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Department of Psychiatry
To be able to describe the common types and causes of
psychiatric emergencies.
Objectives
History
Collateral history
General assessment
Physical examination
General assessment
Mental state examination
General assessment
Aims
◦ Engagement
◦ Assess future risk
◦ Identify risk factors for harm (especially
modifiable maintaining factors )
◦ Create management plan
◦ Understand the patients wish to die
◦ Diagnose psychiatric disorder if present
Catatonia/Mute
Agitation is excessive motor or verbal activity.
◦ hyperactivity
◦ verbal abuse
◦ threatening gestures and language
◦ physical destructiveness
◦ vocal outbursts
Agitation
Violent Patient
Ensure safety of patient and staff.
Violent Patient
◦ Haloperidol(5-10mgs)
◦
◦
Novel
◦ Risperidone
◦ Olanzapine
◦ Quetiapine
Benzodiazapines
◦ Lorazepam(1-4 mgs)
Oral options
Haloperidol (5-10 mgs)
Zuclopenthixol Accuphase
◦ Reduces injection frequency but it has a delayed onset
of action 3-4 hours, effects last 2-3 days, including
sedation, EPS
Olanzapine
I.M. options
Flow chart for rapid tranquillisation of acutely disturbed patient