This document discusses common psychiatric emergencies including suicidal threats, violent or aggressive behavior, panic attacks, catatonic stupor, hysterical attacks, and transient situational disturbances. For each emergency, the document outlines potential etiologies, presenting symptoms, and general management strategies. Management often involves sedation, reassurance, searching for underlying causes, and ensuring patient safety and medical stabilization.

1. PSYCHIATRIC
EMERGENCIES
SAM KENAZ PAUL
M.SC. NURSING(PSYCHIATRY)
LECTURER

2. INTRODUCTION
◦ 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
◦ • Suicidal threat
◦ • Violent or aggressive behavior or excitement
◦ • Panic attacks
◦ • Catatonic stupor
◦ • Hysterical attacks
◦ • Transient situational disturbances

4. Suicidal threat
◦ ETIOLOGY
◦ Psychiatric Disorders
◦ • Major depression
◦ • Schizophrenia
◦ • Drug or alcohol abuse
◦ • Dementia
◦ • Delirium
◦ • Personality disorder
◦ Physical Disorders
◦ • Patients with incurable or painful physical disorders like, cancer and AIDS.
◦ Psychosocial Factors
◦ • Failure in examination
◦ • Dowry difficulties
◦ • Marital difficulties
◦ • Loss of loved object

5. MANAGEMENT

6. VIOLENT OR AGGRESSIVE BEHAVIOR OR
EXCITEMENT
◦ This is a severe form of aggressiveness. During this stage, patient will be irrational,
uncooperative, delusional and assaultive.
◦ MANAGEMENT
◦ Talk to the patient and see if he responds.
◦ Usually sedation is given. Common drugs used are: diazepam 10-20mg, IV; haloperidol 10-20mg;
chlorpromazine 50-100mg IM.
◦ Carry out complete physical examination.
◦ Keep environmental stimuli, such as lighting and noise levels to a minimum; assign a single room; limit
interaction with others.
◦ Remove hazardous objects and substances; caution the patient when there is possibility of an accident.

7. 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, pares
◦ MANAGEMENT
◦ • Give reassurance first
◦ • Search for causes
◦ • Diazepam 10mg or lorazepam 2 mg may be administeredthesias, chills or hot flushes.

8. CATATONIC STUPOR
◦ Stupor is a clinical syndrome of akinesias and mutism but with relative preservation of conscious
◦ awareness. Stupor is often associated with tonic signs and symptoms (catatonic withdrawal or catatonic
stupor).
◦ MANAGEMENT
◦ • Ensure patent airway
◦ • Administer IV fluids
◦ • Collect history and perform physical examination
◦ • Draw blood for investigations before starting any treatment

9. HYSTERICAL ATTACKS
◦ 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

10. DRUG TOXICITY
◦ Drug 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.