Emergency in the Psychiatric
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1 Emergency in the Psychiatric Care and its Legal Regulation Márta Farkas - Zoltán Hidasii
2 Psychiatric Emergency I. Any disturbance in toughts, feelings or actions for wich immediate therapeutic intervention is necessary The emergency psychiatrist must be up-todate on medico-legal issues and managed care the number of emergency patients is rising (dementia, alcohol, and other drugs)
3 Psychiatric Emergency II. Violent behaviour : suicide (self-injury) causing bodily harm, assoult, homicide Life-threatening psychiatric disorders: stupor (catatonic sch., depression) impaired consciousness (delirium tremens) EPS e.g laryngospasm (side-effect) NMS neuroleptic malignant syndrome
4 Violence The most common diagnoses are: mood disorders (mania, depression), schizophrenia (agitation, anxiety, hallucination, thought dis.) addict-problems (alcohol) ---- delirium Intoxication (f.e. bad trip ) personality disorders (antisocial, borderline) Organic psychiatric syndromes (dementia) OCD
5 Prediction of violent/assaultive behaviour Consider: Violent ideation, wish, intention Demographics sex (male), age (15-24) socioeconomic status (low), social support (few) Patient s history: h.of violent acts with arrest or criminal activity, h.of childhood abuse, substance abuse (alcohol), dyscontrol (gambling), self-injury, etc Overt stressors (marital conflicts, real or symbolic loss)
6 Acute Treatment Short interview supplemental history from accompany of the patient (Acute transfer to forensic institute - maximum/high security hospitals) Pharmacotherapy (Haloperidol, Risperidone) repeated in min. until the patient becomes calm Acute ECT (rare)
7 Suicidal Behaviour I. psychological final common pathway sociocultural biological factors
8 Suicidal Behaviour II. epidemiological data Suicide rate: suicidal cases/ people > 25 Scandinavia, a a, Germany, Hungary < 10 Spain, Italy, Ireland, Egypt, Netherland
9 Suicide behaviour III ongoing: WHO monitoring study in 13 European Countries, 16 centers: Was detected the decline of number of the suicidal persons (male:14%, female: 17%) Typical attempter: t young, white, single unemployed woman Typical succesfull suicidal person: man over the 65 age, white
10 Suicidal Behaviour IV. Accountable factors: Race (white) Religion (protective: catholic religion) Marital status (risk: single, previously or never married person) Occupational status (risk: without work/job) Climate: in Autum rise the suicidal cases Physical/Mental Health
11 Suicidal Behaviour V. Mental Health Background: magnitude mental disorders 10% of sch. die because of suicide Depression (50%) Alcohol (drug) abuser, - dependent patients Anxiety disorders Personality disorder
12 Suicidal Behaviour VI. Treatment Treatment of the psychiatric disorder (AD ---SSRIs, AP) Treatment of the crisis: focused psychotherapy crisis s units
13 Legal Regulation of Admission on the Psychiatric i Unit and Patient s t Restraint (EU - recommendation) Having regard: Convention for the Protection of Human Rights and Fundamental Freedoms of 4 Nov 1950 Convention on Human Rights and Biomedicine of 7 April 1997 other international conventions on the regulation
14 Criteria for Involuntary Treatment 1. The person has a mental disorderd 2. The person s condition represents significant risk of serious harm to his/her health or to other persons 3. No less intrusive means of providing appropriate care are available 4. The opinion of the person concerned has been taken into consideration (inform the patient)
15 Procedures for taking decisions on involuntary placement and/or involuntary treatment t t should be taken by a court or another competent body previously in emergency situation (Voluntary admission)
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