Psychiatric disorders are an epidemic problem across the world, but the EMS provider’s ability to understand, assess and manage these emergencies remains poor.

Depressive Disorder- Clinical symptoms and patient care considerations

EMS providers are not expected to diagnose patients with psychiatric emergencies. That said, even patients with diagnosed depression do not always complain directly about being depressed.

Depression is distinguished from feelings of being upset or sad by the duration of the symptoms and the absence of a single upsetting incident (e.g., a fight with a family member, a death, etc.).

Long-term care for the patient with depression is provided by a psychologist and/or therapist, and sufferers may be prescribed one of the various prescription drugs available.

EMS providers may interact with patients experiencing depression at their homes and during interfacility transports. When evaluating and managing these patients, management focuses on providing a compassionate, safe and empathetic environment.

Pay attention to your demeanour. Body language such as crossed arms, furrowed brow, clenched hands or standing rigidly suggests to the patient you are judging them or talking down. Instead, sit so your eyes are on the same level as the patient. Speak softly to the patient and ask open-ended questions that encourage the patient to share and speak freely. Be non-judgmental and seek to understand the patient’s situation.

During emergent care of the depressed patient, it is essential to determine if the patient has suicidal ideations . Patients with suicidal or homicidal ideations are an immediate risk and need transport for further psychiatric care.

Bipolar Affective Disorder- Clinical symptoms and patient care considerations

Patients with bipolar experience profound swings in their mental health, with manic episodes followed by major depressive episodes.

The characteristic feature of bipolar is mood elevation.

When evaluating a patient with depression or bipolar, consider the following: appearance, affect/mood, thought content, judgment and violence/suicide/aggression.

Caregivers and prehospital providers should take any reference to suicidal ideations seriously.

Management of bipolar patients is driven by the phase the patient is experiencing. It is not uncommon for patients to require in-patient care during both manic and depressive episodes.

The care of a patient with a bipolar-associated major depressive episode is identical to managing any other depressed patient. Patient care during manic episodes is safety driven. Avoid aggressive behaviors at all times! speak calmly with the patient and try to build a bond without lying or participating in any delusions the patient may be experiencing. These patients require safe transport for medical management.

It may become necessary to provide pharmacological support to safely transport these patients. Sedation for psychiatric emergencies is a controversial issue and should only be performed in consultation with medical direction.

Conclusion

Depression and bipolar disorders are two psychological emergencies commonly seen by EMS providers and both are closely linked with suicide.

By being compassionate and speaking in an honest, reassuring manner to your patients, you may discover valuable information that means the difference between life and death.

 

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