Clinical Research Case Report

Abstract

Co-authored by Dr. Saurabh Kumar, Swarandeep Singh, and Raman Deep, this study, published in The National Medical Journal of India, provides a comprehensive analysis of psychiatric emergencies at a leading tertiary care center in India. The research investigates the patterns, clinical profiles, and service utilization associated with mental and behavioral emergencies over a 13-month period. It highlights the need for optimized mental health emergency services in India, particularly in general hospital settings, where psychiatric care often intersects with medical emergencies.
 

Key Findings of the Research:

1. High Incidence of First-Time Psychiatric Emergencies: The study found that 71% of the patients presenting with mental or behavioral emergencies had no prior psychiatric history, indicating that for a significant proportion of individuals, their visit to the emergency department was their first contact with mental health services. This underscores the critical role of emergency services in the initial management and diagnosis of psychiatric conditions.
2. Common Causes of Emergency Visits: The most frequent reasons for psychiatric emergency consultations were self-harm attempts (19.5%), aggression or agitation (18.3%), and psychoactive substance use-related problems (10.3%). These findings reflect the urgent need for immediate interventions in cases of acute distress, violence, and substance-related crises.
3. Psychiatric Diagnoses: Schizophrenia and other psychotic disorders (13.4%) and mood disorders (13.1%) were the most commonly diagnosed conditions, followed by psychoactive substance use disorders (12.6%) and dissociative disorders (10.1%). This distribution highlights the diverse range of psychiatric emergencies encountered in a general hospital setting.
4. Medicolegal Concerns: Approximately 31.4% of cases were associated with medicolegal issues, often linked to incidents involving self-harm or police intervention. These cases required coordination between psychiatric care providers and legal authorities, underscoring the complexity of managing psychiatric emergencies that intersect with legal and societal challenges.
5. Pharmacological Interventions: Benzodiazepines (44.4%) were the most frequently prescribed medications in the emergency setting, followed by antipsychotics (28.1%) and antidepressants (13.5%). The use of these medications reflects the urgent need to manage acute agitation, psychosis, and depressive symptoms in psychiatric emergencies.
6. Hospital Admissions: About 11% of patients required immediate psychiatric admission, with half of these patients being admitted directly from the emergency department. The remaining patients faced barriers to admission, such as bed shortages or refusal by attendants, highlighting the need for improved psychiatric inpatient infrastructure.

Applicability to the General Population:

This study has significant implications for public health and mental health service delivery in India. It reveals the growing demand for psychiatric emergency services, driven by acute mental health crises that often present for the first time in emergency settings. For the general population, the findings underscore the importance of timely access to mental health care and the need for better integration of psychiatric services within general hospitals.

The study also raises awareness about the prevalence of self-harm, substance-related emergencies, and psychotic disorders, calling for public health interventions aimed at prevention, early detection, and support for individuals experiencing mental health crises. By improving emergency psychiatric care and expanding mental health resources, the burden on emergency departments can be alleviated, leading to better outcomes for individuals with acute psychiatric needs.

In conclusion, "Mental and Behavioral Emergencies at a Tertiary Healthcare Centre in India" provides critical insights into the patterns and challenges of psychiatric emergencies in India. Dr. Saurabh Kumar and his colleagues offer valuable recommendations for optimizing psychiatric services in emergency settings, emphasizing the need for enhanced mental health infrastructure and multidisciplinary approaches to care. This study highlights the urgent need for systemic changes to meet the growing demand for mental health services in India.

Author Information:  Saurabh Kumar, Swarndeep Singh, and Raman Deep. "Mental and behavioural emergencies at a tertiary healthcare centre in India: Pattern and profile." National Medical Journal of India 31, no. 6 (2018).