A Practical Approach to the Assessment and Management of Psychiatric Emergencies

Abstract

Patients present to the psychiatric emergency room manifesting a wide variety of symptoms ranging from mild anxiety to violent, uncontrollable behavior. The emergency room psychiatrist must recognize these various presentations and provide appropriate interventions for such patients. It may not be of the utmost importance to distinguish between the subtypes of schizophrenia or endogenous vs. exogenous depression, just as it is not crucial to decide immediately the cause of an acute abdomen, primarily to recognize its presence. However, it is critical to recognize the presence of a psychosis, suicidal intent or the presence of an organically caused alteration in mental status. These are, in essence " triage" decisions. In fact, the concordance rate between emergency room and final diagnoses other than alcoholism is no higher than 62% (1). According to Bassuk (2), " the immediate goal of any emergency evaluation is to identify and manage life-threatening or potentially life-threatening problems, including out-of-control behaviors, serious and chronic self-neglect and severe medical problems either co-existing with or causing psychiatric symptoms. "The psychiatrist must have acute management strategies and disposition decisions in mind so that within the initial phases of the interview, impressions regarding the need for restraint and/or psychoactive medication can be put into action. In less emergent situations or after appropriate measures have been taken to ensure safety and control, more time can be devoted toward a complete evaluation.