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.
2. Stupor &Catatonic syndrome
3. Excited and violent behaviour
4. Aggressive behaviour
6. Other psychiatric emergencies
Meaning: It is a human act of self intentioned and self inflicted death.
· 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.
· Major depression
· Drug or alcohol
· Personality disorder
· Loss of loved one
· Financial problems
· Marital problems
Risk factors for suicides
o Males above 40 years
o Females above 55 years
o Men have more completed suicide
o Women have higher rate of attempted suicide
o Single individuals
o History of previous suicidal attempts.
· 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.
• Organic psychiatric disorders
• Non-Organic psychiatric disorder
• Drug and alcohol dependence
• Acute stress reaction
• Neurotic disorders
• Impulsive violent behaviour
• Reactive psychosis
• 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
• Neurological disorders
• Metabolic disorders
• Drugs and poisoning
• Psychiatric disorders
• 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