Psychiatric Emergency Patients Research Articles

"Is there a Link Between Heat Waves and Mental Health Emergencies in the Emergency Department?"

There is evidence suggesting that climate change, coupled with an increase in the frequency and severity of heatwaves, affects mental health. The aim of this study was to investigate potential associations between high temperature and the utilization of an emergency department (ED) by individuals with psychiatric disorders. A retrospective analysis of all psychiatric emergency patients from 2015 to 2022 (N=15478) was conducted and compared with local temperature data. Particularly during heatwaves, more psychiatric emergency patients presented to the ED. Beyond the results identified during heatwaves, our extensive analysis of the examined ED revealed no additional significant effects of heat on psychiatric emergencies. This contradicts findings from other studies. Other systemic influences, such as the utilization of the ED during the Covid-19 pandemic, could have modified the results.

Retrospective study on suicide attempts among psychiatric emergencies admitted to the emergency department of a Regional hospital in Turkey

Abstract Introduction The aim of this study was to determine the sociodemographic characteristics of psychiatric emergencies presenting to emergency departments (ED), the provisional diagnoses and reasons for consultation by emergency physicians, and to determine the rate of suicide attempts among patients presenting to emergency departments for psychiatric emergencies. Methods The records of all patients aged 18 years and older admitted to the emergency department of the Department of Emergency Medicine, a tertiary hospital, with either a pre-existing psychiatric diagnosis or a new psychiatric provisional diagnosis made by emergency physicians between January 2020 and December 2023 were reviewed. Results According to the data obtained in the study, it was determined that the most common provisional diagnoses made by emergency physicians in psychiatric emergencies were suicide attempts (41.88%), agitation (21.94%), schizophrenia (8.44%), psychosis (7.91%) and manic attack (6.54%). It was found that 49.3% of psychiatric emergencies resulted in discharge and 25.5% resulted in hospitalisation. Among the provisional diagnoses, depression, mutism and sleep disorders were most commonly associated with refusal of treatment, while depression and suicide were the most common reasons for hospitalisation. Among psychiatric emergency patients who attempted suicide, medication, sharp objects and chemicals were the most common substances ingested. Discussion In this study, it was determined that a great portion of the emergency psychiatric cases admitted to the emergency department consisted of patients who attempted suicide. However, due to the crowdedness and fast pace of emergency departments, it is understood that in psychiatric emergencies, epidemiological profile data are missing in the files of the cases and detailed medical history cannot be obtained from the patients We think that recording better data of patient who admitted a psychiatric condition to the emergency department will provide better information about the patients in future visits and improve the care to be provided. Psychiatrists and psychiatric nurses recommend the implementation of emergency department-based rehabilitation programs for these patients.

Coercion During Psychiatric Ambulance Versus Police Transport in Mental Health Crises: A Pre- and Postimplementation Study.

Police officers are often the first responders when individuals experience a mental health crisis and typically remain responsible for transport to a psychiatric emergency department. In 2014, a psychiatric ambulance (PA) was introduced in the city of Amsterdam to take over the transport of individuals in a mental health crisis. The purpose of the PA was to use fewer restrictive measures while guaranteeing safety for both patients and personnel. A preimplementation-postimplementation design was used to assess the feasibility and utility of a single-vehicle PA service compared with police transport. Data on 498 rides were collected in the 4 months before implementation of the PA (pre-PA cohort) and on 655 rides in the 6 months after implementation (PA cohort). After PA implementation, most patients were transported by the PA (82%), and rides by police vehicle were very rare (1%). Individuals in the PA cohort had a greater transportation delay, compared with those in the pre-PA cohort, but the PA reduced use of coercive measures with no increase in the incidence of patient aggression. Among individuals in the PA cohort, hospitalization was more often voluntary than among those in the pre-PA cohort. Transporting emergency psychiatric patients by a special PA rather than by the police reduced the use of coercive measures during transport, kept the occurrence of aggressive incidents stable, and was associated with fewer coercive hospital admissions.

