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correcting electrolyte imbalances. • Exclude other medical causes such as UTI / delirium. • Consider serotonin antagonists like cyproheptadine for severe cases. c. Lithium Toxicity: Narrow therapeutic index: 0.6 - 1.2 meq/l. Steps: Recognise stages and discontinue lithium immediately. Remember to complete examination: Lithium level, U&E, FBC, Thyroid function, Pregnancy test (if indicated) and ECG. Stages of Lithium toxicity Stage Toxic level Symptoms Treatment Mild 1.5 - 2.0 meq/l GIT symptoms: nausea, anorexia, abdominal pain, vomiting and diarrhoea Prevent further absorption by gastric lavage and induce emesis with activated charcoal. Supportive management: Rehydrate orally Moderate 2.0 - 2.5 meq/l The above + CNS symptoms: blurred vision, marked tremor, confusion, increased deep tendon reflexes. Manage in medical ward and IVI fluids. Severe >2.5 meq/l GIT + CNS signs and progression to cardiac arrhythmia, oliguria, seizures, altered LOC, coma and death Initiate hemodialysis and intensive supportive care with specialist referral and guidance. d. Catatonia: • Identify Symptoms: Look for signs like mutism, immobility, negativism, posturing, or rigidity use the Bush Francis Scale to determine severity and response to treatment. • Emergency Care: Ensure patient safety, hydration, and nutrition. • Medication: Administer benzodiazepines (e.g. lorazepam) for immediate relief. • Further Assessment: Evaluate for underlying psychiatric or medical conditions. • Treatment Plan: Consider electroconvulsive therapy (ECT) if unresponsive to medication. e. A cute Alcohol or Drug Withdrawal: • Assess severity: Determine the level of withdrawal symptoms and potential complications. • Supportive care: Provide a safe environment, hydration, and nutritional support. • Medication: Use benzodiazepines for alcohol withdrawal; consider appropriate medications for other substance withdrawals based on the substance type. • Monitor: Regularly assess withdrawal symptoms and potential complications. • Long-term plan: Initiate addiction treatment services including counselling and rehabilitation. f. Acute Dystonia: • Immediate recognition: sudden muscle spasms, abnormal postures, or oculogyric crisis. • Treatment: Administer anticholinergics (Biperiden) intravenously or intramuscularly. • Monitor and adjust: Observe the patient closely and consider adjusting the causative medication. 4. Seizures: • Initial response: Place the patient in lateral (recovery) position, and secure airway while monitoring breathing. • Abort the seizure with medication as soon as possible: emergency trolley and establish IVI line if possible. Commonly used to abort seizures: 7. 4mg lorazepam IVI 8. 10mg Midazolam IVI/IMI (both can be repeated 5-10mins if seizures continue) 9. Unsuccessful IVI line: 10mg Diazepam per recty or if available, 10mg buccal Midazolam • After the Seizure: Check for injuries, measure blood glucose and treat hypoglycaemia if present. • Medical Evaluation: Assess for new-onset seizures, electrolyte abnormalities and post seizure psychosis. Refer if necessary, identify potential triggers, and underlying conditions. • Treatment and Monitoring: Administer anti-epileptic drugs as per guidelines depending on the patient and monitor for recurrence or complications. In conclusion, the purpose of this article is to provide an overview and emphasise the importance of swift, empathetic and strategic responses in psychiatric emergencies while highlighting essential skills. By integrating these techniques into practice, doctors can effectively navigate psychiatric emergencies and provide crucial support to patients in distress. References available on request. MHM | 2024 | Volume 11 | Issue 2 | Crisis Intervention Skills for Doctors MHM Issue 2 | 2024 | MENTAL HEALTH MATTERS | 23 MHM