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Psychiatric emergency services have become necessary due to rapidly changing lifestyle. Aggression and violence, dementia, delirium, serotonin syndrome, suicide and neuroleptic malignant syndrome are all by products of the modern world. Psychiatric emergencies always need to be handled in a professional manner as it involves risk of life and property of one or more individuals. Handling of such emergencies involves proper diagnosis, treatment as well as post treatment care. Professionals from medical domain specialized in Psychiatry, Psychology and Nursing along with Social Care Workers handle these emergencies. Managed care, changes in health care delivery services, and increasing access to mental health care services are support the treatment of psychiatric emergencies.
Decisions that determine a psychiatric emergency are based on patient's presentation or state and involve the following conditions:
- Danger of harming immediately self or others
- Level of functioning and ability of self care and ability to comply with treatment recommendations
- Severity of psychiatric symptoms
- Quality and availability of support systems and resources
- Patient and family preferences
Regardless of the treatment setting, the appropriate identification and subsequent management of psychiatric emergencies involves an array of clinical expertise that offer patient appropriate, expeditious, and quality mental health services in an effective manner.
Safety considerations in handling psychiatric emergencies: Managing psychiatric emergencies begins with appreciating the importance of personal, family and staff safety. During initial assessment of the patient in crisis, health care providers must gather as much information as possible of the patient involved through patient records, discussions with family members and of course with the patient involved. Before taking patients into a closed area for treatment, watch out for items that can be used as weapons such as scissors.
A summary of key safety issues when handling a psychiatric emergency is as follows,
- Make the clients' personal, family and staff safety a priority
- Understand and realize that violent behavior from patient in psychiatric emergency is expected.
- Closely watch and position yourself between client and the exit before providing treatment
- Gather as much information about the patient as possible, including history of violence and family problems
Diagnosis of psychiatric disorders:
First step in making a diagnosis is asking the patient what is wrong. If possible, make the patient comfortable, offer water or snacks and a spot to relax. Ask questions to gather a full history of the presenting condition and other relevant facts. After this a general and full medical examination with a special focus on present situation should be carried out.
The general physical examination consists of,
- Basic observations like patient's walk, breathing signs, voice intonation, skin tone and ability to hold normal conversation
- Recording the blood pressure. Checking for diseases like pneumonia, anemia or swelling of legs, head or bodily injuries
- Observing vital organs such as heart, lungs, bowels, etc
- Neurological examination, to obtain information of patient's brain, nerves, mental function and muscle coordination
Based on the signs and symptom, the medical professional is then able to make a diagnosis of psychiatric emergency. From the list of possible diagnoses, the medical professional identifies the most likely cause and rules out other probabilities. The medical professional will consider both psychiatric conditions and physical diseases.
Emergency response: Psychiatric emergency response according to the condition of the patient can be classified as follows,
- Emergent Category:
Symptoms: Situations that may require urgent medical attention and must be considered a medical emergency are impending alcohol withdrawal, drug intoxication, acute drug related side effects, unstable or abnormal vital signs, violent or threatening behavior and suicide attempts.
Initial Intervention: Initial medical emergency care includes the following,
- Assess the physical status to rule out physical problems and make a appropriate medical or psychiatric referral
- Initiate psychosocial and/or pharmacological interventions
- Assess mental status
- Initiate physical controls including verbal de-escalation, restraints, one to one observations and seclusion
- Urgent Category:
Symptoms: Symptoms like bizarre behavior, intoxication, acute agitation, suicidal gestures or homicidal risk, require immediate medical attention but it does not constitute to a medical emergency.
Initial Intervention: Initial handling of this situation is similar to an emergent situation described above.
- Non-emergent Category:
Symptoms: Symptoms such as mild to moderate anxiety, situational disturbances and desire to talk medical questions, etc. do not require immediate medical attention, but it is better to assess the patient in a timely manner
Initial Intervention: Initial handling of this situation is as follows, Offer comfort, courtesy and reassurances that say you can help, address other treatment issues at the right time, offer alternatives like keeping mental health appointments or relaxation therapies.
Privacy of the psychiatric patients: Privacy is crucial in therapeutic interaction which includes securely gathering personal information and treating the patient in the wake of medical emergencies. The medical professional must also develop a therapeutic relationship that enables patient safety, empathy, reassurance and a cooperative environment.
Psychiatric emergencies thus must be handled with delicate hands. Do make an effort to make sure you have your questions about psychiatric emergencies answered on time.
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