Management of acute psychiatric emergencies

Approaches and challenges in emergency departments

https://doi.org/10.53730/ijhs.v5nS1.15139

Authors

  • Sultan Mohammed Alanazi KSA, National Guard Health Affairs
  • Hatim Faihan Alotaibi KSA, National Guard Health Affairs
  • Ibrahim Mohammed Alanazi KSA, National Guard Health Affairs
  • Adel Mohammad Aldukhain KSA, National Guard Health Affairs
  • Rakan Faisal Albasri KSA, National Guard Health Affairs
  • Salman Abdullah Alharbi KSA, National Guard Health Affairs
  • Hamoud Ghayyadh Alanizi KSA, National Guard Health Affairs
  • Yussef Falah Alharbi KSA, National Guard Health Affairs
  • Diyanah Bander Almutairi KSA, National Guard Health Affairs
  • Najla Abdulaziz Alturki KSA, National Guard Health Affairs
  • Aseel Hasson Alhasson KSA, National Guard Health Affairs
  • Sawsan Ahmed Ghassap KSA, National Guard Health Affairs
  • Khalid Assaf Almutairi KSA, National Guard Health Affairs
  • Mohammed Rashed Al Otaibi KSA, National Guard Health Affairs
  • Ali D. Alshahrani KSA, National Guard Health Affairs
  • Sulaiman Ahmed Almansour KSA, National Guard Health Affairs

Keywords:

Psychiatric emergencies, public disasters, mental health, crisis management, telepsychiatry, healthcare infrastructure

Abstract

Background: The prevalence of psychiatric emergencies increases significantly during public disasters, highlighting the need for effective management strategies. Disasters, including pandemics and epidemics, exacerbate mental health conditions and strain healthcare systems. Despite established models for psychiatric emergency management, there remains a crucial need to ensure accessibility and effectiveness in such high-stress scenarios. Aims: This article aims to review and propose strategies for managing psychiatric emergencies in the context of public disasters. It focuses on evaluating the impact of crises on mental health and the capacity of healthcare systems to address these needs effectively. Methods: A comprehensive review of literature was conducted, examining psychiatric emergencies in disaster settings, including pandemics and natural disasters. The review involved analyzing current management models, assessing their effectiveness, and identifying gaps in healthcare provision. Results: The study finds that the prevalence of mental disorders during disasters is significantly higher compared to normal conditions. Key challenges include inadequate infrastructure, limited staff, and the need for specialized psychiatric interventions. Effective strategies include enhanced triage systems, increased availability of outpatient and inpatient care, and the use of telepsychiatry where applicable. 

Downloads

Download data is not yet available.

References

Kipnis K, Shander A. The taxonomy of calamity: the view from the operating room. Int Anesthesiol Clin. (2015) 53:79–89. doi: 10.1097/AIA.0000000000000069 DOI: https://doi.org/10.1097/AIA.0000000000000069

Correa H, Malloy-Diniz LF, Da Silva AG. Why psychiatric treatment must not be neglected during the COVID-19 pandemic. Braz J Psychiatry. (2020) 42:449. doi: 10.1590/1516-4446-2020-0995 DOI: https://doi.org/10.1590/1516-4446-2020-0995

Da Silva AG, Miranda DM, Diaz AP, Teles ALS, Malloy-Diniz LF, Palha AP. Mental health: why it still matters in the midst of a pandemic. Braz J Psychiatry. (2020) 42:229–31. doi: 10.1590/1516-4446-2020-0009 DOI: https://doi.org/10.1590/1516-4446-2020-0009

Li W, Yang Y, Liu ZH, Zhao YJ, Zhang Q, Zhang L, et al. Progression of mental health services during the COVID-19 outbreak in China. Int J Biol Sci. (2020) 16:1732–8. doi: 10.7150/ijbs.45120 DOI: https://doi.org/10.7150/ijbs.45120

Gomez JM, Verdu M. Network theory may explain the vulnerability of medieval human settlements to the Black Death pandemic. Sci Rep. (2017) 7:43467. doi: 10.1038/srep43467 DOI: https://doi.org/10.1038/srep43467

