First Presentation of Behavioural Disturbance
PSYCHIATRY: First Presentation of Behavioural Disturbance
Assessment
Applies to patients displaying behavioural disturbance e.g: Restlessness, aggression, inappropriate behaviour or confusion. Emergency assessment: Focused to EXCLUDING A DELIRIUM caused by an organic or general medical condition (GMC)
- D-MIST handover from Ambulance
- COLLATERAL from carer or escort is vital
SAMPLE History
- S igns and Symptoms: Ask about precipitating causes
- A llergies
- M edications
- P ast Medical and Psychiatric History
- E vents surrounding Presentation
RECORD NAME, CONTACT NUMBER AND ADDRESS OF CARERS OR FAMILY
Physical Observations and Full Medical Examination
| Perform MENTAL STATE EXAMINATION (Record this in notes) | |
| Fluctuating or Stable? | What is the Mood or Affect? |
| Speech: Fast or Slow? Is the content coherent and logical? | Assess cognition, insight and judgement |
| Are there delusions? Are there Auditory Hallucinations? Other types or more than one kind? | |
Management
Ensure SAFETY of yourself, staff, the patient and other patients.
Ensure security personnel are present.
Screen for weapons and if present, disarm the patient
Evaluate the patient in a safe room with help accessible: Position yourself so that neither you nor the patient feel threatened
d
Drafted 2010. Review Jan 2013. Ref: Western Cape Psychiatry Protocols. Rosen's Emergency Medicine 7th ed. Tintinalli's 4th ed. Western Cape Emergency Medicine Protocols