Psychiatric emergencies
Definition: Psychiatric emergency is a disturbance in thought,
mood and/or action which causes sudden distress to the individual (or to
significant others) and/ or sudden disability, thus requiring immediate
management.
Types
1.
Suicide
2.
Stupor
&Catatonic syndrome
3.
Excited and
violent behaviour
4.
Aggressive
behaviour
5.
Anger
6.
Other psychiatric
emergencies
Suicide
Meaning: It is a human act of self intentioned and
self inflicted death.
Epidemiology:
·
Highest prevalence
of adolescence suicide is in South East Asia and Europe (Mac.Louglin A B)
·
Highest suicide is
seen in India.
·
One person commits
suicide in every 40 seconds
·
According to WHO
report more than 2 lakh people committed suicide in the year 2012.
·
Suicidal death
rates are higher in males than females.
·
Most common methods are poisoning and hanging.
Etiology
Psychiatric Disorders
·
Major depression
·
Schizophrenia
·
Drug or alcohol
·
Dementia
·
Delirium
·
Personality
disorder
Physical Disorders
·
Cancer
·
AIDS
·
pain
Psychosocial factors
·
Loss of loved one
·
Isolation
·
Financial problems
·
Marital problems
Risk factors for
suicides
·
Age
o Males above 40 years
o Females above 55 years
·
Sex
o Men have more completed suicide
o Women have higher rate of attempted suicide
o Single individuals
o History of previous suicidal attempts.
Management
·
Identify the early
warning signs of suicides like
o Suicidal threat
o Making a will
o Closing bank accounts
o Giving away possessions
o Writing suicidal notes
o Being happy after a period of depression
·
Consider all the
suicidal threat/gestures as serious and notify the mental health professional
·
Do a risk
assessment and take precautions
·
Remove all sharp
objects, ropes and any potentially hazardous objects from the reach of the
patient.
·
Avoid patient
access to drug tray.
·
Keep the patient
under close observation by assigning a room which is visible from nurse’s
station.
·
Don’t allow the
patient to lock the room or doors of toilet.
·
Patient should not
be left alone.
·
Have vigilant
observation during morning hours.
·
Encourage to
express his/her feelings
·
Sedation if severe
suicidal tendencies exist based on Doctor’s prescription.
·
Counselling and
guidance in helping to resolve the problems faced by the patient.
·
Maintain a
suicidal pact after discussing with the patient.
·
Encourage in
discussing with the staff nurse if any suicidal thoughts are coming.
·
Promote self
esteem of the patient by identifying strength and weaknesses and promoting the
positive qualities.
·
ECT can be
effective if the patient is diagnosed to have major depression and associated
suicidal risk.
Management of attempted suicide
·
Monitor the vital
signs.
·
Stabilize the
patient by immediate management
·
Refer to
counselling services
·
Closely monitor
for repeated attempts
Management in
suicidal death
·
Inform the hospital
authority and police immediately
·
After police
arrives remove the body from the public area
·
Involve other
patients in diversional activities
·
Record the
incidence
·
Transfer body to
mortuary
·
Hand over patient
properties to relatives.
·
Observe all the
other patients carefully for any change in behaviour and notify the mental
health professional.
Violence
Etiology
• Organic psychiatric disorders
• Non-Organic psychiatric disorder
• Mania
• Depression
• Drug and alcohol dependence
• Epilepsy
• Acute stress
reaction
• Neurotic disorders
• Impulsive violent behaviour
• Reactive psychosis
Nursing
Management
• Talk to the
patient
• Collect detailed
history
• Physical
examination
• Have less
furniture in room
• Reduce the
environmental stimuli
• Remove sharp
objects
• Stay with the
patient
• Redirect violent
behaviour
• Encourage
expression of feelings
• If unable to
manage restraint can be used
• Protection of self
Stupor
Etiology
• Neurological
disorders
• Metabolic
disorders
• Drugs and
poisoning
• Psychiatric
disorders
Management
• Ensure patent
airway
• Collect history
• Draw blood for investigations
• 50ml of 50%
dextrose in case of hypoglycemia
• If stupor is drug
induced
In case of Morphine poisoning, Naloxone 0.4mg IV
In case of Anticholinergic poisoning, Physostigmine
1-2mg IV
In case of Wernicke’s encephalopathy, Thiamin 100mg IV
Other
psychiatric emergencies
• Delirium tremens
• Hysterical attacks
• Drug induced extra
pyramidal syndrome
• Drug toxicity
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