The document discusses psychiatric emergencies, defining suicide and suicidal clients. It covers common psychiatric emergencies, risk factors for suicide, and guidelines for preventing suicide through education, screening, treatment, restricting access to lethal means, and responsible media reporting. The document also provides guidance on managing suicidal clients in emergency departments and inpatient psychiatric wards.

1. .
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• Presented by:-
• Mr. Suresh Kumar Sharma
• RN, ACCN, MSN(PSYCHIATRY)

3. Psychiatric
emergency
• DIFINITION:-
It is a condition where patients has a
disturbances of thought, affect and
psychomotor activity leading to a threat to
his existence (suicide) or threat to other
people in the environment (homicide) with
himself.

4. Common Psychiatric emergencies
1. Suicidal threat
2. Violent/aggressive behaviour/excitement
3. Panic attacks eg snake
4. Hysterical attacks
5. Transient situational disturbances eg. Earth quake
6. Epileptic furor
7. Drug toxicity
8. Victims of disaster
9. Rape victim
10. grief

5. DEFINITION’S
Suicide:-
• It is a type of deliberate self-harm.
• It is defined as an international human act of
killing one self.
Suicidal client:-
The person who is more prone
to kill himself & had one or
more suicidal attempt

6. • Attempted suicide:-
person try to kill own
self but not succeed.
More by women
• Completed suicide:-
person kill own self
successfully.
More by men.

7. ETIOLOGY
Of
suicide

8. Suicidal tendencies in
psychiatric ward
1. Major depression:-
Suicide is a major depressive
episode is due to-
• Persistent sadness
• Pessimistic cognition to past, present &
future
• Delusion of guilt
• Helplessness , hopelessness & worthlessness
• Derogatory voices urging him to take his life.

9. •Risk of suicide more when acute
phase is passed & psychomotor
retardation has improved b,coz
patients have more energy.

10. 2.schizophrenia
• Because of hallucination &
delusion schizophrenic
patients see suicide as a
reasonable alternative.

11. 3.mania:-
• Result of grandiose ideation.
• Patient may believe he is a great person or
wish to prove his supernatural powers.
• Because of this he may carry out some
dangerous activity that can cost him his life.
• Eg. Jesus, lord Krishna,
• superman

12. 4.Drug or alcohol abuse
• Suicide among alcoholics
can be due to depression
in the withdrawal phase.
• Loss of friends, family,
self respect, status &
a general realisation of
that aspect can cause
the individual to with to die.

13. 5.Personality disorder:-
• Individual with histrionic
& borderline traits may
occasionally attempt
suicide.
• But their success rate is low.

14. 6.Organic condition:-
• Delirium & dementia due to changes of
mood like anxiety & depression may attempt
suicide.

15. 2.Physical disorders:-
patients with incurable or painful
physical disorder like cancer & AIDS
Severe pain
BURN

16. 3. PSYCHOSOCIAL FACTOR
• Failure in
examination
• Loss of loved object
• DEATH OF LOVED
REALATIVE

17. • Dowry harassment
• Marital problems
Isolation & alienation of society
• Financial & occupational
problems

18. INCIDENCE

19. 1.AGE:-
• Male above 40 yrs of age
• Female >55yrs of age
2. sex:-
• Men have greater risk of completed suicide
• Women have higher rate of attempted suicide
• Suicide is 3 time more common in men than
women
• Successful suicide number about 70% men &
30% women

20. CONTD….
3. Marital status:-
• Twice in single person than of married
person
• Being unmarried, divorced, widowed or
separated have 5-6 time more risk.

21. 4.Socioeconomic status:-
• Acc to SADOCK & SADOCK “highest & lowest
class individual have high rate than middle
class
• Occupation related suicide is higher among
artists, law enforcement officers, lawyer &
insurance agents.
• health-related occupations higher
(dentists, doctors, nurses, social workers)
especially high in women physicians

22. • History of childhood trauma or abuse, or of
being bullied
• Family history of death by suicide
• Being unemployed
• Retired Occupation

24. Myths Versus Facts
About Suicide
29

25. SIGECAPS

26. Preventing
Suicide
One cOmmunity at
a time

27. 1.Education
2.Screening
3.Treatment
4.Means Restriction
5.Media Guidelines

28. 1.Education:-
A.Individual and Public Awareness:-
•Primary risk factor for suicide is
psychiatric illness as aware about it.
•Teach depression is treatable so no
need to take stress or think deeply.
•Try to deestimate the illness.
•Destigmatize treatment
•Encourage health seeking behavior &
continuation of treatment.

