Psychiatric Emergency Strategies

Author(s):

Mark Newman, MD,Divy Ravindranath, MD, MS

Here we present how to assess safely patients who become oppositional or menacing in a clinic or office.

TIPSHEET:

SIGNS OF AGITATION IN A PATIENT

â Verbal: He or she becomes louder, demanding, and/or menacing; uses foul language, oppositional or forboding tone, and/or put-downs.

â Behavioral: He or she is unable to sit still, uses "fierce" eye contact, makes fists, tightens muscles, and/or tenses jaw.

MANAGEMENT OF PSYCHIATRIC EMERGENCIES IN THE CLINIC

â The safe assessment and successful resolution of a psychiatric emergency in the clinic begins well before the patient’s arrival and includes preparation of the physical environment and a well-trained staff.

â In determining whether a patient is dangerous, focus on factors that tend to elevate the patient’s risk of intentional or unintentional harm to self and others.

â If an empathetic response and safety planning by the clinician are not enough to diffuse a dangerous patient, referral and transfer to an emergency department are essential.

Note: Adapted from an article originally published in 2010 by Mark Newman, MD, and Divy Ravindranath, MD, MS, titled "Managing a Psychiatric Emergency: What Every Psychiatrist Needs to Know to Be Prepared."