Introduction:

A psychiatric emergency is a disturbance of behavior, affect and thought for which immediate treatment is judged to be necessary by: The patient The family, friends and the authority The nurses and the physicians

Definition :
Psychiatric emergency is a condition where in the patient has the disturbance of the thought, affect and the psychomotor activity leading to threat to his existence or the threat to the other people in the environment. It is defined as a sudden onset of an unusual, disordered or socially inappropriate behavior caused by an emotional or physiological situation.

Emergency psychiatry is the clinical application of psychiatry in emergency settings Conditions requiring psychiatric interventions may include attempted suicide, substance abuse, depression,psychosis, violence or other rapid changes in behavior.

INCIDENCE:

WHO estimates that about 1,00,000 people die by suicide every year. A global mortality rate is 16/100,000 per year.

Purpose:
To safeguard the life of the patient To bring down the anxiety of the family members To enhance emotional security to others in the environment.

Common psychiatric emergency:

Suicide Violent behaviour Drug induced extra pyramidial symptoms Delirium tremens Panic reaction Drug withdrawal Hysterical attack Excitement stupor

Suicide:
According to Sheidman suicide is defined as the human act of self inflicted,self intentioned cessation of life which involves tortured and tunneled logic in a state of inner felt,intolerable emotions. suicide means killing one self .The act constitutes a person willingly,perhaps ambivalently ,taking his or her own life. Half hearted suicide may be desperate cries for help and the individual

Etiology:
1.Psychiatric disorder: Depression Anxiety disorder Alcoholism and drug dependence Schizophrenia 2.physical disorder 3.psychosocial factors 4.genetic factors 5.proximal factors 6.neurochemical factors

Warning signs:

Change in grades at the school Loss of interest ,initiative Sudden apperance of peacefulness in agitateda and the depressed May becomes secretive Making a will Withdraws from the family interaction Unexpected visiting friend and the family members

Change in the personal hygiene Talking about hopelessness or feeling guilty Isolates self from others

Talking about suicide and death in general

Isolates self from others Talking about suicide and death in general Giving away prized possessions Writing a suicidal note Talking about going away Hints about intention Engaging in self distractive behaviour

Purchasing a gun or rope.

MYTHS: Just a threat Harmful for a person to talk about suicide Only psychotic persons commit suicide Nice home, good job or an intact family prevent suicide Failed attempt may be treated as a manipulative behaviour

Covert clues:

I just want to go to sleep and not think anymore.

I want it to be all over.

it will just be the end of the story.

You have been a good friend

Remember me

Contd

If there is ever any need for anyone to know this my will and insurance papers are in the top drawer of my dressers.

I cant stand the pain anymore Everyone will feel bad soon Everyone would be better of without me

Suicide Rating Scale

S A D P E R SEX age depression Previous attempt ETOH Rational thought loss males Middle age 45 and over 65 25-30% 50-80% 20-90% psychosis

S
O

social support, lack

organized plan

lacking support from near ones

method,time,date,place,fantasies of funeral and grieving of significant other. single, windowed ,divorced, and separated people

no significant other

sickness

painful,debilitating,terminal illness

Points 0-2

3 or 4

5 or 6 >7

intervention guidelines can stay at home with support of others and outpatient treatment support of significant others with more intense outpatient care,may consider hospitalization hospitalization strongly recommended hospitalization recommended

Management of suicidal/risk attempt:

Suicidal attempt: Needs surgical or medical management

Talk to the patient

Keep patient under supervision Patient should not be left alone Hospitalize if needed Treatment of psychiatric disorder: benzodiazepines like lorazepam or diazepam

ECT Counseling Follow up

Steps for preventing suicide:

Early recognition of depression

Intervene before these individuals become suicidal

Take all the suicide threats seriously Keep the environment free from potential dangers. Do not leave the patient alone Establish a good rapport and trusting relationship with the patient. Make sure windows are locked or grill Located near the nurses station and not at the end of a near an exit,elevator or stairwell.

Spend sometime with the patient and allow him to ventilate his feelings. Assess need for disposable metal trays,no metal or glass. Patients room should be centrally located preferably nears the nurses station and within view of the staff. Increased public and professional awarenss about depression and suicide. Perform a suicide risk assessment just before discharge to ensure that the patient is not a high risk for suicide.

Do not leave the drug tray within the reach of the patient, make sure daily medication is swallowed Keep the medication in cupboard under the lock and the key Stay with patient when he meets the hygienic needs Check in the bathroom and toilet Check the patient at frequent ,irregular intervals during night,evening,morning Provide for maintenance of physical status Beware of the risk time

Thank-you