PANIC ATTACKS
Episodes of acute anxiety and panic can occur as a part of psychotic or neurotic illness. The patient will experience palpitations, sweating, tremors, and feelings of choking, chest pain, nausea, abdominal distress, and fear of dying, paresthesias, chills or hot flushes.
MANAGEMENT
- Give reassurance first
- Search for causes
CATATONIC STUPOR
Stupor is a clinical syndrome of akinesis and mutism but with relative preservation of conscious awareness. Stupor is often associated with catatonic signs and symptoms. The various catatonic signs include mutism, negativism, stupor, ambitendency, echolalia, echopraxia, automatic obedience, posturing, mannerisms, stereotypies, etc.,
MANAGEMENT
- Ensure patient airway
- Administer IV fluids
- Collect history and perform physical examination
- Draw blood for investigations before starting any treatment
- Other care is same as that for an unconscious patient
HYSTERICAL ATTACKS
A hysteric may mimic abnormality of any function, which is under voluntary control. The common modes of presentation may be:
- Hysterical fits
- Hysterical ataxia
- Hysterical paraplegia
All presentations are marked by a dramatic quality and sadness of mood.
MANAGEMENT
- Hysterical fit must be distinguished from genuine fits.
- As hysterical symptoms can cause panic among relatives, explain to the relatives the psychological nature of symptoms. Reassure that no harm would come to the patient
- Help the patient realize the meaning of symptoms, and help him find alternative ways of coping with stress
TRANSIENT SITUATIONAL DISTURBANCES
These are characterized by disturbed feelings and behavior occurring due to overwhelming external stimuli
MANAGEMENT
- Reassurance
- Mild sedation if necessary
- Allowing the patient to ventilate his/her feelings
- Counseling by an understanding professional
DELIRIUM TREMENS
Delirium tremens is an acute condition resulting from withdrawal of alcohol
MANAGEMENT
- Keep the patient in a quiet and safe environment
- Maintain fluid and electrolyte balance
- Reassure patient and family
EPILEPTIC FUROR
Following epileptic attack patient may behave in a strange manner and become excited and violent
ACUTE DRUG-INDUCED EXTRAPYRAMIDAL SYNDROME
Antipsychotics can cause a variety of movement related side effects, collectively known as extrapyramidal syndrome (EPS). Neuroleptic malignant syndrome is rare but most serious of these symptoms and occurs in a small minority of patients taking neuroleptics, especially high-potency compounds.
MANAGEMENT
The drug should be stopped immediately. Treatment is symptomatic and includes cooling the patient, maintaining fluid and electrolyte balance and treating intercurrent infections.
DRUG TOXICITY
Drug over-dosage may be accidental or suicidal. In either case, all attempts must be made to find out the drug consumed. A detailed history should be collected and symptomatic treatment instituted.
A common case of drug poisoning is lithium toxicity. The symptoms include drowsiness, vomiting abdominal pain, confusion, blurred vision, acute circulatory failure, stupor and coma, generalized convulsions, oliguria and death.
MANAGEMENT
- Administer O2
- Start IV line
- Assess for cardiac arrhythmias
- Refer for hemodialysis
- Administer anticonvulsants
VICTIMS OF DISASTER
Victims of disaster are people, who have survived a sudden, unexpected, overwhelming stress. This is beyond normally what is expected in life, like in an earthquake, flood, riots and terrorism. Anger, frustration, guilt, numbness and confusion are common features in these people.
MANAGEMENT
- Treatment for life threatening physical problems
- Critical incident debriefing (CID) is a special technique, which is used to lessen the discomfort of the disaster victims
- CID includes five phases: fact, thought, reaction, reaching and re-entry:
- In the fact phase, each participate is involved to share his or her perception of the incident. The group members describe the incident, new information and pieces of information are integrated into a more understandable whole
- The though phase, builds on this information by asking participants to reflect the incident and to share what they were feeling personally during different personally during different times of the crisis
- In the reaction phase, participants are asked to evaluate the impact of the emotional aspects of the incident. Previously not discussed and less acceptable feelings are allowed to emerge in a safe environment. Knowing that other people are experiencing the same feelings makes them realize that these feelings are normal behavioral responses to abnormal circumstances, and this brings a lot of relief to people who are under intense stress. Participants discuss stress related symptoms they had during the incident or are experiencing currently
- The teaching phase, focuses on specific cognitive, emotional and spiritual strategies to reduce stress and ways to enhance group support
- In the final re-entry phase, the facilitator encourages questions and summarizes the process. Finally, individuals are referred to further counseling if needed.
- In the fact phase, each participate is involved to share his or her perception of the incident. The group members describe the incident, new information and pieces of information are integrated into a more understandable whole
- Group therapy
- Referral to mental health service, if required
- Educate the victims that these emotional reactions are normal reactions to an extraordinary and abnormal situation, and are to be expected under the circumstances. Educated about the available services
- Teach coping strategies to avoid the development of the crises. For example, strategies to be taught can include how to request information, access resources and obtain support.
RAPE VICTIM
Rape is a perpetuation of an act of sexual intercourse with a female against her will and consent.
SIGNS AND SYMPTOMS
Acute disorganization characterized by self blame, fear of being killed, feeling of degradation and loss of self-esteem, feelings of depersonalization and de-realization, recurrent intrusive thoughts, anxiety and depression are commonly seen. Long-term psychological effects like post traumatic stress disorders (PTSD) can occur in some cases.
MANAGEMENT
- Be supportive, reassuring and non-judgmental
- Physical examination for any injuries
- Give morning after pill to prevent possible pregnancy
- Send samples for STD and HIV infection
- Explain to the patient the possibility of PTSD, sexual problems like vaginismus and anorgasmia which may appear later.
TYPES OF PSYCHIATRIC EMERGENCIES AND THEIR MANAGEMENT