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Psychiatric Emergencies - Causes, Symptoms, Risk Factors, and Management

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Psychiatric emergencies are sudden changes in mood, thoughts, and actions leading to sudden distress for an individual and needing immediate medical intervention.

Written by

Dr. Osheen Kour

Medically reviewed by

Dr. Vipul Chelabhai Prajapati

Published At August 16, 2023
Reviewed AtDecember 27, 2023

Introduction:

Psychiatric emergencies are situations in which a person's life is in danger and requires immediate medical attention. The person is usually in severe distress, has self-neglect, has suicidal tendencies, and can also be a risk factor for others. The article talks in detail about various psychiatric emergencies that need immediate attention and intervention, as well as the treatment and management of such incidents.

What Are the Various Types of Psychiatric Emergencies?

Psychiatric emergencies are as follows:

  • Agitation, Excitement, or Violence: These are the severe form of rage and anger where a person can be uncooperative, irrational, assaultive, and delusional. A person can be agitated and violent and show anger by destroying things around him or causing harm to others also. A person suffering from this psychiatric problem often has a wrinkled and restless face, show violent behavior, and use verbal threats, has dilated pupils, palpitations, fast breathing. These symptoms can occur due to panic disorders, personality disorders, delusions, hallucinations, dementia, delirium, acute stress reactions, and forced medication. Such patients are often treated with restraint methods (physical or chemical) by tieing them with chains and ropes while brought to the hospital and later can be untied not to humiliate them. Also, patients are often restrained by tranquilizing them with sedatives if the situation becomes uncontrollable and the patient is severely agitated.

  • Catatonia or Stupor - This psychiatric emergency is presented with negative thoughts, mutism, automatic obedience, and habitual involuntary movements.

  • Deliberate Self-harm or Suicides - These are intentional ways of ending one's life using different means, such as hanging with a rope, drowning, eating poison, deliberate gunshots, and accidents.

  • Delirium - It is an organic mental disorder in which a person experiences impaired consciousness, restlessness, disorientation, and disturbed perception. The condition can arise due to various reasons, such as intracranial bleeding, hypertensive encephalopathy, cerebral malaria, meningitis, encephalitis, drug intoxication, traumatic events, metabolic or endocrine disorders, such as shock, diabetic coma, hepatic failure, and hyperthyroidism.

  • Panic Attacks - These are anxiety attacks caused by psychiatric illnesses, leading to sweating, tremors, palpitations, nausea, choking, chest pain, hot flushes, abdominal distress, and chills. Panic attacks are often treated with cognitive behavioral therapy, which includes breathing exercises, exposure to fear, and counseling. Medications, along with these behavioral therapies, accompany severe cases.

Other Psychiatric Emergencies Include:

  • Drug abuse or alcohol.

  • Substance intoxication and withdrawals.

  • Psychosis or severe depression with homicidal or suicidal tendencies, stupor, or agitation.

What Are the Causes of Psychiatric Emergencies?

Psychiatric emergencies are caused by the following reasons:

Physical Disorders:

  • A person suffering from painful and incurable physical disorders, such as AIDS (acquired immunodeficiency syndrome) and cancer.

Psychiatric Disorders:

  • Dementia and Delirium - These conditions can occur due to mood changes caused by depression and anxiety and thus leads to suicidal tendencies in people.

  • Major Depression- It is a common mental condition causing a high risk of suicide due to persistent sadness. The continuous pessimistic thoughts about helplessness, worthlessness, and hopelessness lead to such events. Also, worrying about the past, present, and future can make a person end up with suicidal deaths due to depression. People usually start thinking about suicide, their psychomotor skills improve, and they can plan such events with full energy.

  • Alcohol or Drug Abuse - Alcoholics and drug abusers can have depression during withdrawal. In addition, they can also choose to end their life because of loss of self-respect, loved ones, family, social status, or the havoc in their lives due to alcohol consumption.

  • Personality Disorder - People with suicidal tendencies and borderline traits of personality disorders, such as fear of isolation, instability, and abandonment usually commit suicide.

  • Schizophrenia - Association with depression, young age, and premorbid personality, such as the onset of any chronic illness or disease in youngsters during college, are some risk factors for psychiatric emergencies. People falling in this category usually have a significant devastating effect on their career due to this chronic illness, and therefore they suffer more than other schizophrenic patients. In such situations, they find suicide a straightforward and reasonable option.

