4.4.7 Psychiatric emergencies

4.4.7 Psychiatric emergencies

The Pharmacological Management of Psychiatric Emergencies

Pharmacological management of psychiatric emergencies refers to the use of psychopharmacological agents to treat individuals with acute symptoms of a mental health disorder who are presenting with a risk to themselves or others. The main goal of pharmacological treatment in these cases is to rapidly reduce symptoms and improve the patient’s overall stability, with the ultimate goal of preventing further harm.

Psychiatric emergencies refer to situations where individuals are experiencing severe symptoms of a mental health disorder and are at risk of harm to themselves or others. Some examples of psychiatric emergencies include:

  1. Acute psychosis: individuals may be experiencing delusions, hallucinations, and disordered thinking, which can lead to dangerous or erratic behaviour.
  2. Suicidal ideation or behaviour: individuals may express intent to harm themselves or may have already engaged in self-injurious behaviour.
  3. Acute agitation: individuals may become highly agitated, irritable, or aggressive, and may pose a threat to themselves or others.
  4. Severe depression with catatonia: individuals may become unresponsive, rigid, or have strange movements, making it difficult to communicate or engage in activities of daily living.
  5. Mania: individuals may experience an elevated mood, excessive energy, decreased need for sleep, and impulsivity,

Antipsychotics, such as haloperidol and olanzapine, are commonly used in the management of acute psychotic symptoms, such as delusions and hallucinations. Benzodiazepines, such as lorazepam and diazepam, are commonly used to manage symptoms of anxiety, agitation, and insomnia in individuals presenting with psychiatric emergencies. Antidepressants, such as fluoxetine and sertraline, may also be used to treat depression and suicidal ideation. Mood stabilizers, such as lithium and valproic acid, are commonly used to manage manic and depressive episodes in individuals with bipolar disorder.

It’s important to note that while medication can be an effective tool in the management of psychiatric emergencies, it is not a standalone treatment and should be used in conjunction with other forms of therapy (Semple, 2019).

The Pharmacological Management of Emergency Psychiatric Side Effects

Neuroleptic Malignant Syndrome:

NMS is typically treated by discontinuing the antipsychotic medication that is believed to be responsible for the syndrome. In some cases, a switch to a different antipsychotic medication may be necessary. In severe cases, hospitalization and supportive measures, such as hydration, electrolyte supplementation, and fever control, may be necessary.

Serotonin syndrome:

Serotonin Syndrome is typically treated by discontinuing the medication that is believed to be responsible for the syndrome. In some cases, a switch to a different medication may be necessary. In severe cases, hospitalization and supportive measures, such as hydration and electrolyte supplementation, may be necessary. In addition, medications that block the effects of serotonin, such as cyproheptadine, may be used to treat serotonin syndrome.

Acute akathisia:

Acute akathisia is a type of movement disorder characterized by restlessness and agitation, and it can be a side effect of certain antipsychotic medications. The following are some treatment options for acute akathisia:

  1. Medication adjustment: In some cases, adjusting the dose of the antipsychotic medication causing the akathisia or switching to a different antipsychotic medication may help alleviate symptoms.
  2. Beta-blockers: Medications such as propranolol can be used to help relieve symptoms of acute akathisia.
  3. Benzodiazepines: In severe cases, benzodiazepines such as lorazepam or diazepam may be used to relieve symptoms.
  4. Psychotherapy: Cognitive behavioural therapy (CBT) and other forms of psychotherapy can help individuals manage their symptoms and cope with the distress caused by akathisia.

References:

(1) Semple, D. and Smyth, R. (2019). Oxford handbook of psychiatry. Oxford ; New York, Ny: Oxford University Press.