PSYCHIATRIC EMERGENCY
PSYCHIATRIC EMERGENCY
Conditions need immediate interventions &any
Delay increase risk for patients and others One of the most Pitfall in Psychiatric
Emergency is NEGLECT &IGNORE of ORGANIC CAUSALITY in Emotional Disorders
PSYCHIATRIC EMERGENCY
SUICIDE & HOMICIDE AGGRESSION & VIOLENCE CATATONIA NMS (Neuroleptic Malignant Syndrome)
PSYCHIATRIC EMERGENCY
Prevalence:
%20 of referrals; Suicidal
%10 of referrals; Aggressive or Violency Behavior
%40 of ALL Referrals need Hospitalization Male= Female Single> Married Often Night Time
PSYCHIATRIC EMERGENCY
Clinical Evaluation:
FIRST : Emergency Interventions
THEN: Diagnosis & Treatment of Major Disease
SUICIDE
Suicidal Thought Suicidal Threat Suicidal Attempt: F >M Committed Suicide: M>F
SUICIDE
Psychiatric Disorder:
MDD, Dysthymia, BMD
Schizophrenia,Schizophreniform,Brief Psychotic Disorder
PTSD,OCD,GAD
Personality Disorders
SUICIDE Medical Problems:CNS Disease (Epilepsy, MS, AIDS, Dementia,
Hantington)Endocrine (Cushing Disease, Anorexia Nervosa,
Kleinfelter)GI (Peptic Ulcer, Cirrhosis)
Immobility , Disfigurement , Persistent Chronic Pain
SUICIDE
ETIOLOGY Biologic
Serotonergic Hypofunction, Platlet MAO decrease
,Genetic Psychologic
Hoplessness, Depression, Impulsivity, Aggressivity Social
Family Discord ,Divorce, Single, Lack of Support
SUICIDE
HIGH RISK SUICIDE: Male >45 Yrs old Single & Divorce Unemployment Unstable Family & Interpersonal Relationship Severe Depression, Psychosis, Personality
Disorder, Substance Use (Alcohol)
SUICIDE
HIGH RISK SUICIDE Hopelessness Prolonged & Severe Suicidal Thought HX of Several Attempts, with Plan, Low
Rescue, Use of Fatal Methods
SUICIDE
TREATMENT OF SUICIDAL PATIENTS:
AGGRESSION & VIOLENCE
AGGRESSION Goal directed Behavior (verbal or
nonverbal) for Hurt
VIOLENCE Severe & Sudden Goal directed Behavior
to Destruction of property OR Hurt OR Kill others
AGGRESSION & VIOLENCE
BMD Schizophrenia, Schizophreniform, Brief
Psychotic Disorder MDD Personality Disorders
AGGRESSION & VIOLENCE
RISK EVALUATION: Demographic Characteristics:Male ,15-24 Yrs,
Low SES &Social Support Evaluation of Thought, Attempt, Plan for
Violence, Weapons Availability Past HX of: Violence, Antisocial
Behaviors ,Impulse Control Disorder (Substance,….)
HX of Major Stressor: Loss, Family Discord…
AGGRESSION & VIOLENCE
Impending Violence: Verbal or Physical Threatening Progressive Restlessness Weapons Carrier Substance or Alcohol Abuser Excited Catatonia Paranoid (Psychosis) Personality Disorder
AGGRESSION & VIOLENCE
TREATMENT ALGORYTHM:
CATATONIA
TREATMENT ALGORYTHM
NOROLEPTIC MALIGNANT SYNDROM(NMS) Fatal Complication due to Antipsychotics Abrupt Discontinuation Levodopa in
Parkinsonism Anytime in Treatment Course Prevalence:%/02- 2.4 Mortality Rate:%10-20 Male>Female Young>Geriatrics
NOROLEPTIC MALIGNANT SYNDROM(NMS)
Major Symptoms: Muscle Rigidity Increase in Body Temperature
AND 2 Symptoms of:
Diaphoresis/ Tremor/ Dysphagia/ Mutism/ Urinary Incontinency/Tachycardia/Alteration in Consciousness level/Leucocytosis/HTN/ Muscle Injury (CPK)
NEUOROLEPTIC MALIGNANT SYNDROM(NMS)
Treatment (Conservative) FIRST: Discontinuation of AP Decrease Body Temperature Monitoring of Vital Signs, Hydratation,
Electrolyte, I/O Muscle Relaxant (Bromocriptine,Amantadine,
Dantrolene)
FOR 5-10 DAYS
NEUOROLEPTIC MALIGNANT SYNDROM(NMS)
Prevention Use of AP in Appropriate Indications Use of AP in Minimum Effective Dose Use of AP with Cholinergic Properties