PENGETAHUAN PERAWAT TENTANG PENANGANAN RESTRAIN DALAM KEGAWATDARURATAN PSIKIATRI : DESKRIPTIF KUANTITATIF SURVEY

Background: Mental health crisis is a major issue for ODGJ and can endanger others and the environment. In handling psychiatric emergencies, the expertise of nurses is very important and needed. In the process, nurses have personal traits or qualities that can influence knowledge. Objective: The purpose of this study was to find the effect of age and education on the knowledge of health center nurses on how to handle patients with psychiatric emergencies. Methods: Using a sample of 91 respondents selected by cluster sampling technique. The research method used a cross-sectional approach. Demographic survey and knowledge assessment test (The Phisical Restraint Questionare) on how to handle psychiatric emergencies in patients were used to collect data. Results: Ordinal logistic regression analysis of the model fitting data provided results in the form of an association between the variables of age and education with knowledge and the degree of nurse expertise as indicated by a decrease in the value of -2 log Like hood decreased from 73.99 (Intercept Only) to 61.52 (Final) with p=0.029 (<0.05). Conclusion: The variables show that the model fits the data, meaning that the variables of age and education level together affect the level of knowledge of nurses about handling restraints in psychiatric emergency patients. Suggestion: Training programs for nurses on physical restraints need to be carried out continuously so that the quality of care provided by nurses when physically restraining psychiatric patients is getting better. Keywords: Knowledge, Restraint, Psychiatric Emergency

A step-by-step and data-driven guide to index gender in psychiatry.

Beyond sex as a binary or biological variable, within-sex variations related to sociocultural gender variables are of increasing interest in psychiatric research to better understand individual differences. Using a data-driven approach, we developed a composite gender score based on sociodemographic and psychosocial variables showing sex differences in a sample of psychiatric emergency patients upon admission (N = 1708; 39.4% birth-assigned females; mean age = 40 years; age standard deviation = 14). This gender score was extracted from a confirmatory factor analysis (CFI = 0.966; RMSEA = 0.044, SRMR = 0.030) and could predict a person's birth-assigned sex with 67% accuracy. This score allowed the further identification of differences on impulsivity measures that were absent when looking solely at birth-assigned sex. Female birth-assigned sex was also associated with higher rates of mood and personality disorder diagnoses, while higher feminine gender scores were related to higher proportions of anxiety and mood disorder diagnoses. By contrast, male birth-assigned sex and higher masculine gender scores were associated with higher proportions of psychotic and substance use disorder diagnoses. Patients with undifferentiated gender scores (i.e., scoring between masculine and feminine threshold defined by terciles) were more represented in the psychotic disorder group. Considering both sex and gender in psychiatric research is essential and can be achieved even when using secondary data to index gender comprised of demographic and psychosocial variables.

Substance Use in Patients Admitted to the Psychiatric Emergency Department in Northern Iran

Background: Acute psychiatric problems are increasingly observed following substance abuse in emergency departments. To address this significant societal issue, it is essential to understand its various dimensions in order to develop comprehensive control policies. Objectives: This study aimed to evaluate substance use and its related factors in patients admitted to a psychiatric emergency ward in Sari, Mazandaran, Iran. Methods: In this cross sectional investigation, all patients who were admitted to the emergency department of Zare referral psychiatry hospital during the previous one year were studied. A checklist of demographic and psychiatric factors was completed for each patient based on their medical records. Urine rapid tests were routinely conducted in this department to screen for drug consumption. Descriptive statistics, central and dispersion indices, and the chi-square test were used to analyze the data. Results: A total of 578 cases, comprising 406 males (70.2%) and 172 females (29.8%), were examined. The mean age of patients was 34.7 ± 11.2 years. The most common symptoms reported were aggression (50.5%), insomnia (11.2%), paranoia (10.7%), and self-talk (8.1%), respectively. The most frequent final clinical diagnosis was bipolar disorder in 145 cases (25.1%), followed by schizophrenia in 131 cases (22.7%), and substance-induced psychotic disorder in 63 cases (10.9%). In the substance use screening among patients, the urine test was positive for morphine in 17.6% of the patients. Methamphetamine, methadone, and cannabis tests were positive in 16.1%, 9.5%, and 3.5% of cases, respectively. Among patients with positive urine tests (for methamphetamine, methadone, or morphine), the most common clinical diagnosis was substance-induced psychotic disorder, followed by schizophrenia. Schizophrenia and substance-induced psychotic disorder were the two most common diagnoses in patients with positive cannabis urine tests, respectively. Conclusions: The high rate of substance abuse among psychiatric emergency patients, often co-occurring with other psychiatric disorders, the high prevalence of psychosis, and the behavioral risks associated with these patients emphasize the need for special attention to this biopsychosocial problem.

