the emergency care unit. It is necessary to be
familiar with common psychiatric emergencies especially
suicide attempts and violent behaviour and other psychiatric
emergencies so as to improve the level of care offered to the
patients