PSYCHIATRIC EMERGENCY
M.SADRAMELY M.DCHILD&ADOLESCENT PSYCHIATRIST
ASSISTANT PROFESSOR OF MEDICAL
UNIVERSITY
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
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
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
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