This document discusses various psychiatric emergencies and their management. It defines psychiatric emergency as a condition where a patient has disturbances in thought, affect, and psychomotor activity that threaten their existence or environment. Common emergencies discussed include suicidal threats, violent behavior, panic attacks, catatonic stupor, and hysterical attacks. Organic emergencies like epileptic furor and acute drug toxicity are also covered. For each emergency, risk factors, symptoms, and treatment approaches like reassurance, sedation, and removal from dangerous objects are summarized. The document stresses handling emergencies calmly to prevent anxiety in other patients.

1. PSYCHIATRIC EMERGENCIES
SUBMITTED TO-MS NITIKA MAM
SUBMITTED BY – DAMINI GUPTA
MSC (N) FINAL YEAR
SUBMITTED ON-

2. DEFINITIONS
EMERGENCY An emergency is defined as an unforeseen
combination of circumstances which calls for an immediate action.
 MEDICAL EMERGENCY 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 , or threat to environment

3. COMMON PSYCHIATRIC EMERGENCIES
1. Suicidal Threat
1.2. Violent, Aggressive Behavior and
Excitement
1.3. Panic Attacks 1.4. Stupor and Catatonic
Syndrome 1.5.Hysterical Attacks
2.ORGANIC PSYCHIATRIC
EMERGENCIES
2.1 Epileptic Furor
2.2 Acute Drug - Induced
Extrapyramidal Symptoms
2.3 Drug Toxicity

4. SUICIDAL THREAT
 1)In psychiatry a suicidal attempt is considered to be one of the commonest emergencies.
 2) Suicide is a type of deliberate self-harm and is defined as an intentional human act of
killing oneself.
 3) Suicide- self murder or deliberate self-harm in males
 4) Parasuicide/pseudocide- attempted suicide or non-fatal deliberate self-harm in females

5. ETIOLOGY
1.Major depression
2.Schizophrenia
3.Drug or alcohol abuse
4.Dementia
5.Delirium
6.Personality disorder
7.Physical Disorders

6. CONTINUE
8.Patients with incurable or painful
physical disorders like, cancer and AIDS.
9.Psychosocial Factors
10.Failure in examination
11.Dowry difficulties
12.Marital difficulties
13.Loss of loved object Isolation and
alienation from social groups
14.Financial and occupational difficulties

7. RISK FOR SUICIDE
 1. Age- males above 40 years of age Females above 55 years of age
 2. Sex- men have greater risk of suicide suicide is 3 times more common in
men than women.
 3. Being unmarried, divorced, widowed or separated
 4. History of previous suicidal attempts
 5. Recent losses

8. MANAGEMENT
Be aware of the warning signs Monitor the patient’s safety needs
  Take all suicidal threats or attempts seriously.
  Search for toxic agents such as drugs/ alcohol.
  Do not leave the drug tray within reach of the patient
  Make sure that daily medication is swallowed.
  Remove sharp instruments from the environment.
  Remove straps and clothing such as belts.
  Somebody should accompany to the bathroom.
  Patient should never be left alone

9. CONTINUE
  A ‘ no suicide’ agreement may be signed
  Enhance self esteem by focusing on his strengths.
 Acute psychiatric emergency interview
 Counseling and guidance
  To deal with the desire to attempt suicide
  To deal with ongoing life stressors and teaching new coping skills.
Treatment of psychiatric disorders

10. VIOLENT BEHAVIOR
 VIOLENT BEHAVIOR This is a severe form of aggressiveness. During this
stage, patient will be irrational, uncooperative, delusional and assaultive.
 ETIOLOGY- • Organic psychiatric disorders like, delirium, dementia,
Wernicke-Korsakoff's psychosis.
 • Other psychiatric disorders like, schizophrenia, mania, agitated depression,
withdrawal from alcohol and drugs, epilepsy, acute stress reaction, panic
disorder and personality disorders

11. MANAGEMENT
 1.Protect yourself , Unarm the patient , Keep the doors open , Keep others near you
, Do restrain if necessary Assert authority , Show concern, establish rapport and
assure the patient
 2. 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 family member in
the room , Do not confront , Do not sit close to the patient

12. continue
 3.Untie the patient, if tied up Reassurance
  Talk to the patient softly
  Ask direct and concise questions
  Assist the patient in defining the problem with Sedation
  Diazepam 5-10 mg slow IV
  Haloperidol 2-10 mg IM/IV
  Chlorpromazine 50-100 mg IM
 4.Physical Restraints

13. PANIC ATTACKS
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,
paresthesia’s, chills or hot flushes.

15. MANAGEMENT
Give reassurance first.
Search for causes.
Diazepam 10mg or lorazepam 2 mg may be administered

16. CATATONIC STUPOR
 Stupor is a clinical syndrome of akinesias and mutism but with relative
preservation of conscious awareness. Stupor is often associated with
catatonic signs and symptoms (catatonic withdrawal or catatonic stupor).
The various catatonic signs include mutism, negativism, stupor,
ambitendency, echolalia, echopraxia, automatic obedience, posturing,
mannerisms, stereotypies, etc.

17. MANAGEMENT
1.Ensure patent airway.
2.Administer I.V. fluids.
3.Collect history and perform physical examination.
4.Draw blood for investigations before starting any
treatment.
5.Other care is same as that for an unconscious patient

18. HYSTERICALATTACKS
 A hysteric attack which is under voluntary control. Most common risk in
children and also in females. The common modes of presentation may be:
Hysterical fits Hysterical ataxia Hysterical paraplegia
 All presentations are marked by a dramatic quality and sadness of mood

20. MANAGEMENT
 Hysterical fit must be distinguished from genuine fits.
 As hysterical symptoms can cause panic among relatives, explain to the relatives the
psychological nature of symptoms. Reassure that no harm would come to the patient.
 Help the patient to realize the meaning of the symptoms and help him find alternative ways of
coping with stress.

21. ACUTE DRUG INDUCED
EXTRAPYRAMIDAL SYNDROME
Antipsychotics can cause a variety of movement related side-effects,
collectively known as extrapyramidal symptoms (EPS).Neuroleptic
malignant syndrome is rare but most serious of these symptoms and
occurs a small minority of patients taking neuroleptics especially high
potency compound

22. MANAGEMENT
 The drug should be stopped immediately.
 Treatment is symptomatic and includes cooling the patient, maintaining fluid and electrolyte
balance and treating intercurrent infections.
 Diazepam can be used for muscle stiffness
 Dantrolene, a drug used to treat malignant hyperthermia, bromocriptine, amantadine and L-
dopa have been used.
 Drug toxicity or over-dosage may be accidental or suicidal. In either case all attempts must be
made to find out the drug consumed. A detailed history should be collected and symptomatic
treatment instituted.
 A common case of drug poisoning is lithium toxicity.

23. GENERAL GUIDELINES TO MANAGE THE
PSYCHIATRIC EMERGENCIES
Handle with the utmost of tact and speech so that wellbeing
of other patients is not affected. Act in a calm and
coordinate manner to prevent other clients from getting
anxious. Shift the client as early as possible to a room
where they can be safe guarded against injury. Ensure that
all other clients are reassured and the routine activities
proceed normally. Psychiatric emergencies overlap medical
emergencies and staff should be familiar with the
management of both

24. BIBLIOGRAPHY