Psychiatric

Emergency
 Introduction

Psychiatric emergencies are conditions requiring

psychiatric interventions.
The demand for psychiatric emergency services
has rapidly increased throughout the world since
the 1960s especially in urban areas.
Psychiatric emergencies may include attempted
suicide, violence, substance abuse, depression
and other rapid change in behavior.
Definition of Psychiatric
Emergencies
Psychiatric Emergency is an
acute disturbance of
behavior, thought or mood of
patient which if untreated
may lead to harm, either to
the individual or to others in
the environment and need
immediate intervention
Causes of Psychiatric
Emergencies
 Causes of Psychiatric Emergencies

Alcoholism and Affective

Drugs (38%) disorders (29%)

Personality Anxiety reaction

disorder (9%) (8%)
 Causes of Psychiatric Emergencies

Undiagnosed Organic brain

patients (8%) syndrome (6%)

Schizophrenia (2%)
Types of Psychiatric
Emergencies
 Types of Psychiatric Emergencies
Major Types Minor Types

Suicide or deliberate self-harm Pain attack

Agitated and violent patient Rape

Overdosage of common psychiatric

Grief reaction
medication

Overdosage and withdrawal from

addicting substance
 01.

Suicide
Definition of Suicide
Suicide is an act of deliberate,
self- inflicted, intentional,
taking of one's own life
Incidence of Suicide
700,000
People die of suicide every year
15-29 year-olds 77%
Suicide is the fourth of global suicides
leading cause of occur in low- and
death among these middle-income
age groups countries
 Incidence of Suicide

For every suicide there are many more people who attempt
suicide

A prior suicide attempt is the single most important risk factor

for suicide in the general population

Females generally attempt suicide more often than males, but

males are about four times more likely to die from the suicide
attempt
Etiology of Suicide
 Etiology of Suicide
Biological factors Psychogenic factors Sociological factors

The neurotransmitter Alcoholism and substance

Loneliness
imbalance abuse

Familial or genetic factors Major depression Loss of loved object

Terminal or chronic illness Hopelessness Educational problem

Financial and occupational

Low self esteem
difficulties

Stress and anxiety

Risk Factors of Suicide
 Risk Factors of Suicide

Age Prior suicide attempt(s)

above 45 years of age

Sex Alcohol Abuse

more common among males

Stress Access to lethal means

prejudice and discrimination

Middle-aged men Chronic disease

stressors that challenge
traditional male roles
 Risk Factors of Suicide

Mental disorders
particularly depression

An Arrest

Financial problems

Death of a loved one

Warning Signs of
Suicide
 IS PATH WARM

I S P
Ideation Substance Abuse Purposeless

A T H
Anxiety Trapped Hopelessness
 IS PATH WARM

W A R M
Withdrawal Anger Recklessness Mood Change
Suicidal Theories
 Sociological Theory

This theory is applied by Erik Durkheim (anomic, egoistic, altruistic,

fatalistic). This theory clarifies that suicide is repeatedly linked to lack of
social support. For this reason, living alone and transience are major
contributors to suicidal behavior.
 Psychoanalytical Theory

This theory applied by Freud who explains suicide as self-destructive

related to a love object. After that, he adds self-guilt to this view.
 Interpersonal Theory

This theory applied by Sullivan who views suicide as evidence of failure

to resolve interpersonal conflicts.
Levels of Suicide
 Levels of Suicide
Direct or indirect thoughts or fantasies of suicide or self-injurious acts
1- Suicidal Ideation Expressed verbally or through writing

Direct verbal or written expressions of intent to commit suicide but

2- Suicide Threats Without action

Self-directed action that results in no injury or minor injury by persons

3- Suicide Gestures Who neither intended to end their lives nor expected to die as a result

Serious self-directed actions that sometimes result in minor or major

4- Suicide Attempts Injury by persons who intend to end their lives or seriously harm
themselves

5- Completed or Deaths of persons who ended their lives by their own Means with
Successful Suicides conscious intent to die
Methods of Suicide
 Methods of Suicide

Drowning Alcohol / Drug overdose

Cutting Jumping from a building

Hanging Pesticide

Firearms Throwing self into train

Treatment Modalities
for Suicide
Treatment Modalities for Suicide

Hospitalization
A psychiatric unit is usually the most appropriate treatment setting for seriously
suicidal people during an acute crisis. The nursing staff helps to protect these
patients from hurting themselves while they carry on the tasks of daily living,
such as eating, hygiene, exercise, sleep and communication

Psychotherapy
Weekly psychotherapy is simply insufficient to protect those who are in crisis.
Once an individual is no longer in crisis, therapy to treat the underlying causes of
suicidal ideation or behavior is typically recommended
Treatment Modalities for Suicide

Pharmacotherapy
• Antidepressant drugs for depression, mood disorder and panic
disorder

