[Psychiatric emergencies].

Abstract

Psychiatric emergencies must not just be seen as catastrophies. They invariably represent the nadir of a development which has not been given enough attention while it arose. In contrast to a typical medical emergency situation the doctor is usually not particularly welcome by the disturbed psychiatric patient and his family. This may represent some hardship for the good doctor. When arriving at the scene of a psychiatric emergency, an accurate differential diagnosis will be of primary importance. Suicidality, disturbances of consciousness, states of excitement, dyskinesias and affective crises are the most frequent findings. In contrast to a somatic crisis where rapid intervention may be life-saving, it is advisable, to take your time and make sure you took everything into account, before making a decision. Sometimes the use of medication can dramatically change the scene from drama to dialogue. Basically, one has to determine if a hospitalization is necessary or not. Two primary concerns have to be looked into here: suicidal risk and dangerousness to others. It is good to be aware of those situations and diagnoses well known for their high suicidal potential. The question which - if any - compulsive measures have to be taken has to be answered and acted upon. Unpopular as they may be, they can resolve an extremely difficult situation within minutes. Unnecessary hesitation is not asked here for the sake of the patient as well as his family. The best way to deal with psychiatric emergencies is to avoid them. Looking out for signs and symptoms of a beginning psychotic development or suicidal ideation and acting upon it, for instance with medication and/or intensifying contacts with the patient are the primary means to prevent a crisis. Stopping medication, by patient or doctor, is one of the main reasons for psychiatric emergencies. After a psychiatric emergency has evolved, it pays out, to carefully analyse its development, the way it was handled and how it finally ended. Thus a crisis may, like the Chinese symbol for it with its double meaning, evolve to a chance for the patient.