Udomratn P. Mental health and the psychosocial consequences of natural disasters in Asia. Int Rev Psychiatry. (2008) 20:441–4. doi: 10.1080/09540260802397487 DOI: https://doi.org/10.1080/09540260802397487

Math SB, Nirmala MC, Moirangthem S, Kumar NC. Disaster management: mental health perspective. Indian J Psychol Med. (2015) 37:261–71. doi: 10.4103/0253-7176.162915 DOI: https://doi.org/10.4103/0253-7176.162915

Miranda DM, Reis ZSN, Romano-Silva MA, Malloy-Diniz L, Da Silva AG. Expectations when you are expecting in times of COVID-19. Braz J Psychiatry. (2020) 1–2. doi: 10.1590/1516-4446-2020-1209 DOI: https://doi.org/10.1590/1516-4446-2020-1209

Makwana N. Disaster and its impact on mental health: a narrative review. J Family Med Prim Care. (2019) 8:3090–5. doi: 10.4103/jfmpc.jfmpc_893_19 DOI: https://doi.org/10.4103/jfmpc.jfmpc_893_19

Baldaçara L. Abordagem dos transtornos mentais em calamidades públicas. In: Baldaçara L, Tung TC, editors. Condutas em Psiquiatria. Rio de Janeiro: Manole (2020).

Katz CL, Pellegrino L, Pandya A, Ng A, Delisi LE. Research on psychiatric outcomes and interventions subsequent to disasters: a review of the literature. Psychiatry Res. (2002) 110:201–17. doi: 10.1016/S0165-1781(02)00110-5 DOI: https://doi.org/10.1016/S0165-1781(02)00110-5

Cosic K, Popovic S, Sarlija M, Kesedzic I. Impact of human disasters and COVID-19 pandemic on mental health: potential of digital psychiatry. Psychiatr Danub. (2020) 32:25–31. doi: 10.24869/psyd.2020.25 DOI: https://doi.org/10.24869/psyd.2020.25

Baldaçara L, Ismael F, Leite V, Pereira LA, Dos Santos RM, Gomes Junior VP, et al. Brazilian guidelines for the management of psychomotor agitation. Part 1. Non-pharmacological approach. Braz J Psychiatry. (2019) 41:153–67. doi: 10.1590/1516-4446-2018-0163 DOI: https://doi.org/10.1590/1516-4446-2018-0163

Da Silva AG, Baldaçara L, Cavalcante DA, Fasanella NA, Palha AP. The impact of mental illness stigma on psychiatric emergencies. Front Psychiatry. (2020) 11:573. doi: 10.3389/fpsyt.2020.00573 DOI: https://doi.org/10.3389/fpsyt.2020.00573

Ho CS, Chee CY, Ho RC. Mental health strategies to combat the psychological impact of COVID-19 beyond paranoia and panic. Ann Acad Med Singapore. (2020) 49:155–60. doi: 10.47102/annals-acadmedsg.202043 DOI: https://doi.org/10.47102/annals-acadmedsg.202043

Raphael B, Ma H. Mass catastrophe and disaster psychiatry. Mol Psychiatry. (2011) 16:247–51. doi: 10.1038/mp.2010.68 DOI: https://doi.org/10.1038/mp.2010.68

Shoaf K. Organizing the health sector for response to disasters. Ciência Saúde Coletiva. (2014) 19:3705–15. doi: 10.1590/1413-81232014199.03722014 DOI: https://doi.org/10.1590/1413-81232014199.03722014

Da Silva AG, Pinheiro M, Tres LM, Malloy-Diniz LF. Working during pandemics: the need for mental health efforts to prevent the outbreak of mental disorders at the workplace. Braz J Psychiatry. (2020). doi: 10.1590/1516-4446-2020-1120. [Epub ahead of print]. DOI: https://doi.org/10.1590/1516-4446-2020-1120

Associação Brasileira De Psiquiatria, Associação Médica Brasileira, Conselho Federal De Medicina, Federal Nacional De Médicos, Associação, Brasileira De Impulsividade E Patologia Dual, Sociedade Brasileira De Neuropsicologia. Diretrizes Para um Modelo de Atenção Integral em Saúde Mental no Brasil. Rio de Janeiro (2020). DOI: https://doi.org/10.25118/issn.2965-1832.2024.1190