• Antianxiety drugs for panic disorder and personality disorder

• Antipsychotic drugs for schizophrenia and personality disorder

• Lithium carbonate for mania symptoms in mood disorder

Nursing Care Plan
 Nursing Nursing
Assessment Objectives Evaluation
Diagnosis Intervention
The patient should
Assess the client’s Render close patient The patient is free
Risk for suicide be safe and free
suicidal potential supervision from injury
from injury

Note any previous Patient confesses Suicidal thoughts

Provide a safe and feelings are
suicide attempts Ideation suicidal thoughts
environment reduced
and methods and feelings
The patient should
Observe for risk Assist the patient to
Social isolation stay with a friend or
factors self-express himself
family
History of suicide
Patient responds to Stay with the patient
attempt by oneself Substance abuse
treatment plan more often
or within the family

Assess suicidal Help the patient with

Hopelessness Patient uncovers all
tendencies problem-solving
desires to harm self
and reports to staff
Assess history of promptly Responses to
psychosis
mood disorders suicidal thoughts
 02.

Violence
Definition of Violence
 Violence is the intentional
use of physical force or
power, threatened or actual,
against oneself, another
person, or against a group or
community.

Violent clients are not always

psychiatrically ill.
Risk Factors of Violence
 Risk Factors of Violence

Demographic Limited education

Young age History of violence

Male sex Family factors

Unemployment Medical factors

Etiology of Violence
 Etiology of Violence

Personality disorders Organic psychiatric

disorders

Schizophrenia Mania
 Etiology of Violence

Withdrawal effects Mental retardation

of alcohol

Epilepsy Domestic violence

 Etiology of Violence

Severe depression Acute stress

reaction

Panic disorder Psychotic disorder

Manifestations of
Violence
 Manifestation of Violence
Uncooperativeness

Irrational

Delusions

Violent or assault behavior

Feels humiliated
Types of Violence
 Types of Violence
Occurs when someone uses a part of their body or an object to control
Physical violence a person's actions, e.g., hitting, pushing and throwing

Occurs When a person is Forced to unwillingly Take part in sexual 

Sexual violence activity

Emotional violence Says or does something to make a person feel Stupid or worthless

Violence occurs when an individual Is harmed because of practices

Culture violence that are part of her or his culture religion or tradition

Occurs when someone uses threats and causes fear in an individual to

Psychological violence gain control
Violence Theories
 Psychoanalytical theory

This theory is applied by Freud who view violence is an inborn instinct

controlled by society but always ready to erupt
 Social learning theory

Albert Bandura applies this movement in which he believes that

children are not naturally violent, but instead they imitate adults.

Certain violent attitudes and emotional response patterns through

Modeling.
Management of
Violence
 Management of Violence

Hospitalization
• A psychiatric unit Is usually the most appropriate treatment setting for
seriously violent people during an acute crisis.

• The nursing staff helps to protect these patients from hurting themselves and
others. 

Psychotherapy
• Cognitive behavioral therapy (CBT): It is a talking therapy that can help you
manage your problems by changing the way you think and behave.

• It's most commonly used to treat anxiety and depression, but can be useful
for other mental and physical health problems
 Management of Violence

Pharmacotherapy
• The most commonly used drug is haloperidol Is taken 0.5-5 mg Po
two or three times per daily, adjust as necessary.

• Maximum dose 100 mg/day, for acute psychosis, 2-5 mg IM, which
may be repeated every 4-6 hour.

• Risperidone is a second-generation antipsychotic drug administered

in a variable ways even In its oral Intake form.
 Management of Violence
Physical Therapy
• Restraint: Is any manual method or physical or mechanical device,
material or equipment attached to person body to restrict freedom of
movement  or normal access to one body.

• Factors considered during restraint

1. Restraint should be performed by at least five persons
2. Restraints are never to be removed without adequate number of
staff present
3. This is preferably done when the patient’s attention is distracted
4. Nursing observation every 15 minutes
5. Parenteral sedatives should be readily available and administered As
soon as possible after restraint is completed
6. Supplement they need to talk with the client softly and avoid asking
closed end question
7. Promote self-esteem of the client and avoid abusing the client
 Management of Violence
Physical Therapy
• Seclusion: the confinement of a person, at any time of the day or
night, in a room or area from which free exit is prevented

• Factors are considered in assessing and monitoring:

1. Identifying the patient’s hygiene and toileting needs and making
arrangements for these to be met
2. Assess Physical and psychological status and comfort
3. Asses vital signs
4. Observe patient every 15 minutes
5. Assess patient needs to have access to communication or physical
aids in seclusion
Nursing Management
 Nursing Nursing
Objectives Evaluation
Diagnosis Intervention
High risk for violence Patients will not harm to Assaulting and abusive
directed towards others self or others An environment with low behavior towards parents
related to Inaccurate level of stimuli and staff was noticed
perception of the during the first 2 weeks
environment (delusions Provide a safe and reduced gradually In
and hallucinations) and environment the 3rd week
impairment of impulse
control disorientation
Physical restraints as a
least option. Restraint
care was given

Relaxation exercises

Family members are

encouraged to report If
any anger, irritability or
mood swings are noticed
Thanks!