Psychiatric emergencies
Acute agitation, suicide risk, and serious drug-related complications in psychiatry.
High-yield points
Acute agitation: try verbal de-escalation first; oral sedation before IM; exclude delirium, hypoglycaemia, hypoxia and intoxication.
Suicide risk: ask about plans, means, intent, previous attempts and protective factors; focus on a safety plan and the person's needs.
Reduce access to means (e.g. firearms, stockpiled medications) and involve family or carers where possible.
Neuroleptic malignant syndrome, serotonin syndrome and lithium toxicity are medical emergencies.
Delirium can look like psychosis; always look for a medical cause in new confusion.
People can be detained involuntarily under the state Mental Health Act if criteria are met.
India vs Australia
Where the answer the AMC marks correct differs from what’s usually taught in Indian MBBS.
| Aspect | India (MBBS)What you learn in MBBS | Australia (AMC)What the exam marks as correct |
|---|---|---|
| Suicide risk | Classify as low, medium or high risk. | Moving away from risk categories toward individualised assessment and safety planning. |
| Acute agitation | IM haloperidol with promethazine is common. | Verbal de-escalation, then oral medicine, then IM (e.g. droperidol, olanzapine, midazolam) per local guideline, with monitoring. |
| Bringing someone for assessment | Family usually brings the patient. | Police and ambulance have powers under state Mental Health Acts to take a person for assessment. |
| Means restriction | Pesticides are a major method. | Ask about firearms and stockpiled medicines. Some states allow or require notifying police about firearms. |
Suicide risk
India (MBBS)
Classify as low, medium or high risk.
Australia (AMC): what the exam expects
Moving away from risk categories toward individualised assessment and safety planning.
Acute agitation
India (MBBS)
IM haloperidol with promethazine is common.
Australia (AMC): what the exam expects
Verbal de-escalation, then oral medicine, then IM (e.g. droperidol, olanzapine, midazolam) per local guideline, with monitoring.
Bringing someone for assessment
India (MBBS)
Family usually brings the patient.
Australia (AMC): what the exam expects
Police and ambulance have powers under state Mental Health Acts to take a person for assessment.
Means restriction
India (MBBS)
Pesticides are a major method.
Australia (AMC): what the exam expects
Ask about firearms and stockpiled medicines. Some states allow or require notifying police about firearms.
The Australian context
Australian practice is moving away from categorising patients as 'low/medium/high risk' toward individualised safety planning. Police and ambulance officers have powers under state Mental Health Acts to bring a person for assessment.