Mohammed Reyazuddin Assistant Professor in Psychiatry 1 INTRODUCTION Defined as the conditions in which there is alteration in behaviors emotions or thoughts present acutely and the patients need immediate attention and care ID: 916900
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PSYCHIATRIC EMERGENCIES
Dr. Mohammed ReyazuddinAssistant Professor in Psychiatry
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Slide2INTRODUCTION
Defined as the conditions in which there is alteration in behaviors, emotions or thoughts, present acutely and the patients need immediate attention and care.There occurs sudden disorganization in patients’ judgement, behavior and social role and it affects the socio-occupational functioning.Patient’s behavior is disturbing to himself, his family, or his community.
Broadly, the situation making patient & relatives to seek immediate treatment is emergency.
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Slide3OBJECTIVE FOR EMERGENCY INTERVENTION
To safeguard the life of patient.To bring down the apprehension of family members.To enhance emotional security of others in the environment.
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NEVER ASSUME PATIENT HAS PSYCHIATRIC ILLNESS UNTIL ALL POSSIBLE PHYSICAL CAUSES ARE RULED OUT!
Slide5Common physical causes presenting as Psychiatric emergency
Hypo/hyperglycemiaThyrotoxicosis and hypothyroid crisisHypoxiaCerebral hypoxemiaTraumatic brain injuryDrugsHeat stroke/ hypothermia
CNS infections
Valvular heart diseases (Mitral Valve Prolapse)
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Slide6Features suggesting physical causes
Sudden onsetVisual, but not auditory hallucinationsMemory loss, impairmentAltered pupillary size, symmetry, reactivityExcessive salivationIncontinenceUnusual breath odours
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Slide7Anxiety and related Disorders
Most common psychiatric illness (10% of adults).Patient complains painful uneasiness about impending problems, situations.Also presents with agitation and restlessness.Frequently misdiagnosed as other disorders.
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Slide8Anxiety and related Disorders
PANIC ATTACKPatient feels intense fear, tension, restlessness and cannot concentrate.
Common sign/symptoms are
Dizziness
Tingling of fingers, area around mouth
Carpal-pedal spasms
Tremors
Shortness of breath
Irregular heartbeat and Palpitations
Diarrhea
Sensation of choking /smothering
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Slide9PHOBIAS
Closely related to anxietyStimulated by specific things, places, situations
Signs, symptoms resemble panic attack
Most common is agoraphobia.
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Anxiety and related Disorders
Slide10DepressionDeep feelings of sadness, worthlessness, discouragement
Factor in 50% of suicidesAll depressed patients should be asked about suicidal thoughts.10
Slide11Bipolar Disorder
May present in manic or depressive phase.Manic phase: Inflated self-image, elation, feelings of being very powerful.Depressed phase: Loss of interest, feelings of worthlessness, suicidal thoughts.Delusions, hallucinations occur in either phase.
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Slide12Schizophrenia
Debilitating distortions of speech, thoughtBizarre hallucinationsSocial withdrawalLack of emotional expressiveness
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Slide13Paranoia
Exaggerated, unwarranted mistrustOften elaborate delusions of persecutionTend to carry grudgesCold, hypersensitive, defensive, argumentative
Cannot accept fault
Excitable, unpredictable
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Slide14Catatonia
Characterized by signs likeMutismPosturing
Negativism
Staring
Rigidity
Echopraxia
/ echolalia
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Slide15Catatonia
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Slide16Suicide
Suicide attempt is any willful act designed to end one’s own life.10th leading cause of death.Second among college students.Women attempt more often.Men succeed more often.50% who succeed attempted previously.75% gave clear warning of intent.
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All suicidal acts are serious!
Slide17RISK FACTORS
Men, >40 yearSingle, widowed, or divorcedDrug, alcohol abuse history
Severe depression
Previous attempts, gestures
Highly lethal plans
Obtaining means of suicide (gun, pills,
etc
)
Previous self-destructive behavior
Current diagnosis of serious illness
Recent loss of loved one
Arrest, imprisonment, loss of job
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Suicide
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Suicide
Risk Factors for Suicide
Slide19Violence
60 to 70% of behavioral emergency patients are assaultive or violent.Common causes are:
Real, perceived mismanagement
Psychosis
Alcohol, drugs
Fear
Panic
Head injury
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Slide2020
Violence
Slide21Dealing with Psychiatric Emergencies
Personal safety of doctors is most importantTrauma, medical problems have priorityCalm the patient; NEVER leave him aloneUse restraints as needed to protect yourself, the patient, othersTransport to facility with appropriate resourcesSpeak calmly, reassuringly, directly
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Slide22Dealing with Psychiatric Emergencies
Maintain comfortable distanceSeek patient’s cooperationMaintain eye contact
No quick movements
Respond honestly
Never threaten, challenge, belittle, argue
Always tell the truth
Involve trusted family, friends
Encourage patient to perform simple, noncompetitive tasks
Disperse crowds that have gathered
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Slide23Assessment
23RULING OUT ANY LIFE THREATENING MEDICAL CONDITION IS MOST IMPORTANT AND MANDATORY!
Slide24Restraining PatientsA patient may be restrained if there is good reason to believe that he is a danger to himself or others.
Use humane restraints (soft leather, cloth) on limbs.Secure patient to stretcher with straps at chest, waist, thighs.If patient spits, cover face with surgical mask.24
Force must NEVER be punitive in nature!
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THANK YOU