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

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