Psychiatric Emergencies
The greatest potential error... is overlooking a physical illness as a cause of a psychiatric illness - Mohamed I. Ramadan MD
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HWN Suggests
How to Tell Whether a Psychiatric Emergency is Due to Disease or Psychological Illness
On the one hand, these psychiatric patients are high-risk medical patients. They not only have a higher incidence of chronic medical conditions, but they’re at greater risk of injury, including serious head injury, than the general population. The rate of missed medical diagnoses in the emergency department ranges from 8 to 48 percent, with the highest missed diagnosis rate among first presentation...
On the other hand, psychiatric patients can stress the emergency department, with the average length of stay ranging from 15 to 30 hours, depending on the whether they require medical clearance and whether they are admitted.
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The Increasing Burden of Psychiatric Emergencies: A Call to Action
The reasons for the rocketing rates of psychiatric-related ED visits are unclear and include: a true increase in the incidence of mental health problems; increased awareness of such problems; decreased stigma of seeking mental health care; a lack of accessible children’s community mental health services, particularly acute care; long waits for appointments; a lack of insight by clinicians as to what is appropriate treatment of children’s mental health problems; not having enough trained child mental health providers; having few specialized services; and the impact of social media or other societal factors.
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Managing Psychiatric Emergencies
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.
Psychiatric Emergencies
The EP must not see the psychiatric patient as merely presenting with a behavioral health complaint, but rather as a whole with the possibility of underlying illness being a potential cause of their reported symptoms. There are several medical illnesses that can present as behavioral in origin – and even when the primary issue is psychiatric, it is critical not to miss comorbid medical issues.
Resources
American Association for Emergency Psychiatry
The American Association for Emergency Psychiatry (AAEP) sponsors educational programs and provides a network of experts to address clinical, educational, administrative, research and legal programs for the diverse disciplines involved in emergency psychiatry.
