Management of Acute and Chronic Psychiatric Symptoms
Acute Symptom Management
- Agitation/aggression: ensure safety (call for help, remove dangerous objects), use de-escalation (calm tone, personal space, offer choices), medications (antipsychotics, benzodiazepines) if needed, restraints as last resort with monitoring.
- Psychosis: hallucinations, delusions; respond to underlying emotion, reality-test gently, distract, use PRN antipsychotics; monitor for command hallucinations.
- Mania: high energy, impulsivity; safe environment, low stimulation, mood stabilizers, limit setting.
- Suicidal ideation: direct questioning, safety plan, remove means, close observation.
- Withdrawal: alcohol (benzodiazepines, thiamine, monitor for DT), opioids (methadone/buprenorphine), benzodiazepines (taper).
Chronic Symptom Management
- Depression: medication adherence, psychotherapy, behavioral activation, exercise.
- Anxiety: CBT, relaxation techniques, SSRIs/SNRIs, buspirone.
- PTSD: trauma-focused therapy, SSRIs, avoid benzodiazepines.
- Personality disorders: DBT for borderline; set limits, validate feelings, avoid power struggles.
- Dementia: orientation, routine, safety, caregiver support; manage agitation non-pharmacologically first.
Traps in Questions
- Choosing restraints before de-escalation.
- Arguing with delusions or reinforcing hallucinations.
- Missing medical causes of agitation (hypoglycemia, hypoxia, infection).
- Forgetting withdrawal protocols (e.g., alcohol withdrawal requires benzodiazepines, not antipsychotics alone).
Worked Example
A patient with schizophrenia says, “The CIA is listening through the walls.” What is the best response? Answer: “That sounds frightening. You’re safe here.”-acknowledge feeling without reinforcing or arguing. Rule of thumb: validate emotion, not the delusion.