Emergency Psychiatry and Acute Behavioral Management: Psychiatric Holds, Suicide Risk Assessment (SAD PERSONS, PHQ, SAFE-T), Acute Agitation, Delirium, Pharmacologic and Physical Restraints, Antipsychotics and Benzodiazepines, Neuroleptic Malignant Syndro

Emergency Psychiatry and Acute Behavioral Management: Psychiatric Holds, Suicide Risk Assessment (SAD PERSONS, PHQ, SAFE-T), Acute Agitation, Delirium, Pharmacologic and Physical Restraints, Antipsychotics and Benzodiazepines, Neuroleptic Malignant Syndrome, Extrapyramidal Effects, New-Onset Psychosis, Organic Causes, Patient Safety, Verbal De-escalation, Nonpharmacologic Interventions, High-Risk Populations, Intensive Outpatient Services, and ED Psychiatric Evaluation Protocols Questions Provided with A+ Graded Rationales Latest Updated 2026 Uncover an organic condition what is the goal of ED encounter with a psychiatric patient? "medically stable" or "completed focused medical assessment" what are some better clinical terms to say instead of "Medical clearance" Psychiatric Hold -involuntary confinement for safety -gives healthcare providers legal custody of patient -does not confer treatment against their wishes, except for threat to life or limb • Holds vary from as little as 8 hrs. to as much as 3 days, can be extended. • An imminent danger to themselves (suicide/self-harm/poor insight) • An imminent danger to others (homicidal ideation) • Gravely disabled. what are the patient qualifications for Psychiatric hold? Acute Agitation • True medical emergency, high risk situation • Ensure safety for patient, staff, and start medical evaluation • If possible: start with verbal de-escalation • Then pharmacologic sedation, then physical restraint Agitate Delirium -can be cause by severeal street drugs • Hyperactive heart, muscle contractions, tachypnea can lead to --- • Hypoxia, hyperthermia, rhabdomyolysis, or cardiac arrest • Provocative behavior, threats • Angry demeanor • Loud, aggressive speech • Tense posturing (clenched fists/jaw) • Frequently changing positions, pacing • Acts of aggression, hitting wall, self-harm, throwing objects. Signs of impending violence • Be alert, keep patient in private, quite area with sharp/heavy objects removed. • Keep door/exit open, do not allow your exit to be blocked. What are some tips for when you observe signs of impending violence • Respect personal space (at least 2 arms length distance) • Do not be provocative • Establish verbal contact • Be concise • Identify expectations • Listen closely to what patient is saying • Agree/agree to disagree • Set limits • Offer choices • Do not threaten the patient • Debrief patient and staff Tips for Verbal De-escalation IM what is the most common method of administration of pharmacologic restraints? Benzodiazepine Pharmacologic Restraint of choice if sympathomimetic overdose Antipsychotic Pharmacologic Restraint of choice if psychiatric/alcohol intoxication Diphenhydramine drug that can reduce side effects of antipsychotics Physical Restraints • Indication: Patient poses immediate threat to self/others/obstructing evaluation • Indication: Patient poses immediate threat to self/others/obstructing evaluation • 4 point, hard restraints (not soft restraint) • Damages rapport and is potentially harmful • Reassess frequently and remove as soon as safe to do so. • Safety is paramount, usually requires a team approach • Use in concert with pharmacologic restraints New Onset Psychosis • A profound disturbance of patient's mood/ability to think, no longer in touch with reality • Consider a medical illness first, especially if the psychosis is new. • Full mental status/neurologic evaluation needed, • Abnormal vital signs • Age 12 or 40 years without previous dx • Focal neurologic findings • Visual hallucinations • Psychomotor retardation • Recent memory loss • Sudden onset • No prior psychiatric illness • No family history of psychiatric illness • History of substance abuse What are some clues that they could have an organic cause to their psychosis Neuroleptic Malignant Syndrome • Symptoms: fever, muscle rigidity, altered mental status, autonomic instability • Can