Psychiatric Emergencies

Over the last few decades, in keeping with the demographic shift associated with an aging population, there has been a consistent increase in the number of geriatric patients visiting emergency departments across North America. The assessment of older adults for psychiatric emergencies is complicated by increased systemic medical and cognitive comorbidities, higher rates of polypharmacy, and a greater sensitivity to medications. Adding further complications to the care of older adults are a psychosocial issue associated with a fixed/limited income, the potential for elder abuse, and questions of level of decisional capacity. This chapter reviews the assessment, diagnosis, and management of the common psychiatric emergencies among the geriatric population, including delirium, major depressive disorder with suicidality, major neurocognitive disorder (dementia) accompanied by neuropsychiatric symptoms, elder abuse, and emergencies associated with psychotropic medications.