1. PSYCHIATRIC
EMERGENCIES
SAM KENAZ PAUL
M.SC. NURSING(PSYCHIATRY)
LECTURER

2. INTRODUCTION
◦ Psychiatric emergency is a condition wherein the patient has
disturbances of thought, affect and psychomotor activity leading to
a threat to his existence (suicide), or threat to the people in the
environment (homicide).

3. COMMON PSYCHIATRIC EMERGENCIES
◦ • Suicidal threat
◦ • Violent or aggressive behavior or excitement
◦ • Panic attacks
◦ • Catatonic stupor
◦ • Hysterical attacks
◦ • Transient situational disturbances

4. Suicidal threat
◦ ETIOLOGY
◦ Psychiatric Disorders
◦ • Major depression
◦ • Schizophrenia
◦ • Drug or alcohol abuse
◦ • Dementia
◦ • Delirium
◦ • Personality disorder
◦ Physical Disorders
◦ • Patients with incurable or painful physical disorders like, cancer and AIDS.
◦ Psychosocial Factors
◦ • Failure in examination
◦ • Dowry difficulties
◦ • Marital difficulties
◦ • Loss of loved object

5. MANAGEMENT

6. VIOLENT OR AGGRESSIVE BEHAVIOR OR
EXCITEMENT
◦ This is a severe form of aggressiveness. During this stage, patient will be irrational,
uncooperative, delusional and assaultive.
◦ MANAGEMENT
◦ Talk to the patient and see if he responds.
◦ Usually sedation is given. Common drugs used are: diazepam 10-20mg, IV; haloperidol 10-20mg;
chlorpromazine 50-100mg IM.
◦ Carry out complete physical examination.
◦ Keep environmental stimuli, such as lighting and noise levels to a minimum; assign a single room; limit
interaction with others.
◦ Remove hazardous objects and substances; caution the patient when there is possibility of an accident.

7. PANIC ATTACKS
◦ Episodes of acute anxiety and panic can occur as a part of psychotic or neurotic illness.
◦ The patient will experience palpitations, sweating, tremors, feelings of choking, chest pain,
nausea, abdominal distress, fear of dying, pares
◦ MANAGEMENT
◦ • Give reassurance first
◦ • Search for causes
◦ • Diazepam 10mg or lorazepam 2 mg may be administeredthesias, chills or hot flushes.

8. CATATONIC STUPOR
◦ Stupor is a clinical syndrome of akinesias and mutism but with relative preservation of conscious
◦ awareness. Stupor is often associated with tonic signs and symptoms (catatonic withdrawal or catatonic
stupor).
◦ MANAGEMENT
◦ • Ensure patent airway
◦ • Administer IV fluids
◦ • Collect history and perform physical examination
◦ • Draw blood for investigations before starting any treatment

9. HYSTERICAL ATTACKS
◦ A hysteric may mimic abnormality of any function, which is under voluntary control. The
◦ common modes of presentation may be .
◦ • Hysterical fits
◦ • Hysterical ataxia
◦ • Hysterical paraplegia

10. DRUG TOXICITY
◦ Drug over-dosage may be accidental or suicidal.
◦ In either case all attempts must be made to find out the drug
consumed. A detailed history should be collected and symptomatic
treatment instituted.