Department of Emergency Medicine, Catholic University of the Sacred Heart, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2013 Feb;17 Suppl 1:55-64.
Psychiatric emergencies are conditions that mostly destabilize the already frenetic activity of the Emergency Department. Sometimes the emergency is clearly referable to primitive psychiatric illness. Other times, psychiatric and organic symptoms can independently coexist (comorbidity), or develop together in different conditions of substance abuse, including alcohol and prescription drugs. Differentiating between substance induced and pre-existing psychiatric disorder (dual diagnosis) may be difficult, other than controversial issue. Finally, an organic disease can hide behind a psychiatric disorder (pseudopsychiatric emergency). In this review (part I), psychiatric disorders that occur with organic symptoms are discussed. They include: (1) anxiety, conversion and psychosomatic disorders, and (2) simulated diseases. The physiologic mechanisms of the stress reaction, divided into a dual neuro-hormonal response, are reviewed in this section: (1) activation of the sympathetic nervous system and adrenal medulla with catecholamine production (rapid response), and (2) activation of the hypothalamic-pituitary-adrenal axis with cortisol production (slow response). The concept of the fight-or-flight response, its adaptive significance and the potential evolution in paralyzing response, well showing by Yerkes-Dodson curve, is explained. Abnormal short- and long-term reactions to stress evolving toward well codified cluster of trauma and stressor-related disorders, including acute stress disorder, adjustment disorder and post-traumatic stress disorder, are examined. A brief review of major psychiatric disorder and related behaviour abnormalities, vegetative symptoms and cognitive impairment, according to DMS IV-TR classification, are described. Finally, the reactive psychic symptoms and behavioral responses to acute or chronic organic disease, so called "somatopsychic disorders", commonly occurring in elderly and pediatric patients, are presented. The specific conditions of post-operative and intensive care unit patients, and cancer and HIV positive population are emphasized.
精神科急症大多会使急诊部原本紧张的工作更加混乱。有时急诊明显是由原始精神疾病引起的。其他时候，精神和器官症状可以独立共存（共病），或者在不同的物质滥用情况下一起发展，包括酒精和处方药物。区分物质引起的和预先存在的精神障碍（双重诊断）可能很困难，这是一个有争议的问题。最后，一种器质性疾病可能会隐藏在精神障碍背后（假性精神科急症）。在这篇综述（第一部分）中，讨论了伴有器质性症状的精神障碍。它们包括：（1）焦虑、转换和心身障碍，以及（2）模拟疾病。应激反应的生理机制分为双神经-激素反应，在这一部分中进行了回顾：（1）交感神经系统和肾上腺髓质的儿茶酚胺产生（快速反应）的激活，以及（2）下丘脑-垂体-肾上腺轴的激活和皮质醇的产生（缓慢反应）。战斗或逃跑反应的概念、其适应意义以及在麻痹反应中的潜在演变，通过 Yerkes-Dodson 曲线得到了很好的展示。解释了异常的短期和长期应激反应，这些反应朝着创伤和应激相关障碍的明确聚类发展，包括急性应激障碍、适应障碍和创伤后应激障碍。根据 DMS-IV-TR 分类，简要回顾了主要精神障碍及相关行为异常、植物性症状和认知障碍。最后，介绍了急性或慢性器质性疾病的反应性精神症状和行为反应，即所谓的“躯体精神障碍”，这些障碍在老年和儿科患者中常见。强调了术后和重症监护病房患者以及癌症和 HIV 阳性人群的特殊情况。
