Psychiatric emergencies in the outpatient setting

Abstract

Psychiatric emergencies are stressful and time-consuming for physicians. Comprehensive diagnostic assessment is often not feasible in psychiatric emergency situations. Primary interventions target symptoms and syndromes. Treatments for psychiatric emergencies often lack an evidence base and rely on expert opinions and good clinical practice. Target symptoms for interventions in emergency situations are agitation, aggressive behavior, delirious states, psychotic symptoms and anxiety (psychotic or non-psychotic). Pharmacological treatments are indicated due to their sedative, antipsychotic, and anxiolytic effects. It is important to look for possible medical causes and comorbidity (differential diagnosis). The treatment of delirium should always focus on any underlying medical conditions. Psychiatric emergencies require immediate action by a physician, although the options available are often limited. If an emergency situation can be converted into a crisis situation by means of a successful intervention, additional time is gained and the range of options for action may be widened.