Behavioral emergencies

[Luis Fok]

Patients who are experiencing severe changes in mood, thoughts, or behavior or severe, potentially life-threatening drug adverse effects need urgent assessment and treatment. Nonspecialists are often the first care providers for outpatients and inpatients on medical units, but whenever possible, such cases should also be evaluated by a psychiatrist.
When a patient’s mood, thoughts, or behavior is highly unusual or disorganized, assessment must first determine whether the patient is a

Threat to self
Threat to others

The threat to self can include inability to care for self (leading to self-neglect) or suicidal behavior. Self-neglect is a particular concern for patients with psychotic disorders, dementia, or substance use disorders because their ability to obtain food, clothing, and appropriate protection from the elements is impaired.
Patients posing a threat to others include those who are actively violent (ie, actively assaulting staff members, throwing and breaking things), those who appear belligerent and hostile (ie, potentially violent), and those who do not appear threatening to the examiner and staff members but express intent to harm another person (eg, spouse, neighbor, public figure). It is also important to identify caregivers who cannot safely and adequately care for their dependents.