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• Presented by:-• Mr. Suresh Kumar Sharma

• RN, ACCN, MSN(PSYCHIATRY)

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Psychiatric emergency

• DIFINITION:- It is a condition where patients has a

disturbances of thought, affect and psychomotor activity leading to a threat to his existence (suicide) or threat to other people in the environment (homicide) with himself.

Common Psychiatric emergencies1. Suicidal threat2. Violent/aggressive behaviour/excitement3. Panic attacks eg snake4. Hysterical attacks5. Transient situational disturbances eg. Earth quake6. Epileptic furor 7. Drug toxicity8. Victims of disaster9. Rape victim10. grief

DEFINITION’SSuicide:-• It is a type of deliberate self-harm.• It is defined as an international human act of

killing one self.

Suicidal client:-The person who is more prone to kill himself & had one or more suicidal attempt

• Attempted suicide:-person try to kill own self but not succeed.More by women

• Completed suicide:-person kill own self

successfully.More by men.

ETIOLOGYOf

suicide

Suicidal tendencies in psychiatric ward

1. Major depression:- Suicide is a major depressive episode is due to-• Persistent sadness• Pessimistic cognition to past, present & future• Delusion of guilt• Helplessness , hopelessness & worthlessness• Derogatory voices urging him to take his life.

•Risk of suicide more when acute phase is passed & psychomotor retardation has improved b,coz patients have more energy.

2.schizophrenia• Because of hallucination & delusion schizophrenic patients see suicide as a reasonable alternative.

3.mania:-• Result of grandiose ideation.• Patient may believe he is a great person or

wish to prove his supernatural powers.• Because of this he may carry out some

dangerous activity that can cost him his life.• Eg. Jesus, lord Krishna,• superman

4.Drug or alcohol abuse• Suicide among alcoholics can be due to depression in the withdrawal phase.

• Loss of friends, family, self respect, status &

a general realisation of that aspect can cause

the individual to with to die.

5.Personality disorder:-• Individual with histrionic & borderline traits may occasionally attempt suicide.

• But their success rate is low.

6.Organic condition:-

• Delirium & dementia due to changes of mood like anxiety & depression may attempt suicide.

2.Physical disorders:- patients with incurable or painful

physical disorder like cancer & AIDS Severe pain BURN

3. PSYCHOSOCIAL FACTOR

• Failure in examination

• Loss of loved object• DEATH OF LOVED

REALATIVE

• Dowry harassment

• Marital problems

Isolation & alienation of society

• Financial & occupational problems

INCIDENCE

1.AGE:-• Male above 40 yrs of age• Female >55yrs of age2. sex:-• Men have greater risk of completed suicide• Women have higher rate of attempted suicide• Suicide is 3 time more common in men than

women• Successful suicide number about 70% men &

30% women

CONTD….

3. Marital status:-• Twice in single person than of married

person

• Being unmarried, divorced, widowed or separated have 5-6 time more risk.

4.Socioeconomic status:-• Acc to SADOCK & SADOCK “highest & lowest

class individual have high rate than middle class

• Occupation related suicide is higher among artists, law enforcement officers, lawyer & insurance agents.

• health-related occupations higher (dentists, doctors, nurses, social workers) especially high in women physicians

• History of childhood trauma or abuse, or of being bullied

• Family history of death by suicide• Being unemployed

• Retired Occupation

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Myths Versus Facts About Suicide

SIGECAPS

Preventing Suicide

One Community at a Time

1.Education

2.Screening

3.Treatment

4.Means Restriction

5.Media Guidelines

1.Education:-

A.Individual and Public Awareness:-

•Primary risk factor for suicide is psychiatric illness as aware about it.•Teach depression is treatable so no need to take stress or think deeply.•Try to deestimate the illness.•Destigmatize treatment•Encourage health seeking behavior & continuation of treatment.

B. Professional Awareness:-• Healthcare professional – physician, pediatrician, nurse practiceners etc.

• Mental health professional – Psychologist, social workers etc.

