Definition

An emergency psychiatric is an acute mental disorder in the mind, behavior, mood, or social relationship that requires immediate treatment. Acute means complaints have just occurred or appeared suddenly. This state of emergency must be addressed immediately to save patients and/or others from the dangers that may have occurred due to the disturbance.

Patients who come with psychiatric emergencies usually have mania disorders, acute ministries, suicide ideas, or murder ideas. Psychosis is when a person has a relationship with reality so they cannot distinguish between what is real and not real. 

Cause

The causes of these extreme behavior disorders vary, such as the use of substances, medical conditions, mood disorders, or severe anxiety and trauma. Almost all patients with suicide thoughts also had previous mental disorders, such as severe depression, substance abuse, or fights.

About 50% of patients with psychiatric emergencies also have medical illness. Thus, medical screening is important to assess physical conditions that may play a role in psychiatric emergencies. A series of screening examinations are carried out to see if a person is at risk of experiencing certain diseases.

Some of the causes of acute psychosis and mania is delirium, infections, metabolic disorders, drugs, drug abuse/deletion, and brain disorders or the central nervous system.

Risk Factors

In people with mental disorders, the presence of suicide thoughts in him is one of the emergency conditions that must be handled immediately. Factors that can increase the risk of suicide include:

• Male gender
• Age of more than 60 years
• Widow or divorce
• White race 
• Live alone
• Unemployment or having financial problems
• Victims of bullying
• History of traumatic events
• Long-term medical illness
• Mental disorders such as depression, fights, panic attacks, severe anxiety disorders
• Abuse of substances
• Feelings of despair
• Anoonia berat atau tidak tertarik untuk bahagia
• Ease of access to suicide tools
• The existence of an idea or history of attempted suicide 

Symptoms

Patients with acute and mania psychosis exhibit eccentric and excessive behavior, unusual, irregular, paranoid, and inappropriate or harmful behavior. Other emergency symptoms that require immediate treatment are thinking or trying to commit suicide, killing, hurting, or damaging.

A person's alert signatures can attempt suicide include:

• Talks or writes about death, dying, or suicide
• Making comments about despair, helpless, or worthless
• Expressions have no reason to live, no purpose in life, saying things like "would be better if I wasn't here" 
• Increased alcohol and/or drug abuse
• Withdrawal from friends, family, and community
• Acting recklessly or at risk, as if without thinking
• Dramatic mood swings
• Feeling the burden of others

Meanwhile, signs of an emotional crisis that can develop into a psychiatric emergency include:

• Ignoring cleanliness, for example not taking a shower
• Changes in sleep habits, lack of sleep or excessive sleep
• A significant increase or weight loss
• Decline in performance in the workplace or school
• Extreme changes in moods, such as feeling more easily offended, angry, anxious, or sad
• Withdrawing from activities, work, or relationships
• Other worrying symptoms include paranoid or hallucinatory 

Diagnosed

In a psychiatric emergency condition such as symptoms of acute and mania psychosis, or suicide attempts, doctors will first handle existing emergency conditions and secure the situation. After the atmosphere is safe and conducive, interviews and examinations are carried out on patients and their families or those closest to the patient.

Usually the doctor will ask about what happened during the incident, assess the patient's mental status, daily activities, and his medical history, including mental health, consumption of certain drugs, and if there is a history of substance use. Interviews are also accompanied by physical examinations on the patient's body.

In cases where patients who have the idea of suicide, after the situation is safe and under control, doctors will find out factors that increase or reduce the risk of suicide. Usually it will also be asked if the patient has attempted suicide or the idea of suicide before. It is important to obtain detailed information about patients in order to easily foster good relationships with patients.

The patient's assessment with the idea of murder is similar to that of a suicide patient. It is not known for sure the risk factor of this disturbance. The risk factor that must be assessed by doctors is a history of violence and gun access. When assessing this patient, there must be an exit that can be accessed quickly and cannot be prevented by the patient in anticipation if the patient behaves seriously in the middle of an examination.

