La Revue du praticien
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The practitioner is very frequently confronted by emergencies in drug-addicted patients also having psychiatric symptomatology. In this article the authors will address emergencies related to alcohol (notably intoxication, pre-DTs and the encephalopathies); emergencies related to cannabis (notably intoxication, psychotic states and panic attacks); and emergencies related to other psycho-active substances (overdoses, drug-withdrawal, psychiatric complications related to cocaine or amphetamines). In the domain of drug addiction, as in psychiatry, the practitioner must give as much importance to the organisation of the long-term healthcare plan for the drug addict, ulterior to the management of the immediate emergency. For example, whereas 90% of subjects presenting to the emergency department for acute alcoholic intoxication have a pathological consumption of alcohol (abuse or dependance), management of the alcoholism is proposed in only 2% of them.
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Emergencies in psychiatry depend both on the diagnosis of the pathology (past diagnosis or that revealed by the emergency), and on the situations that caused the crisis, of which their reactional nature demands specific treatment. There is an emergency when this is felt by any of the protagonists: the patient, the doctor or the entourage. The response in the environment can be indifferent, aggravating or pacifying. ⋯ New types of emergency psychiatric consultations are currently being observed, underlaid by outbursts of anxieties and anguish, and this occuring across the board. Patients with diverse pathological anxieties arrive in the emergency department with an imperative demand to be relieved. Thus psychiatirc emergency go from behavioural to more intra-psychi situations, and necessitate an evaluation and an immediate response.