Medical experience as an influencing parameter in emergency medical care for psychiatric emergencies: retrospective analysis of a multicenter survey

BackgroundPrehospital care of psychiatric patients often relies on the medical experience of prehospital emergency physicians (PHEPs). The psychiatrists (PSs) involved in the further treatment of psychiatric patients also often rely on their experience. Furthermore, the interaction between PHEPs and PSs is characterized by interaction problems and different approaches in the prehospital care of the psychiatric emergency.ObjectivesTo analyze the phenomenon of “medical experience” as a cause of possible interaction-related problems and assess its impact on the prehospital decision-making process between prehospital emergency physicians and psychiatrists.MethodsThe retrospective data analysis was conducted between November 2022 and March 2023. Medical experience was defined as follows, based on the demographic information collected in the questionnaires: For PHEPs, the period since obtaining the additional qualification in emergency medicine was defined as a surrogate marker of medical experience: (i) inexperienced: < 1 year, (ii) experienced: 1–5 years, (iii) very experienced: > 5 years. For PSs, age in years was used as a surrogate parameter of medical experience: (i) inexperienced: 25–35 years, (ii) experienced: 35–45 years, (iii) very experienced: > 45 years.ResultsInexperienced PSs most frequently expressed anxiety about the psychiatric emergency referred by a PHEP (27.9%). Experienced PHEPs most frequently reported a lack of qualifications in handling the care of psychiatric emergencies (p = 0.002). Very experienced PHEPs were significantly more likely to have a referral refused by the acute psychiatric hospital if an inexperienced PS was on duty (p = 0.01). Experienced PHEPs apply an intravenous hypnotic significantly more often (almost 15%) than PSs of all experience levels (p = 0.001). In addition, very experienced PHEPs sought prehospital phone contact with acute psychiatry significantly more often (p = 0.01).ConclusionPHEPs should be aware that the PS on duty may be inexperienced and that treating emergency patients may cause him/her anxiety. On the other hand, PHEPs should be receptive to feedback from PS who have identified a qualification deficiency in them. Jointly developed, individualized emergency plans could lead to better prehospital care for psychiatric emergency patients. Further training in the prehospital management of psychiatric disorders is needed to minimize the existing skills gap among PHEPs in the management of psychiatric disorders.

Suicidality and mood disorders in psychiatric emergency patients: Results from SBQ-R.

Patients with mood disorders are at high risk of suicidality, and emergency departments (ED) are essential in the management of this risk. This study aims to (1) describe the suicidal thoughts and behaviours of patients with mood disorders who come to ED; (2) assess the psychometric properties of the Suicidal Behaviours Questionnaire-Revised (SBQ-R) in a psychiatric ED; and (3) determine the best predictors of suicidality for these patients. A total of 300 participants with mood disorders recruited for the Signature Bank of the Institut universitaire en santé mentale de Montréal (IUSMM) were retained. Suicidality was assessed using the SBQ-R. Other clinical and demographic details were recorded. Bivariate analyses, correlations and multivariate regression analyses were conducted. SBQ-R's internal consistency, construct and convergent validities were also tested. In the Patient Health Questionnaire-9 (PHQ-9), 53.3% of the sample stated they had suicidal or self-harm thoughts in the last 2 weeks. The mean score obtained at the SBQ-R was 8.3. Multivariate analysis found that SBQ-R scores were associated with depressive symptoms and substance use, especially alcohol, accounting for 44.3% of the model variance. Cronbach's alpha was 0.81 [0.78, 0.84] and factor loadings for items 1-4 were 0.68, 0.88, 0.54, and 0.85, respectively. The confirmatory factor analysis indicated that the model fit the data well. The SBQ-R is a brief and valid instrument that can easily be used in busy emergency departments to assess suicide risk. Depressive symptoms and alcohol use shall also be assessed, as they are determinants of increased risk of suicidality.

Factors Affecting the Length of Stay in the Emergency Department in Psychiatric Emergency Patients in the COVID-19 Pandemic Context.

