PSYCYHIATRIC EMERGENCY MANAGEMENT

in
THE FAMILY SETTING

The Star of life,

representing emergency medical services

Dr. Muhammad Lawi Yusuf, SpKJ (K)

Dept. of Psychiatry of Med. Fac. of Sriwijaya Univ. and
RSMH Palembanmg

INTRODUCTION
DEFINITION
Emergency Psychiatry / Psychiatric Emergency is the
clinical application of
psychiatry in emergency settings.
Psychiatric Emergency Services (PES) is a 24-hours a day
service provided for psychiatric emergencies for both
voluntary and involuntary patients

 CONDITIONS REQUIRING INTERVENTIONS

1.
2.
3.
4.
5.
6.
7.
8.

Suicide
Substance Abuse
Anxiety/Panic
Disaster
Abuse, physical/sexual
Psychosis
Violence or
other rapid changes in behaviour

FAMILY

ALL FAMILY MEMBERS AS ONE INTEGRATED UNIT, CONNECTED

TO EACH OTHER, LIKE A ROPE NETWORK

IF ONE MEMBER OF THE FAMILY BECOME SICK, THE WHOLE

FAMILY MEMBERS MUST BE INVOLVED IN THE TREATMENT
PROCESS, AND THE PATIENT TREATED AS A CENTRAL POINT.

1. Suicide attempts and suicidal thoughts

predict acts of violence patients may commit against
themselves (or others), even though the complex factors
leading to a suicide stem from so many sources,
including psychosocial, biological, interpersonal,
anthropological and religious
use any resources available to them to determine risk
factors, make an overall assessment, and decide on any
necessary treatment.

2. Substance abuse, dependence, intoxication

Psychoactive drugs
- intoxication,
Alcohol: idioyncratic intoxication could occur in some individuals even
after the consumption of relatively small amounts of alcohol. Episodes
of this impairment usually consist of confusion, disorientation,
delusions and visual hallucinations, increased aggressiveness, rage,
agitation and violence.
Acting as a depresant of the CNS, the early effects of alcohol are
usually desired for and characterized by increased talkativeness,
giddiness, and a loosening of social inhibitions. Besides considerations
of impaired concentration, verbal and motor performance, insight,
judgment and short term memory loss which could result in
behavioral change causing injury or death, levels of alcohol below 60
milligrams per deciliter of blood are usually considered non-lethal.
Chronic alcoholcs may also suffer from alcoholic hallucinosis, wherein
the cessation of prolonged drinking may trigger auditory
hallucinations. Such episodes can last for a few hours or an entire
week.

Alcohol.
However, individuals at 200 milligrams per deciliter of blood
are considered grossly intoxicated and concentration levels at
400 milligrams per deciliter of blood are lethal, causing
complete anesthesia of the respiratory system.
Patients may also be treated for substance abuse following the
administration of psychoactive substances containing
amphetamine, caffeine, tetrahydrocannabinol, cocaine,
phencyclidine, or other inalants, opioid, sedatives, hypnotic,
anxyolitycs, psycedelics dissosiatives and deliriants
the clinician must determine substances used, used of the route
of administration, dosage, and time of last use to determine the
necessary short and long term treatments. An appropriate
choice of treatment setting must also be determined must also
be determined.

3. Anxiety / Panic
Feelings of anxiety may present in different ways from:
a) an underlying medical illness or psychiatric disorder,
b) a secondary functional disturbance from another psychiatric
disorder,
c) from a primary psychiatric disorder such as panic disorder or
generalized anxiety disorder, or as a result of stress from such
conditions as adjustment disoreder or post-traumatic stress
disorder.
Clinicians usually attempt to first provide a "safe
harbor" for the patient so that assessment processes and
treatments can be adequately facilitated.
The initiation of treatments for mood and anxiety disorders are
important as patients suffering from anxiety disorders have a
higher risk of premature death

5. Abuse, physical / sexual

Incidents of physical abuse, sexual abuse, or rape can
result in dangerous outcomes to the victim of the criminal
act. Victims may suffer from extreme anxiety, fear,
helplessness, confusion, eating or sleeping disorders,
hostility, guilt and shame. Managing the response usually
encompasses coordinating psychological, medical and legal
considerations.

6. Psychosis
Patients with psychotic symptoms are common in
psychiatric emergency service settings.
An individual could also be suffering from an acute onset
of psychosis. Such conditions can be prepared for diagnosis
by obtaining a medical or psychopathological history of a
patient, performing a mental status examination,
conducting psychological testing, obtaining neuroimage,
and obtaining other neurophysiologic measurements

7. Violent behavior
Aggression can be the result of both internal and
external factors that create a measurable activation in
the autonomic nervaous system.
Violence is also associated with many conditions such as
acute intoxixation, acute psychosis, paranoid
personality disorder, antisocial personalioty disorder,
narcisisstic personality disorder, and borderline
personality disorder.

TREATMENT
1) Medications
the rapidity of effect is an important consideration.
Pharmacokinetics is the movement of drugs through the body
with time and is at least partially reliant upon the router of
administration, absorption, distribution and metabolism of the
medication
In cases of vomiting and nausea this method of administration
is not an option. Suppopsitories can, in some situations, be
administered instead. Medication can also be administered
through intramuscular injection, or through intravenous
injection.
Generally, though, the timing with medications is relatively
fast and can occur within several minutes. As an example,
physicians usually expect to see a remission of symptoms thirty
minutes after haloperidol, an antipsychotic, is administered
intramuscularly.

2) Psychotherapy
Brief psychotherapy can be used to treat acute conditions
or immediate problems as long as the patient understands
his or her issues are psychological, the patient trusts the
physician, the physician can encourage hope for change,
the patient has motivation to change, the physician is
aware of the psychopathological history of the patient, and
the patient understands that their confidentiality will be
respected.

If the physician determines that deeper psychotherapy

sessions are required, he or she can transition the patient
out of the emergency setting and into an appropriate clinic
or center

4) Hospital admission
The emergency care process.
The staff will need to determine if the patient needs to
be admitted to a psychiatric inpatient facility or if they
can be safely discharged to the community after a
period of observation and/or brief treatment.
Initial emergency psychiatric evaluations usually
involve patients who are acutely agitated, paranoid, or
who are suicidal. Initial evaluations to determine
admission and interventions are designed to be as
therapeutic as possible

THE END
&
THANK YOU