29. B. Professional Awareness:-
• Healthcare professional
– physician, pediatrician, nurse practiceners etc.
• Mental health professional
– Psychologist, social workers etc.
• Primary & secondary school staff
– Principle, teacher, counselors, nurses
• College & university resource staff
– Counselors, student health services, student
residence services

30. Contd…..
• Gatekeepers
• Religious leader ,
• police,
• fire departments,
• armed services.

31. 2.Screening:-
•Identify At Risk Individuals
•Identify the patient who have high prone mental
disease R/T suicide
•Identify the “WARNING SIGNS OF SUICIDE’’

32. Warning signs of suicide:-
• Suicidal threat
• Writing farewell letters
• Giving away treasured articles
• Making a will
• Closing bank account
• Appearing peaceful happy after a period of
depression
• Refusing to eat /drink
• Refusing to maintain personal hygiene

33. 3. MEANS RESTRICTIONS:-
• Fire alarm safety
• Construction of barriers of jumping sites
• Detoxification of domestic gas
• Restriction on pesticides
• Reduce lethality or toxicity of prescription
– Use lower toxicity antidepressants
• Restrict sales of lethal hypnotics e.g.
barbiturates

34. 4.Media
a)Media Guidelines
•Encourage implementation of
responsible media guidelines for
reporting on suicide.

35. b) Media Considerations
 Consider how suicide is portrayed in the
media
 TV
 Movies
 Advertisements
 The Internet danger
 Suicide chat rooms
 Instructions on methods
 Solicitations for suicide pacts.

36. Treatment
of
suicidal client
Antidepressants
Psychotherapy

37.  Antidepressants
 Adequate prescription treatment and
monitoring
 Only 20% of medicated depressed patients
are adequately treated with antidepressants
– possibly due to:
Side effects
I.Lack of improvement
II.High anxiety not treated
III.Fear of drug dependency
IV.Didn't combine with psychotherapy
V.Dose not high enough
VI.Didn't add adjunct therapy such as
lithium or other medication(s)
VII.Didn't explore all options including:
ECT or other somatic treatment

38. Psychotherapy:-
• Specifically designed to treat depression
• Relatively short term(10-16 WKS)
• Structured
– It should be step by step treatment instructions
that any other therapist can easily follow
• E.g.
– Cognitive behaviour therapy(CBT)
– Interpersonal therapy (IPT)
– Dialectical behaviour therapy (DBT)
• Implement teaching of these techniques

39. .
Clinical
application

40. Initial approach during emergency:-
• warm, direct & concerned.
• Quick evaluation to identify the condition
• Care on the basis of seriousness is
essential
• Emergency staff should have basics
knowledge of handling psychiatric
emergency.

41. • Medico legal cases need to
be registered separately &
informed to concerned officers
Security should be
adequate to control
violent & dangerous
patients

42. • Findings should be recorded in emergency
file.
• Patient condition & plans
of management should
be explained in simple
language to patient &
family members

44. 1. monitoring the patient safety need
• Take all suicidal threats or attempts seriously
& notify to psychiatrist.
• Remove toxic agent like drugs/alcohol
• Donot leave medication tray within patient
reach.
• Make sure that daily medication swallowed.
• Remove sharp instrument

45. • Contd…
• Remove straps & clothing like belts, necktie
etc.
• Do not allow the patient to bolt his door on the
inside.
• Make sure somebody accompanies him to the
bathroom
• Constant observation & should not be alone
• Good vigilance especially morning hours
• Spend time to him, talk to him & allow him to
ventilate his feelings.

46. Contd….
• Encourage him to talk about his suicidal
plans/method
• If suicidal tendencies are very severe, sedation
should be given.
• Enhancing self-esteem of the patients by
focusing on his strengths & positive qualities
than weakness.

47. 2.Mangement of attempted
suicide in the IPD
• Assess for vitals, check airway
• If pulse weak start IV fluids
• Turn patient head & neck to one side to
prevent regurgitation & swallowing of
vomitus.
• Emergency measures to be instituted in case
of self-inflicted injuries.

48. 3.Management of shock:-
• Transfer the patient to medical centre
immediately
• It there is no evidence of life leave the body in
the same position/room in which it was found.
• Patient has attempted suicide By jumping, do
not leave the body in a place which is visible to
other patient af the ward.
• Inform authorities, record the incident
accurately

49. • Contact local guardian & inform them
• Hand over the patient properties to the
concerned authorities/relatives.
• Senior staff should discuss with all staff
about passive lapse & preventive
measure that need to be undertaken.

50. .
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51. • ASSIGNMENT
Identification of suspected
client for suicide