Behavioral emergencies are common; goals of the intervention are rapid evaluation, containment and referral to appropriate follow up. Clinicians will be likely called on to assess and manage agitation, acute psychosis and suicidality alone or in combination. Reaching an accurate diagnosis must be emphasized. Physician should be aware of the differences among the major psychiatric disorders, also to look for medical reasons in patients with psychiatric presentations. Mechanisms that lead to agitation also predispose to impulsivity, aggression and psychosis. This patient population needs careful and special approach in order to evaluate, treat and refer. Suicide is a serious, growing and complex public health problem and its rate continue to rise. This article will discuss how to assess acute psychosis, agitation impulsivity, aggression and suicidality. Introduction Psychiatric emergencies are a common and serious problem for patients, their loved ones, communities and the healthcare setting on which they rely (1). Patients often present to the emergency room with an altered mental status and/or behavior and their evaluation can be difficult and time-consuming. At times, the perceived urgency to arrive at a disposition brings premature closure to the diagnostic evaluation (2). Emergency physicians face the challenge of assessing and managing patients presenting with acute psychosis, agitation, impulsivity and suicidal intent. Evaluations are frequently complicated by the necessity to investigate numerous domains, such as underlying medical conditions, prior psychiatric disorders and substance abuse, as well as psychosocial factors. It is crucial to rule out organic causes for what may appear to be a psychiatric disease. The assessment may be further complicated by the patients' limited ability to recall pertinent aspects of the history due to either cognitive impairment or acute distress (3).Due to the complexity of a patients' presentation, the emergency clinician, in the case of behavioral emergencies, must be a clinical and medical specialist, anthropologist, detective and a diplomat (4). The task force on psychiatric emergency care, referred to as the Triage Model describes the goals of the intervention as ‘Rapid evaluation, Containment and Referral'. Treatment of psychiatric patients by general hospital emergency department physicians at times is affected by the stigma attached to the field of psychiatry, which has occasionally led to less diligent efforts by healthcare providers on behalf of the psychiatric patients (5).In dealing with psychiatric patients, empathy is the most useful psychotherapy tool for understanding patients' feeling of grief, fear, agitation and powerlessness. It is useful to understand that even patients' anger is often a defense against intolerable emotions. This approach will help physicians in acting beneficently when patients' impaired mental faculties prevent them from making sound autonomous decisions. In addition, an empathic approach will facilitate gathering information from the patient and their loved ones. This patient population is interesting because in assessing the patient, the focus is on the brain, which is the affected organ, as well as the patient's source of history for their present illness. This article will discuss how to, assess and manage acute psychosis, agitation, impulsivity, aggression and suicidality. Acute Psychosis The definition of the term psychotic, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), is “disorganized speech, grossly disorganized or catatonic behavior, delusions or prominent hallucinations, with the hallucinations occurring in the absence of insight into their pathological nature” (6).DiagnosisEmergency physicians regularly attend to patients presenting with acute psychosis and 20% are found to have a purely medical etiology (7). Every disturbance of the central nervous system increases the probability tha
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