King RV, Burkle FMJr, Walsh LE, North CS. Competencies for disaster mental health. Curr Psychiatry Rep. (2015) 17:548. doi: 10.1007/s11920-015-0548-2 DOI: https://doi.org/10.1007/s11920-015-0548-2

Baldaçara L, Cordeiro DC, Calfat ELB, Cordeiro DC, Chung TC. Emergências Psiquiátricas. Rio de Janeiro: Elsevier (2019).

Baldaçara L, Pereira LA, Cordeiro Q, Tung TC. Medicina psiquiátrica de emergência. In: Meleiro AMAS, editor. Psiquiatria - Estudos Fundamentais, 1 ed. Rio de Janeiro: Guanabara Koogan (2019). p. 999–1020.

Schleifer JJ. Management of acute agitation in psychosis: an evidence-based approach in the USA. Adv Psychiatr Treat. (2011) 17:91–100. doi: 10.1192/apt.bp.109.007310 DOI: https://doi.org/10.1192/apt.bp.109.007310

Garriga M, Pacchiarotti I, Kasper S, Zeller SL, Allen MH, Vazquez G, et al. Assessment and management of agitation in psychiatry: expert consensus. World J Biol Psychiatry. (2016) 17:86–128. doi: 10.3109/15622975.2015.1132007 DOI: https://doi.org/10.3109/15622975.2015.1132007

Wa Health. The Management of Disturbed/Violent Behaviour in Inpatient Psychiatric Settings. M. H. Division. WA: Department of Health (2006).

Kawakami D, Prates JG, Tung TC. Propostas para o futuro: estrutura física e equipe ideal nas emergências psiquiátricas. Revista Debates em Psiquiatria. (2016) 6:28–34. doi: 10.25118/2236-918X-6-4-3 DOI: https://doi.org/10.25118/2236-918X-6-4-3

Marder SR. A review of agitation in mental illness: treatment guidelines and current therapies. J Clin Psychiatry. (2006) 67(Suppl. 10):13–21. doi: 10.4088/JCP.0706e03 DOI: https://doi.org/10.4088/JCP.0706e03

Richmond JS, Berlin JS, Fishkind AB, Holloman GHJr, Zeller SL, Wilson MP, et al. Verbal de-escalation of the agitated patient: consensus statement of the american association for emergency psychiatry project BETA De-Escalation Workgroup. West J Emerg Med. (2012) 13:17–25. doi: 10.5811/westjem.2011.9.6864 DOI: https://doi.org/10.5811/westjem.2011.9.6864

Caldieraro MA, Spode A, Fleck MPA. Avaliação do paciente na emergência. In: Quevedo J, Schimitt R, Kapczinski F, editors. Emergências Psiquiátricas. Porto Alegre: Artmed (2008). p. 17–48.

Baldaçara L, Diaz AP, Leite V, Pereira LA, Dos Santos RM, Gomes Junior VP, et al. Brazilian guidelines for the management of psychomotor agitation. Part 2. Pharmacological approach. Braz J Psychiatry. (2019) 41:324–35. doi: 10.1590/1516-4446-2018-0177 DOI: https://doi.org/10.1590/1516-4446-2018-0177

O'brien L, Cole R. Close-observation areas in acute psychiatric units: a literature review. Int J Ment Health Nurs. (2003) 12:165–76. doi: 10.1046/j.1440-0979.2003.t01-1-00286.x DOI: https://doi.org/10.1046/j.1440-0979.2003.t01-1-00286.x

Vaaler AE, Morken G, Flovig JC, Iversen VC, Linaker OM. Effects of a psychiatric intensive care unit in an acute psychiatric department. Nord J Psychiatry. (2006) 60:144–9. doi: 10.1080/08039480600583472 DOI: https://doi.org/10.1080/08039480600583472

Niel M. Atitudes na entrevista psiquiátrica. In: Cordeiro DC, Baldacara L, editors. Emergências Psiquiátricas. 1 ed. São Paulo: Roca (2007). p. 11–18.

