Introduction
Acute psychiatric emergencies are psychological distress such as depression or stress, which can harm themselves and the environment, and should undergo urgent treatment. Any mental disorder such as depression, schizophrenia (a disorder that affects the person’s thinking), or alcohol abuse carries the risk of suicide. Every psychiatric patient should undergo an assessment of suicidal ideation and should understand that these thoughts are related to their mental disorder. In case the patient has attempted, any risk to life should be assessed, and they should be admitted to the ICU (intensive care unit) and referred to a psychiatrist.
What Are Acute Psychiatric Emergencies?
Acute psychiatric emergencies are a type of severe disturbance in behavior and psychological distress, such as depression or stress, that require urgent treatment. If these conditions are left untreated, they could harm the affected person and the environment. These emergencies require urgent intervention to make sure the patient is safe, along with their mental health. Some emergencies are:
1. Suicidal Behavior: This situation includes suicide attempts, therefore causing harm to oneself or others. This requires immediate intervention to make sure the patient is safe, and tools should be assessed, which can increase the risk of suicide. Apart from these, the patient’s state of mind should also be evaluated. Patients with an increased risk of suicidal behavior should undergo electro-convulsive therapy (ECT), where small electric currents are given to reverse mental illness symptoms.
2. Violent or Aggressive Behavior: This situation occurs when a person poses a threat by harming themselves physically or others. This can include threats of violence, physical aggression, or harmful behaviors. Alcohol and drug abuse can predispose violent behaviors. Some psychiatric disorders can also cause violent behaviors, such as schizophrenia, mania (extreme mood changes), paranoid psychosis (unreasonably suspicious), post-traumatic stress disorder, or personality disorder. Some medical conditions that can cause violent behavior include brain infections, injury to the brain, seizures, hypoglycemia (decreased blood sugar level), hypoxia (decreased oxygen level), vitamin deficiencies, and disturbance in temperatures.
3. Psychotic Episodes: Psychotic episodes can involve hallucinations (seeing or hearing things that are not there) and delusions (strong beliefs that are not real).
4. Acute Severe Anxiety or Panic Attacks: This is characterized by intense anxiety or panic attacks, which cause an increase in the risk of harming themselves. Certain medications, such as anti-anxiety drugs or sedatives, can be given.
5. Substance Intoxication or Withdrawal: In these cases, the individuals experience severe intoxication or withdrawal symptoms from substances such as alcohol, cocaine, or phencyclidine. The patient should be kept under observation, and sedation or physical restraints should be used in case of violent behavior.
6. Neuroleptic Malignant Syndrome: This occurs in the case of patients taking antipsychotic drugs such as Butyrophenones or Phenothiazines. High doses of these medications cause a block in central dopamine receptors and cause muscle rigidity, increased heart rate, altered mental status, and increased blood pressure.
7. Serotonin Syndrome: This occurs in patients who are taking serotonergic agents, which affect the pathway of serotonin (a chemical that carries information from the brain to the body). A sudden increase in serotonin can cause life-threatening conditions.
How Are Acute Psychiatric Emergencies Managed?
Management of acute psychiatric emergencies includes:
1. Assessment and Evaluation of Risk: This is an important step in managing psychiatric emergencies. This involves the evaluation of the patient’s mental state, along with the level of distress. Apart from these, any potential risks should also be assessed. This should also involve the identification of signs of self-harm or to others and any act of violence. Along with these, any underlying medical conditions or substance use should also be assessed.
2. Crisis Intervention Techniques: These intervention techniques are important in managing acute psychiatric emergencies. These provide immediate safety, support, comfort, and stabilization to the affected person. Showing empathy, actively listening, and validating their feelings and concerns are important in building trust and rapport. Strategies include maintaining a calm environment, using non-confrontational language, and reducing stimuli, reducing anxiety and agitation.
3. Communication and Collaborative Approach: Effective and clear communication is important when managing acute psychiatric emergencies. This involves engaging in open dialogue, involving them in decision-making, and explaining the interventions that can enhance their cooperation and reduce their stress, anxiety, and depression. Collaborating with family members, friends, or other mental health professionals can provide improved support.
4. Protection Against Assault: Strategies should be used to control aggressive behavior and assault on health workers. Signs such as demanding immediate attention, staring eyes, loud voices, possessing weapons, and slamming objects should be noted, which can be a threat to assault. This can be controlled by using sedation, physical restraints, and medications.
5. Medication Management: Some cases require medication to manage the symptoms and stabilize the individual's condition. In the case of known psychiatric conditions, their medications should be evaluated. Sedation can be given to control aggression. If the patient is willing, medication such as Haloperidol 10 milligrams IM (intramuscular) can be given every half an hour with a maximum dose of 60 milligrams, or Lorazepam 2 mg with a maximum dose of 10 milligrams can be given. In case of substance intoxication, Lorazepam or Diazepam can be administered. In the case of serotonin syndrome, Dantrolene or Cyproheptadine, which are serotonin antagonists, can be used. In the case of an overdose of psychoactive drugs, emesis should be done, and activated charcoal should be administered.
6. Follow-up Care and Referral: After the immediate crisis is resolved, proper follow-up care should be maintained for long-term management. The affected individuals should be informed about their health condition, local mental health services, community resources, and crisis hotlines that can facilitate further support and treatment.
Conclusion
The management of acute psychiatric emergencies requires a comprehensive and motivational approach. This involves thorough assessment, crisis intervention techniques, clear and effective communication, collaboration with mental health professionals, medication management, follow-up care, and referrals. Individuals should receive the necessary support, safety, and care. These interventions should also stabilize their situation and identify any potential risks. Additionally, managing follow-up care is important for long-term management.