To reduce overcrowding in emergency departments (ED), which is a serious international problem, it is important to reduce the length of ED stay (ED LOS) of emergency patients. In particular, due to the COVID 19 pandemic, psychiatric emergency patients spent much longer in ED. This study was conducted to identify the characteristics of psychiatric emergency patients who visited the ED during the COVID-19 pandemic and to identify factors affecting ED LOS. This retrospective study was conducted on adult patients aged 19 years or older who visited a psychiatric emergency center operated by an ED from 1 May 2020 to 31 April 2021 because of the COVID-19 pandemic. In this study, the average ED LOS of psychiatric emergency patients was 7.8 h. Factors affecting ED LOS for over 12 h were isolation (OR = 2.39, CI = 1.409-4.052), unaccompanied police officers (OR = 2.106, CI = 1.338-3.316), night-time visits (OR = 2.127, CI = 1.357-3.332), use of sedatives (OR = 1.671, CI = 1.030-2.713), and restraints (OR = 1.968, CI = 1.172-4.895). The ED LOS of psychiatric emergency patients is longer than that of general emergency patients, and a long ED LOS causes ED overcrowding. To reduce the ED LOS of psychiatric emergency patients, they must be accompanied by a police officer when visiting the ED, and the treatment process should be reorganized so that a psychiatrist can promptly intervene. Furthermore, it is necessary to reorganize the isolation guidelines and admission criteria for mental emergency patients.

Implementation of a Medical Clearance Algorithm for Psychiatric Emergency Patients

Despite evidence demonstrating limited benefit, many clinicians continue to perform routine laboratory testing of well-appearing children to medically clear them before psychiatric admission. We conducted a quality improvement project to reduce routine laboratory testing among pediatric patients requiring admission to our psychiatric unit. We convened key stakeholders whose input informed the modification of an existing pathway and the development of a medical clearance algorithm. Our outcome was a reduction in routine laboratory testing for children requiring psychiatric admission. Our balancing measure was the number of patients requiring transfer from the inpatient psychiatry unit to a medical service. We used run charts to evaluate nonrandom variation and demonstrate sustained change. Before the introduction of the new medical clearance algorithm, 93% (n = 547/589) of children with psychiatric emergencies received laboratory testing. After implementing the medical clearance algorithm, 19.6% (n = 158/807) of children with psychiatric emergencies received laboratory testing. Despite a decreased rate of routine testing, there were no transfers to the medical service. Implementing a medical clearance algorithm can decrease routine laboratory testing without increasing transfers to the medical service among children requiring psychiatric admission.

Emergency medical care of patients with psychiatric disorders - challenges and opportunities: Results of a multicenter survey

BackgroundPre-clinical psychiatric emergencies are generally treated by emergency medical staff. The subsequent clinical treatment is often conditioned by interaction problems between emergency medical staff and psychiatric clinical staff.ObjectivesTo identify problems affecting interaction between emergency medical and psychiatric care of mentally ill patients and pinpoint aspects of optimized emergency care.MethodsTo shed light on the interaction problems an anonymous, questionnaire-based, nonrepresentative survey of 98 emergency physicians (EM) and 104 psychiatrists (PS) practicing in acute psychiatry was conducted between March 1, 2021 and October 1, 2021.ResultsThe chi-square test for multiple response sets revealed consistently significant differences (p < 0.001) between EM and PS with respect to the questions analyzed. Approximately 36% of EM reported not to be adequately qualified to handle psychiatric emergencies (p = 0.0001), while around 50% of respondents were neutral in their assessment in how to deal with psychiatric emergencies. 80% of EM reported a negative interaction (rejection of patients) with PS when referring a psychiatric emergency patient to the acute psychiatric unit. The most common reasons for refusal were intoxication (EM: 78.8%, PS: 88.2%), emergency physician therapy (EM: 53.8%, PS: 63.5%), and not resident in the catchment area of the hospital (EM 68.8%, PS: 48.2%). In the casuistry presented, most respondents would choose “talk down” for de-escalation (EM: 92.1%, PS: 91.3%). With respect to drug therapy, benzodiazepine is the drug of choice (EM: 70.4%, PS: 78.8%). More EM would choose an intravenously (i.v.) or a Mucosal Atomization Device (MAD) administration as an alternative to oral medication (i.v.: EM: 38.8%, PS: 3.8%, p = 0.001, MAD: EM: 36.7%, PS: 10.6%, p = 0.006). Significantly more EM would seek phone contact with the acute psychiatric hospital (EM: 84.7%, PS: 52.9%, p = 0.0107). A psychiatric emergency plan was considered useful in this context by more than 90% of respondents. The need for further training for EM with regard to treating psychiatric clinical syndromes was considered important by all respondents. In particular, the topics of “psychogenic seizure,“ “intoxication,“ and “legal aspects of psychiatric emergencies” were considered important (Mann-Whitney U test, p < 0.001).ConclusionThe interaction-related problems identified in the emergency medical care of pre-clinical psychiatric patients relate to non-modifiable, structural problems, such as insufficient admission capacity and non-existent or inadequate monitoring capabilities in acute psychiatric hospitals. However, factors such as the education and training of EM and communication between EM and PS can be improved. Developing personalized emergency care plans for psychiatric patients could help to optimize their care.

