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16 mental health
  1. R Doy,
  2. E J Blowers,
  3. E Sutton
  1. University of East Aglia School of Nursing and Midwifery, Norwich, UK
  1. Correspondence to:
 Rosie Doy
 UEA School of Nursing and Midwifery, Edith Cavell Building, Colney Lane Norwich, NR4 7TJ, UK; r.doy{at}

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This article will consider the identification and management of psychosis, violence, and drug misuse in a pre-hospital and emergency setting.

Box 1 Article objectives


  • Cause

  • Identification

  • Management


  • Cause

  • Identification

  • Management

  • Safety

Drug misuse:

  • Identification

  • Management


One per cent of the population experience at least one acute episode of schizophrenia1 during their life and a similar number will be affected by bipolar disorder (manic depression). These patients have an increased risk of harming themselves—for example, postnatal depression and psychosis is now the leading cause of all maternal deaths by suicide.

Psychosis is therefore a relatively common condition with serious consequences.


Psychosis usually first appears in the late teens or early twenties (slightly later for women). Classically the person is unable to distinguish between reality and thoughts because of hallucinations or delusions.

Box 2 Signs and symptoms of psychosis

  • Delusions—false, fixed beliefs that are not amenable to change despite objective and contradictory evidence to the contrary

  • Hallucinations—disordered perception of senses, including hearing voices (auditory), visual, taste (gustatory), smell (olfactory), feeling strange sensations (tactile)—these may cause the person to act on their perceptions

  • Mood (affect) disturbances

  • Social isolation, withdrawal, and apathy—poor social and living skills, self neglect

  • Thought (cognitive) disturbances—the person may believe that thoughts are being inserted into or taken out of their mind; or that their thoughts are being broadcast; they may have disordered thinking and communicate bizarrely or incoherently

  • Unpredictable or bizarre behaviour

It is likely that most prehospital and emergency care practitioners will encounter patients in crisis who have an undetected illness (the incidence of new cases of schizophrenia is 1–2 per 10 000 population per year), or who are experiencing relapse, or who are deteriorating because of non concordance with medication or lack of engagement with services.


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  • Competing interests: none declared