Psychosocial Factors:

  • Marital problems.

  • Academic failures.

  • Loss of loved ones or most prized possession.

  • Occupational and financial problems.

  • Family disputes and dowry problems.

  • Isolation from social activities and groups.

What Are the Risk Factors For Psychiatric Emergencies?

The following are the risk factors for psychiatric emergencies:

  • Age: Females 55 and above and males 40 and above are more at risk for psychiatric emergencies.

  • Sex: Attempted suicide rate is higher in females, whereas completed suicide is three times more common in the male population.

  • Marital Status: Being unmarried, Separated, divorced, and widowed are also risk factors for psychiatric emergencies.

In addition, people with a definite suicidal plan or those who have a previous history of suicidal attempts are more at risk. People undergoing traumatic and tragic events in life, such as the loss of loved ones, are also at risk for psychiatric emergencies.

What Are the Warning Signs of Psychiatric Emergencies?

Warning Signs of Immediate Risk of Psychiatric Emergencies:

  • If a person is finding ways to end their life, such as buying a gun or searching online.

  • If a person is talking about death or dying or killing themself.

  • A person looking depressed, hopeless, and talking about no reason to survive.

Warning Signs of Serious Risk of Psychiatric Emergencies:

  • Excessive consumption of drugs and alcohol.

  • Insomnia (lack of sleep) or excess sleep due to stress and anxiety.

  • Feeling isolated and abandoned.

  • Seeking revenge and showing aggression or rage.

  • A person showing unbearable pain and getting trapped.

  • A person talking about their feeling of being a burden on other people.

  • A person shows extreme mood swings.

Other Warning Signs:

  • Writing farewell notes and letters.

  • Closing bank accounts and making wills.

  • A person gives away their personal belongings and prized possessions to others.

  • People show calmness and peace after coming out of a long depression phase.

  • A person is giving suicidal threats.

How Are Psychiatric Emergencies Managed?

Preventive Measures:

  • Psychiatric emergencies are managed by preventing the patient from self-harming and restoring their self-esteem and functional state.

  • Psychiatric emergencies need full attention, as the patient can lose their life due to negligence.

  • Therefore, such patients should be admitted to the hospital near the nursing station in an open space for close monitoring and observation.

  • Psychiatrists and medical teams should try to find out the cause of suicidal thoughts and should counsel the patient to drop the idea of committing suicide.

  • Everyone in the medical setup should be informed about the patient's mental issues and suicidal tendencies to keep them alert. The patient should not be labeled for a psychiatric emergency, but caution cards should be given to nurses to hand over the case properly.

  • No sharp objects, such as scissors, rope, wire, or medication tray, should be kept near the bedside of such patients as they can kill themselves. Also, check the patient’s belongings and pockets for harmful objects or medication.

  • The patient should be busy with various activities to withdraw their attention from suicide.

  • Check for forks and knives after the patient eats in the hospital setting, as they can use them for self-harm. Also, keep all the medications under lock and also keep the keys in a safe place.

Medication:

If the psychiatric emergencies are severe, sedation can be given to the person.

The drugs commonly used for this purpose are:

  • Diazepam 10 to 20 mg.

  • Intramuscular injection of Chlorpromazine 50 to 100 mg.

  • Intravenous injection of haloperidol 10 to 20 mg.

After sedation, the doctor checks for any history of fever, fluctuations of consciousness, or convulsions. They also carry out the patient's physical examination and prescribe complete blood tests, such as total cell count, hemoglobin, etc. In cases where a person has malnutrition and dehydration, the doctor may also start a glucose saline drip.

Conclusion

Psychiatric emergencies cause acute changes in patient's behavior, negatively impacting their health and ability to function in their environment. Such people can not only harm themselves but can also be a risk factor for others and cause harm to them too. Therefore, if any such cases are encountered, medical intervention should be availed for the person as soon as possible to save their own lives and reduce the risk factor for others, including their family and friends.

Dr. Vipul Chelabhai Prajapati
Dr. Vipul Chelabhai Prajapati

Psychiatry

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deliriumpsychiatric emergencies
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