Suicidal thoughts and behaviors (STB) among psychiatric emergency patients at the emergency unit of a university hospital in Belgium (UZ Leuven) . A longitudinal approach with data from 2003-2015

IntroductionSuicidal thoughts and behaviors (STB) are a serious public health problem. Suicide prevention programs have been established over the years but many people who are suicidal do not seek treatment, and when they do they will end up in low-threshold sectors such as the Emergency Department in general hospitals. Previous studies about STB are mostly narrative, rather than a date-driven approach and limited in sample size.ObjectivesThe main goal of this study is to describe the prevalence and evolution of STB (ideation, plan or attempt) of the psychiatric patient referred to the Emergency Department of the University Hospital Gasthuisberg (Leuven, Belgium) over a 12 year period.MethodsDuring a 12 year period (2003-2015), all patients with a psychiatric referral to the Psychiatric Emergency Room (PER) of the University Hospital Gasthuisberg (Leuven, Belgium) were included (N˜25.000). We use descriptive statistics to summarize the data set, focusing on STB in terms of raw numbers, symptoms at referral, mental disorders and demographic characteristics.ResultsAround 1/9 patients presents with suicide attempt; another 1/5 with suicidal thoughts. STB accounts for 35% of psychiatric primary complaints at the PER. Women were more likely to present with STB. The proportion of STB referrals remains stable over the years.ConclusionsDespite several reforms in mental health care, the PER remains a major entry point into mental healthcare for large proportions of STB patients.DisclosureNo significant relationships.

Risk factors for suicide in psychiatric emergency patients in Beijing, China: A large cross-sectional study

Psychiatric emergency patients constitute a population at high risk of suicidal thoughts and behaviors (STB). However, the risk factors for STB in this population have not been clearly defined. This study aimed to explore the risk factors for STB in psychiatric emergency patients in China. A cross-sectional analysis was conducted at the emergency department of psychiatry, Anding Hospital, Capital Medical University from 2015 to 2017. The Chinese suicide risk factors scale was used to test the STB of the patients. Multivariable logistic regression analysis was used to determine the risk factors of STB. A total of 12,345 patients were included. Their average age was 36 years. According to the suicide risk scale, 3436 cases (27.83%) were at risk of STB, mainly young adults. The multivariable analysis showed that urban residence, years of education, living in Beijing, ethnic Han, living alone, unemployment, poor relationship with parents, one or more siblings, visit time in the night, family history, disease course, total duration, the total number of psychiatric hospitalizations, a clear diagnosis, Brief Psychiatric Rating Scale total score ≥28.5, Hamilton Depression Rating Scale total score ≥20, and Young Mania Rating Scale total score ≥12 were independent risk factors for STB.

Paramedics’ Perceptions, Knowledge and Skills regarding Emergency Psychiatric Patients in Riyadh, Saudi Arabia

Introduction Mental healthcare experts worldwide have been calling for increased contributions from medical professionals and organisations to improve the skills of healthcare practitioners and their coordination with mentally ill patients. However, the contributions and roles of paramedics in treating the mentally ill are still considered limited, and few studies have been conducted on paramedics’ judgement and decision-making when caring for patients with mental illness. This study aimed to assess paramedics’ perceptions, knowledge and skills in dealing with psychiatric emergencies. Methods A cross-sectional study was conducted among participants from the Saudi Red Crescent Authority; different hospitals in Riyadh were invited from September to October 2019 to complete a validated structured questionnaire. The Statistical Package for the Social Sciences version 22 (SPSS 22) software was used for data analysis. Results A total of 124 participants were included in this study; their mean age was 29.93 years, 95.2% were male, 78.9% had a bachelor degree and 12.1% had higher education. The majority of participants agreed that it is important for paramedics to know about mental illness (91.1%) and stated that they were comfortable managing a person with mental illness (63.7%). Almost half (49.6%) disagreed with the statement that psychiatric disorders are caused by religious or supernatural factors, whereas 24% were unsure, and 26.4% agreed. On assessing paramedics’ knowledge and skills, 31.4% scored above average, 42% scored average (average defined as answering six to seven out of 10 questions correctly), and 26.6% scored below average. However, when asked if they carry out the mental status examination on mentally ill patients, 66.1% stated ‘no’. Conclusion This study indicated that the majority of paramedics have positive perceptions regarding mental illness; moreover, it was shown that paramedics are knowledgeable and trained in dealing with emergency psychiatric patients. Further investigation regarding the practice and role of paramedics is necessary.

