PSYCHIATRIC EMERGENCY PSYCHIATRIC EMERGENCY Conditions need immediate interventions
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PSYCHIATRIC EMERGENCY
PSYCHIATRIC EMERGENCY Conditions need immediate interventions &any Delay increase risk for patients and others n One of the most Pitfall in Psychiatric Emergency is NEGLECT &IGNORE of ORGANIC CAUSALITY in Emotional Disorders n
PSYCHIATRIC EMERGENCY n n 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 n Male= Female n Single> Married n Often Night Time n
PSYCHIATRIC EMERGENCY Clinical Evaluation: FIRST : Emergency Interventions THEN: Diagnosis & Treatment of Major Disease n
SUICIDE n n 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 n
SUICIDE Medical Problems: CNS Disease (Epilepsy, MS, AIDS, Dementia, Hantington) Endocrine (Cushing Disease, Anorexia Nervosa, Kleinfelter) GI (Peptic Ulcer, Cirrhosis) n Immobility , Disfigurement , Persistent Chronic Pain
SUICIDE ETIOLOGY n Biologic Serotonergic Hypofunction, Platlet MAO decrease , Genetic n Psychologic Hoplessness, Depression, Impulsivity, Aggressivity n Social Family Discord , Divorce, Single, Lack of Support
SUICIDE HIGH RISK SUICIDE: n Male n >45 Yrs old n Single & Divorce n Unemployment n Unstable Family & Interpersonal Relationship n Severe Depression, Psychosis, Personality Disorder, Substance Use (Alcohol)
SUICIDE HIGH RISK SUICIDE n Hopelessness n Prolonged & Severe Suicidal Thought n HX of Several Attempts, with Plan, Low Rescue, Use of Fatal Methods
SUICIDE n TREATMENT OF SUICIDAL PATIENTS:
AGGRESSION & VIOLENCE AGGRESSION n Goal directed Behavior (verbal or nonverbal) for Hurt VIOLENCE n Severe & Sudden Goal directed Behavior to Destruction of property OR Hurt OR Kill others
AGGRESSION & VIOLENCE n n BMD Schizophrenia, Schizophreniform, Brief Psychotic Disorder MDD Personality Disorders
AGGRESSION & VIOLENCE RISK EVALUATION: n Demographic Characteristics: Male , 15 -24 Yrs, Low SES &Social Support n Evaluation of Thought, Attempt, Plan for Violence, Weapons Availability n Past HX of: Violence, Antisocial Behaviors , Impulse Control Disorder (Substance, …. ) n HX of Major Stressor: Loss, Family Discord…
AGGRESSION & VIOLENCE Impending Violence: n Verbal or Physical Threatening n Progressive Restlessness n Weapons Carrier n Substance or Alcohol Abuser n Excited Catatonia n Paranoid (Psychosis) n Personality Disorder
AGGRESSION & VIOLENCE n TREATMENT ALGORYTHM:
CATATONIA n TREATMENT ALGORYTHM
NOROLEPTIC MALIGNANT SYNDROM(NMS) n n n n 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: n Muscle Rigidity n 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) n FIRST: Discontinuation of AP n Decrease Body Temperature n Monitoring of Vital Signs, Hydratation, Electrolyte, I/O n Muscle Relaxant (Bromocriptine, Amantadine, Dantrolene) FOR 5 -10 DAYS
NEUOROLEPTIC MALIGNANT SYNDROM(NMS) Prevention n Use of AP in Appropriate Indications n Use of AP in Minimum Effective Dose n Use of AP with Cholinergic Properties
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