[Emergency: the internist as psychiatrist]

Aspects of psychiatric emergencies of special interest to the general physician are discussed. The perception that a problem constitutes an emergency is often subjective and sometimes reflects the anxieties of others rather than a real need for urgent treatment. Keeping calm and unhurried in front of an agitated patient might be as important as the use of a neuroleptic. The rather unusual psychopathological phenomena catalepsy and psychogenic twilight state (psychogenic trance) are mentioned in view of their importance for urgent assessment of mental status. The scope of the problem of suicide is outlined as far as the general physician is involved. Special attention is paid to panic disorder and attacks, a relatively new concept in medicine. Since the symptoms mimic those of cardiac, endocrine and convulsive disorders, patients with such symptoms often come to the attention of general physicians and frequently use the services of emergency departments. Early identification and treatment of panic disorder might help to avoid unnecessary repeated emergency department visits, and at the same time reduce the associated high risk of suicide and other psychiatric disorders such as depression as well as drug and alcohol abuse.