Behavioral and Psychiatric Emergencies

Abstract

I’ll admit that we emergency physicians (and likely many other acute care providers as well) are a strange lot. We tend to relish caring for the sickest of patients, often even those on the verge of death. We often talk about that “great case” we saw during a shift: the cardiac arrest, the crashing asthmatic with a difficult airway, the patient with sepsis or diabetic ketoacidosis with a pH of 6.9, or the patient with cardiogenic shock requiring dobutamine and norepinephrine. It’s unlikely you’ll ever hear one of us refer to the patient with an uncomplicated ankle sprain or gastroenteritis or migraine headache or simple pneumonia as a “great case.” None of these patients tend to suffer much morbidity, and they are at low risk of mortality. It’s also unlikely that you’ll ever hear an emergency physician refer to a patient with depression and failed suicide attempt, or a patient with agitated delirium from drug use, or a patient with acute psychosis as a “great case.” Why not? Perhaps a major reason for this mindset is that we tend to assume that these patients have a low risk of morbidity or mortality. And perhaps another reason is that we often assume that we cannot change their course of illness. Both of these beliefs, as it turns out, are wrong, and they are likely the result of a lack of education regarding behavioral and psychiatric emergencies. Despite the fact that psychiatric illness is a rapidly increasing problem in our society and a tremendous burden on health care resources, traditional emergency medicine training still requires a relatively small amount of time be spent on this area. Continuing medical education emergency medicine conferences at the national and international level also have a paucity of sessions devoted to psychiatric and behavioral emergencies. A general lack of education leads to a lack of understanding and appreciation of the importance of this area in our practice. We are therefore fortunate to be able to present this issue of Emergency Medicine Clinics of North America, in which Guest Editors Drs Kuo and Tucci have assembled an outstanding team to educate us about the latest advances and approaches to behavioral and psychiatric emergencies. Perhaps the most important of the articles