Psychiatry Emergency

Getu Belay(Msc)

Department of Psychiatry

Dilla University

1
 Psychiatry Emergency

• Credit Hour -2
• ECTS - 3

2
 Out lines

• Overview
• Objectives
• Definition
• History
• Risk factors

3
 Overview

• Emergencies occur in psychiatry just as in every field of medicine does it

happen.
• Includes:
Suicidal ideation & behavior in children & adults
Acutely agigated or violent behavior
Geriatric Bipolar disorder
Border line personality disorder
Eating disorder
Blindly it looks complicated however,it is easily manageable

4
 Objectives
• To enable students to recognize and assess psychiatric emergency
cases
• To manage emergency patients

5
 What is Psychiatric emergency

-Is any disturbance in:

• thoughts,
• behavior,
• feelings or actions in which immediate therapeutic intervention
is necessary.

6
 Types of psychiatric Emergency

• Majorly violence and suicide

 but there are also other psychiatric emergency
- Psychosis
-Substance abuse
-Underlying medical condition

7
 Epidemiology

• Equal proportion of male to female and more by single than married.

• About 20% of patients are suicidal and about 10% are violent.
• About 40% of all patients seen in psychiatric emergency rooms need
Hospitalization.
• The most common diagnosis are mood disorders, schizophrenia,
alcohol dependence

8
 History

• Emergency psychiatry originated during the Russo-Japanese war

( 1904-1905)
 Since the 1960s the demand for emergency psychiatry services has
increased.
 Actual number of psychiatric emergencies has also increased
significantely,especially
 In psychiatric emergency service settings located in urban areas.

9
 History Cont’d

• and currently Emergency cases in Amanuel Hospital has also

increased.
• Services of Emergency have characteristics of accessibility,
convenience, and different policies.
• Therefore these services attract unemployed and homeless people.
• Patients who used psychiatric emergency services shared common
sociological and demographic characteristics .

10
 Suicide

• Definition
-Is derived from the Latin word “self murder"; which is a fatal act that
represents the person wish to die.
Wish to die + act + lose=suicide
• It is not a diagnosis; it is a category of death in which the death was
unnatural and result of the victim’s own actions with the intention to
kill himself/herself.

11
 Suicide Cont’d

• Suicide is the primary emergency for mental health professional.

12
 Etiology

• Even though, it has multiple etiology the most important concept

regarding suicide is that it is almost always the result of mental
illness.
• The most common cause of suicide is depression.

13
 Sociological Factors

• Durkheim’s Theory
.Egoistic suicide applies to those who are not strongly integrated
into any social group.
.Altruistic suicide applies to those susceptible to suicide stemming
from their excessive integration into a group, with suicide being the out
growth of the integration, example, a Japanese soldier who sacrifices
his life in battle.
.Anomic suicide applies to persons whose integration into society is
disturbed so that they can not follow customary norms of behavior .

14
 Psychological Factors

• Freud Theory
Freud stated his belief that suicide represents aggression turned
inward against an interjected, ambivalently love object.
Freud doubted that there would be a suicide without an earlier
repressed desire to kill some one else.

15
 Recent Theory

• Fantasies what would happen and what the consequences would be if

they commit suicide.
• Such fantasies often includes
 Wish for revenge,power,control,or punishment.
 Escape or sleep.
 Rebirth, reunion with the dead, or a new life.
 A study of Aaron Beck showed that hopelessness was one of the most
accurate indicators of long-term suicidal risk.

16
 Biological Factors

 Post- mortem studies have reported

 Modest decrease in serotonin itself or 5-HIAA in either the
brainstem or the frontal cortex of the suicide victims.
Significant changes in presynaptic and postsynaptic serotonin
binding sites in suicide victims.
Reduced central serotonin is associated with suicide.
 Recent studies also report some changes in noradrenergic system
of suicide victims.
 Low concentrations of 5-HIAA in CSF also predict future suicidal
behavior.
17
 Genetic Factors

• Suicidal behavior tends to run in families.

• In psychiatric patients a family history of suicide increases the risk of
attempted suicide and that of completed suicide in most diagnostic
group.
• Concordance rate=monozygotic>dizygotic.

18
 Parasuicidal Behavior

• Deliberate self harming act which mimics the act of suicide but
does not result in a fatal out come.
• Para suicide is a term introduced to describe patients who injure
themselves by self mutilation (Eg.cutting the skin),but who
usually do not wish to die.

19
 Deliberate self Harm

• Self explanatory
 the behavior is self-initiated
 harm is intended (intention to kill is low).
 results in injury or harm.

20
 Psychiatric Disorders Risk for Suicide

• Major depressive disorder

• Psychosis
• Eating disorder
• Personality disorder
• Generalized anxiety disorder
• Geriatric Bipolar disorder
• Acutely agitated & violent behavior

21
 Other Risk factors for Suicide

• CNS disease( Epilepsy,dementia,AIDS,Hantigton disease)

• Endocrine disorder (Cushing disease)
• GI (Peptic ulcer, Cirrhosis)
• End stage of Cancer and persistent chronic pain.

22
 Risk factors for Suicide
Can be majored by SADPERSONS scale
• Sex male 1,female 0
• Age<20>45 1,if not 0
• Depression hx 1,if not 0
• Previous suicide attempt 1,if not 0
• Ethanol or substance hx 1,if not 0
• Rational thinking absence(psychosis) 1
• No spouse 1,if yes 0
• Organized plan 1,if not 0
• No social support 1,if not 0
• Serious medical illness 1,if not 0
23
 SADPERSONS Scale Score

• 0-2 no real problems, keep watch

• 3-4 send home, but check frequently
• 5-6 consider Hospitalization involuntary or voluntary depending on
your level of assurance patient will return for another session.
• 7-10 definitely Hospitalize involuntarily or voluntary.
• So those patients with high intent or attempt to make suicide should
be admitted or referred to psychiatric set up for further management

24
 Neuroleptic Malignant Syndrome

• Fatal complications due to antipsychotics

• Abrupt discontinuation of Levodopa in parkinsonism.
• May occur any time of treatment course
• Prevalence 2-2.4%
• Mortality rate 10-20%
• Male >female
• Young >geriatrics(old age)

25
 Major symptoms

• Muscle rigidity
• Increase in body temperature
• Diaphorosis,tremor dysphagia,mutism
• Urinary incontinence,tachychardia,leukocytosis
• Alteration in consciousness level,hypertention

26
 Treatment( conservative)

• First: discontinuation of antipsychotics medication.

• Decrease body temperature
• Monitoring of vital signs, electrolyte balance
• Muscle relaxant(Bromocroptine,Amantadine,Dantropine) for 5-
10 days.

27
 Prevention

• Use of antipsychotics in appropriate indications.

• Use of antipsychotics in minimum effective dose.
• Use of antipsychotics with cholinergic properties.

28
 References

• Synopsis of Psychiatry
• Text Book of comprehensive psychiatry
• Up to date,html 21.6

29
THANK YOU !!!

30