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Psychiatric Emergency: Urgency in Diagnosis & Treatment

Psychiatric emergencies require immediate attention to conditions like suicide, aggression, and catatonia. Neglecting organic causes can be perilous. Evaluation should prioritize emergency interventions and then diagnose and treat major underlying diseases. Identifying high-risk suicide factors, such as hopelessness and severe suicidal thoughts, is crucial. Effective treatment of suicidal patients involves managing aggression and violence. Understanding risk factors, triggers, and symptoms is key in preventing violent behaviors. Treatment algorithms for conditions like catatonia and neuroleptic malignant syndrome must be followed diligently.

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Psychiatric Emergency: Urgency in Diagnosis & Treatment

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  1. PSYCHIATRIC EMERGENCY

  2. 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

  3. PSYCHIATRIC EMERGENCY • SUICIDE & HOMICIDE • AGGRESSION & VIOLENCE • CATATONIA • NMS (Neuroleptic Malignant Syndrome)

  4. 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

  5. PSYCHIATRIC EMERGENCY • Clinical Evaluation: FIRST : Emergency Interventions THEN: Diagnosis & Treatment of Major Disease

  6. SUICIDE • Suicidal Thought • Suicidal Threat • Suicidal Attempt: F >M • Committed Suicide: M>F

  7. SUICIDE • Psychiatric Disorder: MDD, Dysthymia, BMD Schizophrenia,Schizophreniform,Brief Psychotic Disorder PTSD,OCD,GAD Personality Disorders

  8. 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

  9. SUICIDE ETIOLOGY • Biologic Serotonergic Hypofunction, Platlet MAO decrease ,Genetic • Psychologic Hoplessness, Depression, Impulsivity, Aggressivity • Social Family Discord ,Divorce, Single, Lack of Support

  10. SUICIDE HIGH RISK SUICIDE: • Male • >45 Yrs old • Single & Divorce • Unemployment • Unstable Family & Interpersonal Relationship • Severe Depression, Psychosis, Personality Disorder, Substance Use (Alcohol)

  11. SUICIDE HIGH RISK SUICIDE • Hopelessness • Prolonged & Severe Suicidal Thought • HX of Several Attempts, with Plan, Low Rescue, Use of Fatal Methods

  12. SUICIDE • TREATMENT OF SUICIDAL PATIENTS:

  13. 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

  14. AGGRESSION & VIOLENCE • BMD • Schizophrenia, Schizophreniform, Brief Psychotic Disorder • MDD • Personality Disorders

  15. 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…

  16. AGGRESSION & VIOLENCE Impending Violence: • Verbal or Physical Threatening • Progressive Restlessness • Weapons Carrier • Substance or Alcohol Abuser • Excited Catatonia • Paranoid (Psychosis) • Personality Disorder

  17. AGGRESSION & VIOLENCE • TREATMENT ALGORYTHM:

  18. CATATONIA • TREATMENT ALGORYTHM

  19. 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

  20. 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)

  21. 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

  22. NEUOROLEPTIC MALIGNANT SYNDROM(NMS) Prevention • Use of AP in Appropriate Indications • Use of AP in Minimum Effective Dose • Use of AP with Cholinergic Properties

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