Those who deal professionally with acutely ill patients must always bear in mind the 'unpredictability factor' and the potential for violent behaviour during acute symptomatic 'shifts'. Risk assessment of dangerousness is an imprecise science, but an attempt should be incorporated into all routine clinical assessments during acute phase treatment. Caution should be exercised with patients who are profoundly suspicious, verbally aggressive, resistant to engagement, whose pattern of disorder does not allow for a comprehensive mental state examination, or whose clinical condition is complicated by substance abuse, and especially (for those in relapse) who have a past history of assaultive or threatening behaviour.
Principles of wider management are crucial in avoiding emergency situations, bearing on the quality of the environment and the amount and quality of support available. However, even with high levels of vigilance, pre-emptive plans, and good quality management, emergency situations may still occur and must be dealt with swiftly.
An outline plan relating to emergency situations is shown in Fig 2.
Fig. 2 Outline plan for treatment/management of psychiatric emergencies.
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