1 / 30

PSYCHIATRIC EMERGENCY

PSYCHIATRIC EMERGENCY. 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. PSYCHIATRIC EMERGENCY.

maysl
Download Presentation

PSYCHIATRIC EMERGENCY

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. PSYCHIATRIC EMERGENCY

  2. 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

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

  4. 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

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

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

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

  8. 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

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

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

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

  12. SUICIDE • TREATMENT OF SUICIDAL PATIENTS:

  13. 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

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

  15. 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…

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

  17. AGGRESSION & VIOLENCE • TREATMENT ALGORYTHM:

  18. CATATONIA • TREATMENT ALGORYTHM

  19. NOROLEPTIC MALIGNANT SYNDROM(NMS) • 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

  20. 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)

  21. 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

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

More Related