Medical Emergencies in Psychiatry

Presentation of somatic symptoms in psychiatric patients are frequent for various reasons. Many psychiatric disorders increase the propensity to develop somatic disorders. At the same time, long-term psychopharmacological treatment not seldom harbors the risk to develop somatic side-effects (e.g., cardiac, or metabolic disturbances), even medical emergencies (e.g., Serotonin Syndrome, acute dyskinesia, or Malignant Neuroleptic Syndrome). Further, somatic symptoms are common accessory phenomena in many psychiatric conditions, like pain and weakness in mood disorders, cardiac and circulatory troubles in anxiety or addiction, impaired consciousness in post-traumatic stress disorder (PTSD), bizarre bodily sensations in psychosis. A somatic symptomatology can even be the predominant presentation as in newly DSM-5 coined Somatic Symptom Disorder (SSD) that includes symptom complexes that have been classified previously as somatization disorder, hypochondriasis, pain disorder, and undifferentiated somatoform disorder. Compared to former definitions, SSD diagnosis does not require that the somatic symptoms are medically unexplained, and they may or may not be associated with another medical condition. Nevertheless, in many cases, sustained diagnostic interventions may maintain the disorder, and conventional medical interventions may not be useful.

Thus, not only clinical psychiatrists but also health care providers from other clinical specialties, especially Emergency Medical Services, are faced to a broad range of situations where it can be challenging to classify the dignity (psychiatric vs. somatic) of a somatic symptomatology - even if it is presented as a medical emergency claiming for an early intervention. In these cases, an interdisciplinary interchange of somatic and psychiatric specialties would be an ideal approach that is seldom possible in acute situations. Further, a basic knowledge of somatic interventions would be helpful for the psychiatrist as would be a basic knowledge of psychiatric emergencies for the somatic clinician.

The Research Topic “Medical Emergencies in Psychiatry” aims to provide a multi-professional interchange about somatic presentations in psychiatric patients. We aim to increase the knowledge in psychiatrists as well as in emergency medicine physicians. Various aspects should be presented in a wider context, ranging from basic neurobiology, pharmacology and toxicology to psychopathology and psychotherapy.