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PSYCHIATRIC EMERGENCY

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.

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PSYCHIATRIC EMERGENCY

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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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