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 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