Psychiatric Emergencies

A psychiatric emergency is a situation that if left untreated is likely to cause harm to oneself or others. These acute disturbances of behavior may manifest as suicidal ideation or attempts, violence, agitation, drug overdose, delirium, psychosis, mania, neuroleptic malignant syndrome, or serotonin syndrome. When psychiatric emergencies arise, they can present many challenges to the PMHNP. While many approaches to emergencies are similar when dealing with children and adolescents versus adults, significant differences also exist. This is particularly true with coordination of care, availability of resources, and legal implications of the psychiatric emergency.

This week, you examine psychiatric emergencies and explain the ethical and legal issues surrounding these events. You will also review evidence-based suicide and violence risk assessments that you may use to screen patients.  

Learning Objectives

Students will:

• Explain salient ethical and legal issues relevant to psychiatric emergencies in psychiatric-mental health practice
• Select evidence-based risk assessments for psychiatric emergencies

Learning Resources

Required Readings (click to expand/reduce)

Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones & Bartlett Learning.

• Chapter 7, “Negligence and Malpractice”
• Chapter 8, “Risk Management”
• Chapter 16, “Resolving Ethical Dilemmas”

National Institute for Health and Care Excellence (2019). Brøset violence checklist. http://riskassessment.no/

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer. (For review as needed)

• Chapter 23, “Emergency Psychiatric Medicine”
• Chapter 36.2, “Ethics in Psychiatry”

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (Eds.). (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.  

• Chapter 19, “Legal Issues in the Care and Treatment of Children With Mental Health Problems”
• Chapter 64, “Suicidal Behavior and Self-Harm”

U.S. Department of Veterans Affairs. (2019). VA/DoD clinical practice guidelines: Assessment and management of patients at risk for suicide (2019).https://www.healthquality.va.gov/guidelines/MH/srb/

Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing Company.

• Chapter 15, “Violence and Abuse”

Medication Review

Review the FDA-approved use of the following medicines related to treating psychiatric emergencies:

Aggression	Behavioral problems	Cataplexy syndrome
clozapine propranolol zuclopenthixol	aripiprazole asenapine chlorpromazine haloperidol iloperidone lurasidone olanzapine paliperidone quetiapine risperidone ziprasidone	clomipramine imipramine sodium oxybate

Catatonia	Extrapyramidal side effects	Mania
alprazolam chlordiazepoxide clonazepam clorazepate diazepam estazolam flunitrazepam flurazepam loflazepate lorazepam midazolam oxazepam quazepam temazepam triazolam	benztropine diphenhydramine trihexyphenidyl	alprazolam (adjunct) aripiprazole asenapine carbamazepine chlorpromazine clonazepam (adjunct) iloperidone lamotrigine levetiracetam lithium lorazepam (adjunct) lurasidone olanzapine quetiapine risperidone sertindole valproate (divalproex) ziprasidone zotepine