Temporary diagnosis obtained from the results of the examination above will guide further examination and treatment. Doctors will also consider certain supporting examinations to get rid of common medical causes or substance use, such as:

• Drug examination through urine
• Blood alcohol levels test
• Refuge of lumbar or brain fluid examination is carried out if it is suspected that there is an inflammatory condition of the brain membrane and bone cord (inflammatory) or inflammation of the brain (encephalitis)
• CT scans or other imaging does not add much information if there are no abnormal findings in the examination, except for elderly patients

Governance

Acute, manian, agvitational, or murder ideas

The main goal of treatment is to stabilize and ensure the safety of patients as well as the surrounding environment. The initial approach for patients who experience acute aggregation or anxiety is to help manage their stress, such as through behavioral therapy, drugs, or both.

When a patient has a medical illness that plays a role in his psychiatric emergency, it is important to treat the medical illness. In some cases, medical illness is the cause of a psychiatric emergency and therefore must be distinguished from pure mental disorders.

When examining patients with acute legitimacy, doctors must help patients feel safe by creating an environment that is not threatening and speaks calmly and in a low tone. So, patients can control their emotions and want to be involved in treatment. Doctors or backup examiners need to be prepared as well. 

If quick treatment or Sedation therapy is needed, it must be given through injection medication. If the patient has comorbidities, it is necessary to adjust the drug to prevent complications. 

The idea of suicide

Treating patients with the idea of suicide aims to reduce risks and strengthen protective factors. These factors and risks include patient safety, psychological or social stress, social support, and mental disorders that can be treated.

When treating patients with the idea of suicide, doctors must maintain good relations and include patients and their families in treatment. Doctors need to determine a safe place as a treatment location. Before occupying the treatment area, patients must be released from objects that can be dangerous.

In a state of depression, psychotherapy and cognitive behavioral therapy can help. In addition, cognitive behavioral therapy can reduce despair and suicide attempts in outpatients. For patients with threshold personality disorders and the idea of suicide, psychodynamic therapy and dialectic behavioral therapy may be useful.

ECT (Electroconvulsive Therapy) or electric shock therapy has proven beneficial in patients with the idea of suicide, even safe for pregnant women. However, the therapy is not sufficient to maintain patient condition in the long term and must be combined with drugs.

Complications

The implication of a psychiatric emergency is that it can endanger oneself and the surrounding environment. Physical injury can arise, or even loss of life both yourself and others. Other complications in the form of drug side effects such as benzodiazepin class drugs that can cause respiratory suppression, and antipsychotic drugs can cause neurological disorders.

People who are restless or commit violence often come to health facilities with their condition tied up by the police. Sometimes, patients can die in restraint before or immediately after arriving at the hospital. The cause is thought to be due to a combination of metabolic disorders and an increase in body temperature during a rampage, drug use, aspirations of the contents of the stomach into the respiratory tract, embolism due to restraint for a long time, and sometimes due to underlying serious medical disorders.

Deaths are more likely if people are held in an ankle position tied to the ankle behind the back. This type of restraint can cause asphygicsia (oxygen deficiency condition) and this condition should be avoided.

Prevention

It is important to know the alert for suicide attempts in order to prevent and assist patients. Preventions that can be done include:

• Ask people you're worried about whether they're thinking of committing suicide. Although other people hesitate to ask this, research shows that this action is useful
• Keep them safe. Reduce patient access to suicide tools, such as weapons, sharp objects, matches, or insecticides
• Accompany and listen to what they need
• Help them gain continuous support
• Stay connected with them to monitor its development

When do you have to go to a doctor? 

If you or someone you know has one of the symptoms of a psychiatric emergency above, immediately tell the closest person to get help. Try to take him to an emergency unit if the symptoms cannot be controlled. Handling can immediately prevent complications that harm yourself or others.