This document discusses psychiatric emergencies and their management. It defines a psychiatric emergency as a disturbance in thoughts, feelings, or actions that requires immediate treatment. It covers categories of psychiatric emergencies seen in emergency departments, including psychiatric disorders, symptoms, and issues related to psychotropic medications. It also discusses approaches to assessing and managing psychiatric emergencies, including ensuring safety, evaluating suicide and violence risk, conducting mental status exams, considering medical history, and providing psychotherapy and psychotropic medications.

1. Psychiatric
EmErgEnciEs
By
Dr. Ahmed Albehairy, M.D
Consultant Psychiatry, MOH

2. Definition:
A Psychiatric emergency is
a disturbance in thoughts, feelings,
or actions that require
immediate treatment .

3. Item to be discussed
- Set and situation of intervention.
- Categories and clinical pictures.
- Management
( assessment in psychiatric and
non psychiatric wards,
investigations, treatment )

4. Sets and situations of intervention.
Disasters. survivors.

6. Disaster intervention
- Coordination.
- Protection and human rights standards.
- Human resources.
- Community mobilization and support.
- Health services.
- Education.
- Disseminated information.
- Food security and nutrition.
- Shelter and site planning.
- Water and sanitation.

7. Survivors approach
- safety.
- Calming.
- Self and collective efficiency.
- Connectedness.
- Hope.

8. Emotional response to
disaster
• Impact phase. numbness.
• Crisis phase: denial and intrusive symptoms with hyper
arousal.
somatic symptoms (e.g., fatigue, dizziness, headaches,
nausea) as well as anger, irritability, apathy, and social
withdrawal. Individuals may be angry with caregivers who
fail to solve problems or who are unable
• Resolution phase: Grief, guilt, and depression are often
prominent during the first year as individuals continue to
cope with
• Reconstruction phase: During this phase, reappraisal,
assignment of meaning, and the integration of the event
into a new self-concept

9. Potential outcomes of
traumatic events
• Severe persistent problematic symptoms -
Marked depression, marked hyperarrousal,
Intrusive reexperiencing.
• ASD,PTSD.
• Dissociative symptoms.
• Exacerbation and reoccurrence of psychiatric
disorders.
• Substance abuse.
• Aggression.
• Grief.
• In children, aggression, risk taking, sexual acting
out.

10. Risk factors for ASD and PTSD
• Persons who lost a loved one
• Individuals who experienced an injury
• Persons who witnessed horrendous images
• Persons who had dissociation at the time of the
event
• Those who experience serious depressive
symptoms within a week and lasting for a month
or more
• Individuals with numbness, depersonalization,
sense of reliving the trauma, and motor
restlessness after the event
• Those with preexisting psychiatric problems
• Persons with prior trauma

11. Basic Principles of Intervention
After Emotional Trauma
• Reduce stress., safe environment, Promote contact with
loved ones .
• Support self-esteem. to understand that their reaction to
the trauma is a normal reaction.
• Help the person to focus on immediate needs, such as
rest, food, shelter, social supports, or sense of community
• Promote coping mechanisms.
• Help individuals to reframe any destructive cognitions, such
as he or she acted terribly and is a terrible person or is
• Administer medication (eg, propranolol, alpha-agonists,
benzodiazepines, nonactivating selective serotonin reuptake
• inhibitors [SSRIs]), if needed, to decrease arousal.
• Avoid increasing stress.
• Avoid prompting discussion of issues that cannot be
resolved.
• Avoid abreaction in groups .

12. Therapeutic intervention in
disaster
Debriefing:
• (1) introduction (purpose of the session),
• (2) describing the traumatic event,
• (3) appraisal of the event,
• (4) exploring the participants' emotional reactions during
and after the event,
• (5) discussion of the normal nature of symptoms after
traumatic events,
• (6) outlining ways of dealing with further consequences of
the event
, and (7) discussion of the session and practical conclusions.

13. CBT IN Disaster
• Seeing that people are concerned about them.
• Learning about the range of normal responses to trauma and hearing
that their emotional reactions are normal responses to an abnormal event
(rather than a sign of weakness or pathology).
• Being reminded to take care of concrete needs (eg, food, fluids, rest).
• Cognitive restructuring (changing destructive schema, such as "having
fun is a betrayal of the injured," "the world is totally unsafe," "I am
responsible for the disaster," or "life is without meaning," to more
constructive ones).
• Learning relaxation techniques.
• Undergoing exposure to avoided situations either via guided imagery
and imagination or in vivo

14. Medications in disaster
• Propranolol (as well as clonidine) may limit hyperarousal.
• atypical neuroleptic.
• mood stabilizer .
• Diphenhydramine and other medications may be helpful for
sleep.
• Benzodiazepines may limit hyperarousal and foster sleep
follow-up treatment is in short supply.
• SSRIs .

15. Categories by Presentations
to Emergency wards /clinic
B) Psychiatric disorders.
B) Psychiatric sx & signs.
C) Psychotropic medications.

16. Categories by Presentations
to Emergency wards /clinic
A) Psychiatric disorders.
-Delirium & dementia - Anxiety, panic,
- Alcohol & substance agoraphobia.
related disorders ( abuse, -PTSD, abuse, rape.
idiosyncratic, wernik,
- seizures.
Korsakov, amphetamine,
cocaine, opiate, sedation, - Adjustment D., grief,
bereavement.
withdrawal &,intoxication.
-Adolescence, family,
-Mood disorder,
depression/manic. marital crisis.
- schizophrenia. - BP.D
-AIDS

17. Categories by Presentations
to Emergency wards /clinic
B) Psychiatric sx and signs :
1- abuse of child & adult /rape.
2- amnesia.
3- delirium.
4- catatonia.
5- hallucination.
6- paranoia.
7- psychosis.
8- insomnia.
9- homicidal& assaults.
10-suicidality.
11- high fever.

18. Categories by Presentations
to Emergency wards /clinic
c) Psychotropic medications:
- akathesia.
- Acute dystonia.
- High fever.
- Hyperventilation.
- Litium toxicity.
- NMS
- Parkinsonism.
- Priapism
- tarrdive dyskinesia
- Tremors.

19. Management in psychiatric
emergencies
Assessment :
- General safety in evaluating patients.
- Assessing suicidal ( terms,
epidemiology).
- Assessing violent.
- MSE, disorders, personal history,
demography, medical history,
investigation.

20. Management in psychiatric
emergencies
Management
- psychotherapy.
- Psycho tropics.

21. THANK YOU