Initial approach to the patient with a psychiatric emergency in the emergency room

Background: Psychiatric emergencies are acute disturbances in behavior, mood, and thought processes that require immediate attention to ensure the safety of the patient or others. For this reason, it is of the utmost importance that they be treated promptly, not only by psychiatrists but also by physicians from other specialties involved in critical care. Objective: To provide emergency and general practitioners with a simplified, systematic, and humanized care algorithm for the initial approach to patients with a psychiatric emergency, considering the resource and time constraints inherent to the emergency setting. Method: A narrative review of the scientific literature was conducted, including international clinical guidelines, procedure manuals from the government of Mexico (such as the Código 100 protocol for suicidal behavior), and systematic reviews published in databases like PubMed, Medline, and the Cochrane Library. Results: Key findings emphasize prioritizing the safety of the environment, the patient, and the staff. Continuous observation is paramount in all cases, highlighting the need to rule out critical organic causes that can mimic some psychiatric illnesses. Once the patient is stabilized, a focused and empathetic interview is essential. Agitation management should be tiered, prioritizing verbal restraint, followed by pharmacological restraint, and, as a last resort, physical restraint. Suicide risk assessment is a critical component that should include exploration of risk and protective factors. Conclusions: A systematic and humanized approach significantly improves the safety and quality of care for patients in crisis. The proposed algorithm allows non-psychiatric physicians to stabilize the emergency situation, stratify risk, and formulate an initial therapeutic plan, thus facilitating continuity of care and safe referral.