Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

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MEDICAL DISCLAIMER: The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis, or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd.

Common Psychiatric Emergencies

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Condition	Clinical Presentation	Diagnostic Tests	Treatment
Acute Psychosis	Delusions, hallucinations, disorganized thinking, and behavioral disturbances. Agitation, aggression, and inability to engage in reality-based conversation. Causes may include schizophrenia, bipolar disorder, severe depression, or substance misuse.	Clinical assessment, including mental state examination (MSE). Toxicology screen to rule out substance misuse. Blood tests (e.g., FBC, U&Es, LFTs) to exclude metabolic causes or medication side effects. CT or MRI brain scan if organic causes are suspected (e.g., head injury, tumour).	Administration of antipsychotic medication (e.g., haloperidol, olanzapine). Consider benzodiazepines (e.g., lorazepam) for severe agitation. Admit to a psychiatric unit for further assessment and management. Use the Mental Health Act if patient lacks capacity and poses risk to self or others.
Suicidal Ideation or Attempt	Expressed intent to harm or kill oneself, or recent suicide attempt. May present with low mood, hopelessness, social withdrawal, and self-harm. Common in severe depression, bipolar disorder, personality disorders, and after traumatic events.	Comprehensive psychiatric assessment, including suicide risk assessment. Physical examination to identify injuries or signs of self-harm. Blood tests and toxicology screen if overdose or poisoning is suspected.	Immediate safety measures, such as constant observation and removing means of harm. Admission to hospital (psychiatric or general) based on severity and risk. Initiate antidepressant treatment if indicated and provide psychological support. Crisis intervention and referral to community mental health services for ongoing support.
Acute Mania	Elevated or irritable mood, increased energy, decreased need for sleep, and impulsive behavior. Grandiosity, racing thoughts, pressured speech, and poor judgment. Associated with bipolar disorder, substance misuse, or other psychiatric conditions.	Clinical assessment, including mental state examination (MSE). Toxicology screen to rule out substance-induced mania. Blood tests (e.g., thyroid function tests) to rule out metabolic causes.	Initiate mood stabilizers (e.g., lithium, valproate) or antipsychotics (e.g., olanzapine). Benzodiazepines (e.g., lorazepam) for short-term sedation and agitation management. Admit to a psychiatric unit for stabilization and monitoring.
Neuroleptic Malignant Syndrome (NMS)	Hyperthermia, muscle rigidity, altered mental status, and autonomic instability (e.g., tachycardia, labile blood pressure). Associated with the use of antipsychotic medications, especially high-potency neuroleptics.	Clinical diagnosis based on presentation and antipsychotic use. Blood tests showing elevated creatine kinase (CK), leukocytosis, and renal impairment.	Discontinue antipsychotic medication immediately. Supportive care, including IV fluids, cooling measures, and management of complications. Consider dantrolene, bromocriptine, or amantadine in severe cases. Admit to ICU for close monitoring if condition is severe.
Serotonin Syndrome	Agitation, confusion, myoclonus, hyperreflexia, and autonomic instability (e.g., tachycardia, hyperthermia). May also present with tremor, diarrhoea, and sweating. Often occurs after initiation or overdose of serotonergic drugs (e.g., SSRIs, MAOIs, MDMA).	Clinical diagnosis based on presentation and serotonergic drug use. No specific diagnostic tests, but blood tests may show elevated CK and metabolic acidosis.	Immediate discontinuation of serotonergic drugs. Supportive care, including IV fluids, benzodiazepines for agitation, and cooling measures for hyperthermia. Consider cyproheptadine (a serotonin antagonist) in moderate to severe cases.
Alcohol Withdrawal Delirium (Delirium Tremens)	Agitation, confusion, hallucinations, tremors, and autonomic instability (e.g., tachycardia, hypertension). Occurs 48-72 hours after the last alcohol intake in dependent individuals.	Clinical diagnosis based on history and presentation. Blood tests including electrolytes, magnesium, and liver function tests.	Benzodiazepines (e.g., diazepam, lorazepam) for symptom control. Thiamine supplementation to prevent Wernicke’s encephalopathy. IV fluids and correction of electrolyte imbalances.
Violent or Aggressive Behaviour	Physical aggression, verbal threats, and agitation, posing a risk to self or others. Often associated with acute psychosis, substance misuse, personality disorders, or delirium.	Clinical assessment focusing on cause of aggression. Toxicology screen to rule out substance misuse. Blood tests to identify metabolic or neurological contributors.	De-escalation techniques, including verbal calming. Rapid tranquilization (e.g., intramuscular lorazepam, haloperidol) if necessary. Use of the Mental Health Act if the patient lacks capacity and poses a risk.

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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