Abstract
Patients with affective disorders frequently present to emergency medical settings. Manic patients are typically brought by others, lack insight into their need for treatment, and are best approached in a non-confrontational manner where possible. Sedation and hospitalization are usually required. Suicidal patients represent a broad spectrum, from the dangerously depressed individual who has lost all capacity for enjoyment and harbors serious suicidal thoughts, to the impulsive and immature individual who utilizes suicidal threats and gestures as methods of communication. Recognition of the syndrome of major depression (particularly the melancholic and psychotic subtypes)-and of substance abuse with depression, as well as suicidal schizophrenic patients, are the keys to suicide prevention. Severely depressed patients should be hospitalized for full medical evaluation and antidepressant drug treatment or electro-convulsive treatment. When anti-depressant drugs are indicated, full therapeutic dosages should be used.