Psychiatric emergency Dr Miada Mahmoud Rady Depression Its

Psychiatric emergency Dr. Miada Mahmoud Rady

Depression Its more common in females. Leading cause of disability in people 15 - to 44 years old. Can occur in episodes with sudden onset and limited duration. Onset can also be insidious and chronic.

Clinical symptoms For diagnostic features of depression use the mnemonic GAS PIPES: 1. Guilt and self-reproach 2. Appetite (abnormal) 3. Sleep disturbance ( insomnia ) 4. Paying attention : Impaired ability to concentrate.

1. Interest : loss of interest in things that were once important. 2. Psychomotor abnormalities. 3. Energy : Patients are tired all of the time. 4. Suicidal thoughts.

Schizophrenia Typical onset occurs during early adulthood. Dysfunctional symptoms become more prominent over time. Contributing influences for Schizophrenia may include genetics and neurobiological, psychological, and social influences.

Presenting features Schizophrenics may experience: 1. Delusions and hallucinations 2. Apathy and Mutism 3. A flat affect and lack of interest in pleasure 4. Erratic speech and emotional responses 5. A lack of or excessive motor behavior

Neurotic disorders Definition : class of functional mental disorder involving distress but no delusions or hallucinations, where behavior is not outside socially acceptable terms. It includes : I. Anxiety disorder. II. Generalized anxiety disorder (GAD).

Anxiety disorders Definition : Mental disorders in which dominant moods are fear and apprehension , it is characterized by Persistent, incapacitating anxiety in the absence of external threat. Almost 1/5 of adults will experience some form in any given year.

Generalized anxiety disorder(GAD) Definition (requirement for diagnosis ) : 1. excessive worry or anxiety about multiple issues that last 6 months or more. 2. Patient worries about everything for no particular reason. 3. worrying prevents patient from deciding what to do about upcoming situations. 4. Worry must be difficult to turn off or control.

Management When dealing with a patient with GAD: 1. Identify yourself in a calm, confident manner. 2. Listen attentively. 3. Talk with the person generally about their feelings.

Phobias Phobic disorders : an unreasonable fear, apprehension, or dread of a specific situation or thing. Simple phobia focuses all anxieties onto one class of objects or situations e. g. spider , mice and high altitude.

Presentation and management When confronted with the feared object or situation, the phobic person experiences intolerable anxiety. Patient usually realizes the fear is unreasonable. Management : explain each step of treatment in detail before carrying it out.

Panic disorder Definition : Condition characterized by sudden, usually unexpected, overwhelming feelings of fear and terror. Agoraphobia : Fear of going into public places is type of panic attacks that can cause severe lifestyle restrictions.

Women more likely to be affected than men. Tends to run in families Attacks usually begin when patients are in their 20 s. Most persons can identify a stressful event that preceded their first attack.

Clinical presentation a. Symptoms usually peak in intensity within 10 minutes and last around an hour. b. Most of signs and symptoms are due to autonomic nervous system overstimulation c. Hyperventilation is characteristic finding. d. Panic attacks may mimic a range of physical disorders in their presentation.

Management 1. Separate the patient from panicky bystanders and provide a calm environment. 2. Be tolerant of the patient’s disability. 3. Reassure the patient that they are safe and help the patient regain control. 4. Hyperventilating patients should not be treated with paper bag therapy. 5. Patients should be fully evaluated at the hospital.

Substance-related disorders Definition : Include psychological disorders associated with the use of : 1. Alcohol 2. Cigarettes 3. Illicit drugs 4. Other substances affecting the way a person feels, behaves, or thinks.

Classified into four levels: A. Substance use: Use of moderate amounts of substance without seriously affecting ADLs. B. Substance intoxication: Use of a substance that results in impaired thinking and motor function.

C. Substance abuse: Use of a substance disrupts ADLs. D. Substance dependence: physiological dependence or addiction to a substance that requires increasingly larger amounts to produce the same effect.

Eating disorders More common in : 1. Young females. 2. Upper middle or middle class. 3. Living in socially competitive surroundings. Two major types : 1. Bulimia nervosa 2. Anorexia nervosa

Bulimia nervosa Definition : Condition characterized by consumption of large amounts of food for which patients compensate by using purging techniques e. g. vomiting, laxatives, diuretics, excessive exercise.

Anorexia nervosa § Definition : condition in which the patient Exerts extraordinary control over their eating. § Typical patient presents with : 1. Decreased body weight based on age and height 2. Intense fear of obesity. 3. Amenorrhea (absence of menstruation).

Anorexia nervosa