Psychiatric emergency
Dr. Miada Mahmoud Rady
Depression
Its more common in females.
Leading cause of disability in people 15- to 44-
years old.
Can occur in episodes with sudden onset and
limited duration.
Onset can also be insidious and chronic.
Clinical symptoms
For diagnostic features of depression use the
mnemonic GAS PIPES:
1. Guilt and self-reproach
2. Appetite (abnormal)
3. Sleep disturbance ( insomnia )
4. Paying attention : Impaired ability to concentrate.
1. Interest : loss of interest in things that were once
important.
2. Psychomotor abnormalities.
3. Energy : Patients are tired all of the time.
4. Suicidal thoughts.
Schizophrenia
Typical onset occurs during early adulthood.
Dysfunctional symptoms become more prominent
over time.
Contributing influences for Schizophrenia
may
include genetics and neurobiological, psychological,
and social influences.
Presenting features
Schizophrenics may experience:
1. Delusions and hallucinations
2. Apathy and Mutism
3. A flat affect and lack of interest in pleasure
4. Erratic speech and emotional responses
5. A lack of or excessive motor behavior
Neurotic disorders
Definition : class of functional mental disorder
involving distress but no delusions or hallucinations,
where behavior is not outside socially acceptable
terms.
It includes :
I.
Anxiety disorder.
II. Generalized anxiety disorder (GAD).
Anxiety disorders
Definition : Mental disorders in which dominant
moods
are
fear
and
apprehension
,it
is
characterized by Persistent, incapacitating anxiety
in the absence of external threat.
Almost 1/5 of adults will experience some form in
any given year.
Generalized anxiety disorder(GAD)
Definition (requirement for diagnosis ) :
1. excessive worry or anxiety about multiple issues that last
6 months or more.
2. Patient worries about everything for no particular reason .
3. worrying prevents patient from deciding what to do about
upcoming situations.
4. Worry must be difficult to turn off or control.
Management
When dealing with a patient with GAD:
1. Identify yourself in a calm, confident manner.
2. Listen attentively.
3. Talk with the person generally about their feelings.
Phobias
Phobic
disorders
:
an
unreasonable
fear,
apprehension, or dread of a specific situation or thing.
Simple phobia focuses all anxieties onto one class of
objects or situations e.g. spider , mice and high
altitude.
Presentation and management
When confronted with the feared object or
situation, the phobic person experiences intolerable
anxiety.
Patient usually realizes the fear is unreasonable.
Management : explain each step of treatment in
detail before carrying it out.
Panic disorder
Definition : Condition characterized by sudden,
usually unexpected, overwhelming feelings of fear
and terror.
Agoraphobia : Fear of going into public places is
type of panic attacks that can cause severe lifestyle
restrictions.
Women more likely to be affected than men.
Tends to run in families
Attacks usually begin when patients are in their 20s.
Most persons can identify a stressful event that
preceded their first attack.
Clinical presentation
a. Symptoms usually peak in intensity within 10 minutes and
last around an hour .
b. Most of signs and symptoms are due to autonomic nervous
system overstimulation
c. Hyperventilation is characteristic finding.
d. Panic attacks may mimic a range of physical disorders in
their presentation.
Management
1. Separate the patient from panicky bystanders and provide a
calm environment.
2. Be tolerant of the patient’s disability.
3. Reassure the patient that they are safe and help the patient
regain control.
4. Hyperventilating patients should not be treated with paper bag
therapy.
5. Patients should be fully evaluated at the hospital.
Substance-related disorders
Definition : Include psychological disorders associated with the
use of :
1. Alcohol
2. Cigarettes
3. Illicit drugs
4. Other substances affecting the way a person feels,
behaves, or thinks.
Classified into four levels:
A. Substance use: Use of moderate amounts of
substance without seriously affecting ADLs.
B. Substance intoxication: Use of a substance that
results in impaired thinking and motor function.
C. Substance abuse: Use of a substance disrupts ADLs.
D. Substance dependence: physiological dependence or
addiction to a substance that requires increasingly
larger amounts to produce the same effect.
Eating disorders
More common in :
1. Young females.
2. Upper middle or middle class.
3. Living in socially competitive surroundings.
Two major types :
1. Bulimia nervosa
2. Anorexia nervosa
Bulimia nervosa
Definition : Condition characterized by consumption
of large amounts of food for which patients compensate
by using purging techniques e.g. vomiting, laxatives,
diuretics, excessive exercise.
Anorexia nervosa
 Definition : condition in which the patient Exerts
extraordinary control over their eating .

Typical patient presents with :
1. Decreased body weight based on age and height
2. Intense fear of obesity .
3. Amenorrhea (absence of menstruation).
Anorexia
nervosa