Torales J, O'higgins M, Castaldelli-Maia JM, Ventriglio A. The outbreak of COVID-19 coronavirus and its impact on global mental health. Int J Soc Psychiatry. (2020) 66:317–20. doi: 10.1177/0020764020915212 DOI: https://doi.org/10.1177/0020764020915212

Lee SM, Kang WS, Cho A-R, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Comprehensive Psychiatry. (2018) 87:123–7. doi: 10.1016/j.comppsych.2018.10.003 DOI: https://doi.org/10.1016/j.comppsych.2018.10.003

Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry. (2020) 7:e14. doi: 10.1016/S2215-0366(20)30047-X DOI: https://doi.org/10.1016/S2215-0366(20)30047-X

Jones NM, Thompson RR, Dunkel Schetter C, Silver RC. Distress and rumor exposure on social media during a campus lockdown. Proc Natl Acad Sci USA. (2017) 114:11663–8. doi: 10.1073/pnas.1708518114 DOI: https://doi.org/10.1073/pnas.1708518114

Baldaçara L, Grudtner RR, Leite VS, Porto DM, Robis KP, Fidalgo TM, et al. Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 2. Screening, intervention, and prevention. Br J Psychiatry. (2020). doi: 10.1590/1516-4446-2020-1108. [Epub ahead of print]. DOI: https://doi.org/10.1590/1516-4446-2020-1108

Baldaçara L, Rocha G, Leite V, Porto D, Grudtner R, Díaz A, et al. Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 1. Risk factors, protective factors, and assessment. Braz J Psychiatry. (2020). doi: 10.1590/1516-4446-2020-0994. [Epub ahead of print]. DOI: https://doi.org/10.1590/1516-4446-2020-0994

Ryes G, Elhai JD. Psychosocial interventions in the early phases of disasters. Psychother Theory Res Pract Train. (2004) 41, 399–411. doi: 10.1037/0033-3204.41.4.399 DOI: https://doi.org/10.1037/0033-3204.41.4.399

Tzur Bitan D, Otmazgin A, Shani Sela M, Segev A. The role of entrapment in crisis-focused psychotherapy delivered in psychiatric emergency settings: a comparative study. Front Psychol. (2019) 10:2600. doi: 10.3389/fpsyg.2019.02600 DOI: https://doi.org/10.3389/fpsyg.2019.02600

Ruzek JI, Young BH, Cordova MJ, Flynn BW. Integration of disaster mental health services with emergency medicine. Prehosp Disaster Med. (2004) 19:46–53. doi: 10.1017/S1049023X00001473 DOI: https://doi.org/10.1017/S1049023X00001473

Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. (2014) 383:911–22. doi: 10.1016/S0140-6736(13)60688-1 DOI: https://doi.org/10.1016/S0140-6736(13)60688-1

Cerveira CCT, Pupo CC, Santos SDSD, Santos JEM. Delirium in the elderly: a systematic review of pharmacological and non-pharmacological treatments. Dement Neuropsychol. (2017) 11:270–5. doi: 10.1590/1980-57642016dn11-030009 DOI: https://doi.org/10.1590/1980-57642016dn11-030009

Steinberg M, Lyketsos CG. Atypical antipsychotic use in patients with dementia: managing safety concerns. Am J Psychiatry. (2012) 169:900–6. doi: 10.1176/appi.ajp.2012.12030342 DOI: https://doi.org/10.1176/appi.ajp.2012.12030342

Knox DK, Holloman GHJr. Use and avoidance of seclusion and restraint: consensus statement of the american association for emergency psychiatry project Beta seclusion and restraint workgroup. West J Emerg Med. (2012) 13:35–40. doi: 10.5811/westjem.2011.9.6867 DOI: https://doi.org/10.5811/westjem.2011.9.6867

Rossler W. Stress, burnout, and job dissatisfaction in mental health workers. Eur Arch Psychiatry Clin Neurosci. (2012) 262(Suppl. 2):S65–9. doi: 10.1007/s00406-012-0353-4 DOI: https://doi.org/10.1007/s00406-012-0353-4

