Behavioral and Psychiatric Emergencies
Behavioral emergencies require safety-first assessment and recognition of medical mimics. Candidates must know the approach to the agitated or suicidal patient, the importance of a safe environment, and the principles of de-escalation before pharmacologic restraint. Understand that altered behavior can reflect hypoglycemia, ingestion, hypoxia, or infection, so medical evaluation precedes psychiatric diagnosis.
Key concepts include suicide risk assessment, the recognition of delirium versus psychosis, and the appropriate use of restraints with monitoring. Know the presentation of common pediatric psychiatric emergencies and the importance of involving caregivers and mental health resources.
Traps: assuming agitation is purely psychiatric without ruling out medical causes; using restraints without monitoring; and missing suicidal ideation in a patient presenting with a somatic complaint. Another trap is failing to document risk assessment and safety planning.
Worked example: an adolescent with agitation and a normal examination but a history of ingestion should receive a glucose check, toxidrome assessment, and appropriate monitoring before any psychiatric disposition. Rule of thumb: safety, medical screening, de-escalation, then pharmacologic or physical restraint with close monitoring. Document risk assessment and disposition planning.