Drugs used in psychiatric emergencies
Table of contents
Extract
- As a principal rule, it is inappropriate to start any psychiatric medication in an emergency situation if proper follow-up care is not arranged for. The patient’s overall situation and the background causes should always be sorted out and the possible somatic factors excluded.
- A person with mental problems is most urgently in need of treatment for the acutely developed condition, e.g. anxiety and hopelessness, regardless of the background illness or disturbance. If hospitalization is not considered necessary, the patient’s anxiety should be got under control as soon as possible.
- Risk of suicide should always be kept in mind and should always be inquired into. At the emergency department it is safest always to prescribe the smallest available package of a psychotropic drug.
- It is always necessary to arrange for appropriate follow-up care.
- Benzodiazepines are still the safest and most effective drugs for the treatment of acute anxiety. Dependence is, however, easily developed and the effect of the drug is often decreased within a few weeks. They are thus apt for a very short-term use only, and if their use is considered absolutely necessary the smallest possible package size should be prescribed.
- SSRI drugs are best suitable for chronic anxiety, e.g. for generalized anxiety and panic disorder.
- In an emergency situation it is seldom necessary to start antidepressant medication, and antipsychotic medication still more seldom. An exception is maybe a situation where the patient has had the same problem earlier and it is known what kind of medication was effective then.
Linked evidence summaries
- Haloperidol in low doses (3-7.5 mg/day) may be as effective as higher doses with a lower rate of adverse effects in acute schizophrenia.C
- The evidence is insufficient for the efficacy of risperidone for psychosis-induced aggression or agitation.D
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