Alves VM, Francisco LC, De Melo AR, Novaes CR, Belo FM, Nardi AE. Trends in suicide attempts at an emergency department. Braz J Psychiatry. (2017) 39:55–61. doi: 10.1590/1516-4446-2015-1833 DOI: https://doi.org/10.1590/1516-4446-2015-1833

Bachmann S. Epidemiology of suicide and the psychiatric perspective. Int J Environ Res Public Health. (2018) 15:1425. doi: 10.3390/ijerph15071425 DOI: https://doi.org/10.3390/ijerph15071425

Conejero I, Berrouiguet S, Ducasse D, Leboyer M, Jardon V, Olie E, et al. [Suicidal behavior in light of COVID-19 outbreak: clinical challenges and treatment perspectives]. Encephale. (2020) 46:S66–72. doi: 10.1016/j.encep.2020.05.001 DOI: https://doi.org/10.1016/j.encep.2020.05.001

Boudreaux ED, Miller I, Goldstein AB, Sullivan AF, Allen MH, Manton AP, et al. The Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE): method and design considerations. Contemp Clin Trials. (2013) 36:14–24. doi: 10.1016/j.cct.2013.05.008 DOI: https://doi.org/10.1016/j.cct.2013.05.008

Dunlap LJ, Orme S, Zarkin GA, Arias SA, Miller IW, Camargo CA Jr, et al. Screening and intervention for suicide prevention: a cost-effectiveness analysis of the ED-SAFE interventions. Psychiatr Serv. (2019) 70:1082–7. doi: 10.1176/appi.ps.201800445 DOI: https://doi.org/10.1176/appi.ps.201800445

Mullinax S, Chalmers CE, Brennan J, Vilke GM, Nordstrom K, Wilson MP. Suicide screening scales may not adequately predict disposition of suicidal patients from the emergency department. Am J Emerg Med. (2018) 36:1779–83. doi: 10.1016/j.ajem.2018.01.087 DOI: https://doi.org/10.1016/j.ajem.2018.01.087

Weber AN, Michail M, Thompson A, Fiedorowicz JG. Psychiatric emergencies: assessing and managing suicidal ideation. Med Clin North Am. (2017) 101:553–71. doi: 10.1016/j.mcna.2016.12.006 DOI: https://doi.org/10.1016/j.mcna.2016.12.006

Reger MA, Stanley IH, Joiner TE. Suicide mortality and coronavirus disease 2019-a perfect storm? JAMA Psychiatry. (2020). doi: 10.1001/jamapsychiatry.2020.1060. DOI: https://doi.org/10.1001/jamapsychiatry.2020.1060

Baldaçara, L., Da Silva, A. G., Pereira, L. A., Malloy-Diniz, L., & Tung, T. C. (2021). The management of psychiatric emergencies in situations of public calamity. Frontiers in psychiatry, 12, 556792. DOI: https://doi.org/10.3389/fpsyt.2021.556792

Published

15-01-2021

How to Cite

Alanazi, S. M., Alotaibi, H. F., Alanazi, I. M., Aldukhain, A. M., Albasri, R. F., Alharbi, S. A., Alanizi, H. G., Alharbi, Y. F., Almutairi, D. B., Alturki, N. A., Alhasson, A. H., Ghassap, S. A., Almutairi, K. A., Al Otaibi, M. R., Alshahrani, A. D., & Almansour, S. A. (2021). Management of acute psychiatric emergencies: Approaches and challenges in emergency departments. International Journal of Health Sciences, 5(S1), 1191–1206. https://doi.org/10.53730/ijhs.v5nS1.15139

Issue

Vol. 5 No. S1 (2021)

Section

Peer Review Articles
Copyright & Licensing

Copyright (c) 2021 International journal of health sciences

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Articles published in the International Journal of Health Sciences (IJHS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.

Articles published in IJHS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.

This copyright notice applies to articles published in IJHS volumes 4 onwards. Please read about the copyright notices for previous volumes under Journal History.

Crossref
Scopus
Google Scholar
Europe PMC

Most read articles by the same author(s)

1 2 > >>