2. PSYCHIATRIC EMERGENCY

3. 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

4. PSYCHIATRIC EMERGENCY
SUICIDE & HOMICIDE
AGGRESSION & VIOLENCE
CATATONIA
NMS (Neuroleptic Malignant Syndrome)

5. 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

6. PSYCHIATRIC EMERGENCY
Clinical Evaluation:
FIRST : Emergency Interventions
THEN: Diagnosis & Treatment of Major Disease

8. SUICIDE Suicidal Thought Suicidal Threat Suicidal Attempt: F >M
Committed Suicide: M>F

9. SUICIDE Psychiatric Disorder: MDD, Dysthymia, BMD
Schizophrenia,Schizophreniform,Brief Psychotic Disorder
PTSD,OCD,GAD
Personality Disorders

10. 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

12. SUICIDE ETIOLOGY Biologic
Serotonergic Hypofunction, Platlet MAO decrease
,Genetic
Psychologic
Hoplessness, Depression, Impulsivity, Aggressivity
Social
Family Discord ,Divorce, Single, Lack of Support

13. SUICIDE HIGH RISK SUICIDE: Male >45 Yrs old Single & Divorce
Unemployment
Unstable Family & Interpersonal Relationship
Severe Depression, Psychosis, Personality Disorder, Substance Use (Alcohol)

14. SUICIDE HIGH RISK SUICIDE Hopelessness
Prolonged & Severe Suicidal Thought
HX of Several Attempts, with Plan, Low Rescue, Use of Fatal Methods

16. SUICIDE
TREATMENT OF SUICIDAL PATIENTS:

18. 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

19. AGGRESSION & VIOLENCE BMD
Schizophrenia, Schizophreniform, Brief Psychotic Disorder
MDD
Personality Disorders

20. 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…

21. AGGRESSION & VIOLENCE Impending Violence:
Verbal or Physical Threatening
Progressive Restlessness
Weapons Carrier
Substance or Alcohol Abuser
Excited Catatonia
Paranoid (Psychosis)
Personality Disorder

22. AGGRESSION & VIOLENCE
TREATMENT ALGORYTHM:

24. CATATONIA
TREATMENT ALGORYTHM

26. NOROLEPTIC MALIGNANT SYNDROM(NMS)
Fatal Complication due to Antipsychotics
Abrupt Discontinuation Levodopa in Parkinsonism
Anytime in Treatment Course
Prevalence:%/
Mortality Rate:%10-20
Male>Female
Young>Geriatrics

27. 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)

28. 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

29. NEUOROLEPTIC MALIGNANT SYNDROM(NMS)
Prevention
Use of AP in Appropriate Indications
Use of AP in Minimum Effective Dose
Use of AP with Cholinergic Properties