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Overview of psychiatric emergencies

Last updated: May 28, 2021

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This article gives an overview of the most common psychiatric emergencies and how to treat them.

Overview of psychiatric emergencies
Condition Risk factors/pathogenesis Clinical features Diagostics Management
Suicidal behavior
  • Clinical features of the underlying condition
  • Acute management
    • Imminent risk: hospitalization (if necessary, against the patient's will)
    • Elevated risk
      • Involvement of family
      • Measures to increase patient's social contacts and interaction with medical professionals
  • Long-term management
    • Treatment of underlying psychiatric disorders (e.g., with mood stabilizers, antidepressants)
    • Counseling: providing assistance in improving the patient's social circumstances, as well as development of problem-solving and coping skills
Neuroleptic malignant syndrome
Lithium toxicity
  • Blood work: lithium serum levels > 1.5 mEq/L
Malignant catatonia
Serotonin syndrome
Delirium tremens
Delirium
  • Pediatric, elderly (> 65 years), and hospitalized patients are particularly susceptible
  • Most commonly associated with metabolic conditions, such as electrolyte abnormalities, thyroid disturbances
  • Other precipitating factors include:
  • Treatment of the underlying condition (e.g., discontinuation of precipitating medication, antibiotic treatment of infection)
  • Maintaine adequate hydration
  • Reduce confusion (e.g., reorientation to time, place, and person)
Acute dystonia
Tyramine-induced hypertensive crisis
  • Usually self-limiting, depending on the amount of ingested tyramine
  • Rapid blood pressure reduction is contraindicated
Tricyclic antidepressant toxicity