This document summarizes various psychiatric emergencies and their management. Common psychiatric emergencies include suicidal threats, violent behavior, panic attacks, catatonic stupor, hysterical attacks, and transient situational disturbances. Organic psychiatric emergencies include delirium tremens, epileptic furor, acute drug-induced extrapyramidal symptoms, and drug toxicity. The document provides details on the presentation and management of each of these conditions, with management focusing on ensuring patient safety, medication administration, reassurance, and addressing the underlying causes.

1. Psychiatric emergencies

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

4. Organic psychiatric emergencies are
•
•
•
•
Delirium tremens
Epileptic furor
Acute drug induced extra pyramidal symptoms
Drug toxicity

5. Suicidal threat
• Suicide is a type of deliberate self-harm and is
defined as an intentional human act of killing
oneself.

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. Violent behaviour
• This is a severe form of aggressiveness.

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. Panic attacks
• Episode of acute anxiety or panic as a part of
psychotic or neurotic illness.

10. Management
• Give reassurance.
• Search for causes.
• Diazepam 10 mg or Lorazepam 2 mg

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. Management
• Ensure patent airway.
• Administer IV fluids.
• Give care same as that of unconscious patient

13. Hysterical attacks
• A hysteric may mimic abnormality of any
function which is under voluntary control.
– Hysterical fits
– Hysterical ataxia
– Hysterical paraplegia

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. Transient situational disturbances
• These are characterized by disturbed feelings
and behaviour occurring due to overwhelming
external stimuli.

16. Management
•
•
•
•
Reassurance.
Mild sedation
Promoting ventilation of feelings
Counseling

17. Delirium tremens
• It is an acute condition resulting from
withdrawal of alcohol.

18. Management
• Keep the patient in quiet and safe
environment.
• Sedation
• Fluid and electrolyte balance
• Reassure the patient and family

19. Epileptic furor
• Following epileptic attack patient may behave
in a strange manner and become excited or
violent.

20. Management
• Sedation
– Inj. Diazepam 10 mg IV
– Inj. Haloperidol 10 mg IV

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. 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. Drug toxicity
• It can be accidental or suicidal.
• Very common drug is Lithium

24. Management
•
•
•
•
•
Administer oxygen
Start IV line
Assess for cardiac arrhythmias
Refer for hemodialysis
Administer anticonvulsants

25. Thank you