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Mental health in the care of paramedics: part 2

03 June 2011
Features
02 June 2011
Volume 3 · Issue 6

Abstract

Mental disorders are common and frequently present in emergency and prehospital settings. Conditions presenting to emergency care services include new onset psychiatric disorder, relapse or exacerbation of a pre-existing psychiatric condition, acute reactions to social adversities or problems associated with substance misuse. Although the advanced management of such conditions requires considerable therapeutic sophistication, paramedical services can contribute greatly to the initial management of such patients. In the second of a two article series on mental disorders, this article will provide guidance on the early assessment and management of bipolar disorder, psychiatric conditions in women, parasuicidal behaviours, acutely disturbed patients and substance misuse disorders. Some relevant legal issues in mental health are also discussed.

Paramedics are often called for psychiatric presentations in various settings; some of these presentations are true psychiatric emergencies. While paramedics would not usually start treatment for these presentations, it is valuable to have insight into how to identify, assess and differentiate the psychiatric disorders. It is equally important to understand the principles of commonly used initial management strategies and relevant legislation. The previous article in this series focused on an overview of mental health services, personality disorders, anxiety disorders, depression and psychotic disorders. This article will consider bipolar disorder, women and mental disorders, self-harm and suicidal behaviour, acute behaviour disturbance, substance misuse and some legal aspects of psychiatric practice.

The lifetime course of bipolar disorder is characterized by interspersed episodes of mania and depression. It has a lifetime prevalence of approximately 1–2% (Bebbington and Ramana, 1995) and usually starts in adolescence or young adulthood. Onset after the age of 40 years is uncommon. Bipolar disorder is strongly heritable.

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