• Primary & secondary school staff– Principle, teacher, counselors, nurses

• College & university resource staff– Counselors, student health services, student

residence services

Contd…..

• Gatekeepers• Religious leader ,• police, • fire departments, • armed services.

2.Screening:-

•Identify At Risk Individuals

•Identify the patient who have high prone mental disease R/T suicide

•Identify the “WARNING SIGNS OF SUICIDE’’

Warning signs of suicide:-• Suicidal threat• Writing farewell letters• Giving away treasured articles• Making a will• Closing bank account• Appearing peaceful happy after a period of

depression• Refusing to eat /drink• Refusing to maintain personal hygiene

3. MEANS RESTRICTIONS:-

• Fire alarm safety• Construction of barriers of jumping sites• Detoxification of domestic gas• Restriction on pesticides• Reduce lethality or toxicity of prescription– Use lower toxicity antidepressants

• Restrict sales of lethal hypnotics e.g. barbiturates

4.Media

a)Media Guidelines

•Encourage implementation of responsible media guidelines for reporting on suicide.

b) Media Considerations

Consider how suicide is portrayed in the media

TV Movies Advertisements

The Internet danger

Suicide chat rooms Instructions on methods Solicitations for suicide pacts.

Treatment of

suicidal clientAntidepressants

Psychotherapy

Antidepressants Adequate prescription treatment and

monitoring Only 20% of medicated depressed patients

are adequately treated with antidepressants – possibly due to:Side effectsI.Lack of improvement II.High anxiety not treatedIII.Fear of drug dependency IV.Didn't combine with psychotherapyV.Dose not high enoughVI.Didn't add adjunct therapy such as lithium or other medication(s)VII.Didn't explore all options including: ECT or other somatic treatment

Psychotherapy:- • Specifically designed to treat depression• Relatively short term(10-16 WKS)• Structured– It should be step by step treatment instructions

that any other therapist can easily follow

• E.g.– Cognitive behaviour therapy(CBT)– Interpersonal therapy (IPT)– Dialectical behaviour therapy (DBT)

• Implement teaching of these techniques

Clinical application

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Initial approach during emergency:-• warm, direct & concerned.• Quick evaluation to identify the condition• Care on the basis of seriousness is

essential• Emergency staff should have basics

knowledge of handling psychiatric emergency.

• Medico legal cases need to be registered separately & informed to concerned officers

Security should be adequate to control violent & dangerous

patients

• Findings should be recorded in emergency file.

• Patient condition & plans of management should be explained in simple language to patient & family members

1. monitoring the patient safety need• Take all suicidal threats or attempts seriously

& notify to psychiatrist.• Remove toxic agent like drugs/alcohol• Donot leave medication tray within patient

reach.• Make sure that daily medication swallowed.• Remove sharp instrument

• Contd…• Remove straps & clothing like belts, necktie

etc.• Do not allow the patient to bolt his door on

the inside.• Make sure somebody accompanies him to the

bathroom• Constant observation & should not be alone• Good vigilance especially morning hours• Spend time to him, talk to him & allow him to

ventilate his feelings.

Contd….• Encourage him to talk about his suicidal

plans/method• If suicidal tendencies are very severe, sedation

should be given.• Enhancing self-esteem of the patients by

focusing on his strengths & positive qualities than weakness.

2.Mangement of attempted suicide in the IPD

• Assess for vitals, check airway• If pulse weak start IV fluids• Turn patient head & neck to one side to

prevent regurgitation & swallowing of vomitus.

• Emergency measures to be instituted in case of self-inflicted injuries.

3.Management of shock:-• Transfer the patient to medical centre

immediately• It there is no evidence of life leave the body in

the same position/room in which it was found.• Patient has attempted suicide By jumping, do

not leave the body in a place which is visible to other patient af the ward.

• Inform authorities, record the incident accurately

• Contact local guardian & inform them• Hand over the patient properties to the

concerned authorities/relatives.

• Senior staff should discuss with all staff about passive lapse & preventive measure that need to be undertaken.

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•ASSIGNMENT

Identification of suspected client for suicide