Psychiatric emergencies

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Target exams

Red flags

• Fever, fluctuating attention, hypoxia, hypoglycaemia, or focal neurology with behavioural change — treat as medical emergency first, not primary psychiatric disease
• Acute agitation with hyperthermia, extreme exertion, or collapse risk — manage as severe behavioural disturbance with medical resuscitation capacity
• Lead-pipe rigidity, autonomic instability and fever after antipsychotics — stop dopamine antagonists and manage as NMS
• Clonus, hyperreflexia and rapid onset after serotonergic drugs — stop serotonergics and manage as serotonin toxicity
• IM olanzapine plus parenteral benzodiazepine — never co-administer; risk of profound respiratory depression
• Catatonia with fever or autonomic instability — malignant catatonia pathway including ECT consideration
• Active suicidal intent with accessible means — same-day senior review, means restriction, documented safety plan; do not discharge to an empty plan