Psychiatric Emergency

Psychiatric emergency อ . นพ . พิชัย อิฏฐสกุล ภาควิชาจิตเวชศาสตร์ คณะแพทยศาสตร์ โรงพยาบาลรามาธิบดี

Psychiatric Emergencies ,[object Object],[object Object],[object Object],[object Object],[object Object]

Introduction ,[object Object],[object Object],[object Object],[object Object]

Suicidal Attempt Take ALL suicidal acts seriously!

[object Object],[object Object],[object Object],[object Object]

Suicide : Assessment of Risk ,[object Object],[object Object]

Suicide: Assessment of Risk ,[object Object],[object Object],[object Object],[object Object],4S

Suicide: Assessment of Risk ,[object Object],[object Object],[object Object],[object Object],[object Object]

แนวการถามความคิดฆ่าตัวตาย ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],มี ไม่มี ADMIT When do you hospitalize?

ลักษณะผู้ป่วยที่ต้องรับไว้ในโรงพยาบาล ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Suicidal precaution ,[object Object],[object Object],[object Object],[object Object]

The Violent Patient ,[object Object],[object Object],[object Object]

Mental illness and Violence ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Types of Violence ,[object Object],[object Object],[object Object],[object Object],[object Object]

Predisposing Causes : Alcohol and Drugs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Predisposing causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The (Potentially) Violent Patient ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Impending violence ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Approaching the potentially violent pt ,[object Object],[object Object],[object Object],[object Object]

Approaching the potentially violent pt ,[object Object],[object Object],[object Object],[object Object],[object Object]

Management of the violent patient ,[object Object],[object Object],[object Object],[object Object],[object Object]

Management: Restraint ,[object Object],[object Object],[object Object],[object Object]

Management: Sedation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Management: Continued Care ,[object Object],[object Object]

[object Object],[object Object],The confused patient

Delirium ,[object Object],[object Object],[object Object],[object Object],[object Object]

Clinical Features ,[object Object],[object Object],[object Object]

Clinical features ,[object Object],[object Object],[object Object],[object Object]

Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Management ,[object Object],[object Object],[object Object],[object Object],[object Object]

Management ,[object Object],[object Object],[object Object]

Alcohol withdrawal ,[object Object],[object Object],[object Object],[object Object],[object Object]

Time course and features of simple and complex alcohol withdrawal Onset 6-24 hrs Nausea Tremor Sweats Anxiety Seizures Confusion Distractability Hallucinations Paranoia Delirium tremens Simple withdrawal Days 0 1 2 3 4 5 6 7 8 9 10 Complex withdrawal Adapted from Frank and Pead, 1995 Symptom Severity Symptom Severity Complex withdrawal

ปัจจัยเสี่ยงต่อภาวะ Alcohol withdrawal ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ปัจจัยเสี่ยงต่อภาวะ Alcohol withdrawal ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

การดูแลผู้ป่วย Alcohol withdrawal ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

การดูแลผู้ป่วย Alcohol withdrawal ,[object Object],[object Object],[object Object]

Structured medication regimen (Australia) 5 0 5 0 Day 5 10 5 5 5 Day 4 10 5 5 5 Day 3 10 10 10 10 Day 2 10 10 10 10 Day 1 12MN 6PM 12MD 6AM

Structured medication regimen ,[object Object],[object Object],[object Object],[object Object]

การดูแลผู้ป่วย Alcohol-induced seizure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Alcohol withdrawal delirium (DTs) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Hallmarks of DTs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

การดูแลผู้ป่วย Alcohol withdrawal delirium ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Definition Acute psychosis is the presence of the mental state where appreciation of reality is impaired , as evidenced by the presence of psychotic symptoms

Symptom of psychosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Psychosis ,[object Object],[object Object],[object Object]

Assessment ,[object Object],[object Object],[object Object]

[object Object],[object Object]

Functional VS Organic ,[object Object],[object Object]

Psychiatric disorder Psychosis Neurotic Functional Organic - Schizophrenia - Schizophreniform - Brief psychotic disorder - Delusional disorder - Schizoaffective disorder - Mood disorder with psychotic symptoms ,[object Object]

Physical (Organic) cause of psychosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Features That Point to a Medical Cause of a Mental Disorder ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Intersecting pentagon Clock drawing test 10.50 am

Laboratories test ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Risk assessment and hospitalisation ,[object Object],[object Object],[object Object]

Medications ,[object Object],[object Object],[object Object]

Antipsychotic side effects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Antipsychotic side effects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Acute anxiety ,[object Object],[object Object],[object Object],[object Object]

Acute anxiety ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cause ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Investigation ,[object Object],[object Object]

Medication ,[object Object],[object Object]

Hyperventilation syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object]

Summary ,[object Object],[object Object],[object Object],[object Object]

Psychiatric Emergency

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Psychiatric Emergency