MHM Magazine

manner, maintaining a non- threatening posture, and offering support. • Engage the patient in a way that respects their autonomy while ensuring safety. 5. Assess and Evaluate: • Conduct a thorough assessment of the patient’s mental, emotional, physical and social state to understand the underlying contributing factors. • Evaluate the need for further medical evaluation or psychiatric assessment. 6. Plan and Implement Interventions: • Develop a short-term action plan to address the immediate crisis, such as crisis counseling, medication, hospitalisation, or other interventions. • Utilise the patient’s existing social support and collaborate with the patient, family, and other multidisciplinary team members. 7. Follow-up and Review: • Ensure throughout the initial intervention and recovery process, ongoing treatment and support services are provided • Address any residual effects of the crisis and work on strengthening coping mechanisms to prevent future crises. • Review the effectiveness of the crisis intervention with the patient and make adjustments to the care plan as needed collaboratively. Psychiatric emergencies: In our daily practice we may experience emergencies and when we do it is impervious to have a rapid response. The following psychiatric emergencies are covered briefly: 1. The Suicidal Patient: • Assess Risk: Determine the severity of suicide risk through direct questioning about thoughts, plans and means. • Ensure Safety: Remove any means of self-harm and provide constant supervision if necessary. • Engage and Support: Build rapport, listen empathetically and validate their feelings. • Plan and Act: Develop a safety plan involving family members, caretakers or associates and ensure follow up with a mental health practitioner. • Provide contacts to SADAG or other hotlines, involve multidisciplinary team members such as social workers and psychologists, and consider hospitalisation if risk is high. • Treatment: gastric lavage with activated charcoal. Remember to refer to internal medicine / ICU in cases of organophosphate or antifreeze/coolant ingestions. Common Antidotes: Medication “Antidote” Paracetamol Acetylcysteine Iron Deferoxamine Opioids Naloxone Benzodiazepine Flumazenil 2. The Aggressive Patient • De-escalate: Use calm, non- threatening communication to reduce tension. • Maintain a safe distance and ensure an escape route. • Ensure there are security guards in the facility and if necessary to involve SAPS. • Assess: Evaluate the cause of aggression, considering causes using DIMPTOP. • Physical Safety: Use the least restrictive means and only resort to five point physical restraints or sedation only if absolutely necessary. • Follow-Up: Once the situation is controlled, assess and treat the underlying cause. 1. D: drugs / delirium 2. I: infections 3. M: Metabolic 4. T: Trauma/ Toxins 5. O: Oxygen deprived 6. P: Psychiatric and perceptual 3. Drug-Related Side Effects: a. Neuroleptic Malignant Syndrome (NMS) Recognise symptoms: use pneumonic: F: Fever, E: Elevated CK and other enzymes such as LFTs, U&E, leucocytosis and myoglobinuria V: Vitals unable - autonomic dysfunction E: Encehalopathy: altered mental status R: Rigidity of muscle • Discontinue the offending agent immediately (remember not only antipsychotics can cause NMS - any medication with dopamine receptor blockade such as maxalone can cause it too). • Initiate supportive care, including hydration and cooling and short course of benzodiazepine. • Administer specific treatments like dantrolene or bromocriptine as indicated with consultation of specialist psychiatrist. b. Serotonin Syndrome: Altered level of consciousness Triad of Serotonin syndrome Fever Myoclonus • Identify symptoms: Other signs include: agitation, rapid heart rate, dilated pupils, sweating, diarrhoea, seizures and hyper-reflexia. • Stop serotonergic medications such as antidepressants. • Provide supportive care including rehydration and MHM | 2024 | Volume 11 | Issue 2 | Crisis Intervention Skills for Doctors MHM 22 | MENTAL HEALTH MATTERS | 2024 | Issue 2 H