Assessing Functioning across Common Mental Disorders in Psychiatric Emergency Patients: Results from the WHODAS-2.

Assessing global functioning in psychiatric emergency settings is important for clinicians to estimate severity of mental disorders, devise a treatment plan, and assess the evolution of their patients' progression over time. The World Health Organization Disability Assessment Schedule-2.0 (WHODAS-2) measures psychological, social, and professional functioning and is recommended as a standardized instrument of choice for use in psychiatric settings. Yet, studies investigating disability profiles of mental disorders using the WHODAS-2 are scarce, and psychometric properties have not been evaluated in a psychiatric emergency context. We describe and compare WHODAS-2 (12-item version) scores across mental disorders (anxiety, mood, psychotic, personality, and substance abuse) in adults admitted to psychiatric emergency. Data from the Signature Bank were used. Participants admitted to psychiatric emergency completed the WHODAS-2 at admission (n = 1,125). Mental disorders were evaluated by psychiatrists, and WHODAS-2 scores were compared across groups. Psychometric properties were evaluated using confirmatory factor analysis (CFA). Higher mean WHODAS-2 scores were reported by those with anxiety, mood, and personality disorders (P < 0.001) compared to other psychopathologies. The measure showed good internal consistency (global score α = 0.88; domain subscores α = 0.59 to 0.85) and acceptable goodness of fit indices in CFA confirming the original structure of WHODAS-2. Findings from this large-scale study could assist clinicians in interpreting WHODAS-2 scores in psychiatric populations and provide a more detailed portrait of disability profiles associated with different clinical diagnoses.

119 Paramedic’s Emergency Responses Status and Improvement to Psychiatric Emergency Patients

119 Paramedic’s Emergency Responses Status and Improvement to Psychiatric Emergency Patients

Psychiatric emergencies during the height of the COVID-19 pandemic in the suburban New York City area

BackgroundThis report characterizes patients presenting for psychiatric emergencies during the COVID-19 pandemic and describes COVID-19-related stressors. MethodsPatients seen for emergency psychiatric evaluation during the height of the COVID-19 period (March 1-April 30, 2020; N = 201) were compared with those in the immediate Pre-COVID-19 period (January 1-February 28, 2020; N = 355), on sociodemographic characteristics, psychiatric diagnoses, symptoms, and disposition. Patients tested positive for COVID-19 were compared with those that tested negative on the same outcomes. Prevalence and nature of COVID-19-stressors that influenced the emergency presentation were rated. OutcomeThe most common psychiatric diagnoses and presenting symptoms during both periods were depression and suicidal ideation. Comparing the Pre-COVID-19 and COVID-19 periods, a significant decline in emergency psychiatric volume was observed in children and adolescents (C/A), but not adults. COVID-19 period C/A patients had more new onset disorders and were more likely to be admitted to inpatient care, but were less likely to present with suicide attempts, impulse control disorders and agitation/aggression. Adults were more likely to have no access to outpatient care, present with anxiety disorders, and were also more likely to be admitted for inpatient care. COVID-19 directly affected the psychiatric emergency in 25% of patients, with the more severe stressors triggered by fear of COVID infection (including psychosis), actual COVID infection in self or family members, including death of a loved one. COVID-positive patients were more likely to have psychosis, including new-onset, and were less likely to be depressed/suicidal compared to their COVID-negative counterparts. ConclusionThis report demonstrates the need for emergency psychiatric services throughout the COVID-19 pandemic and the need for clinical and diagnostic COVID-19 screening of psychiatric emergency patients. New and severe pathology underscore the need for enhanced outpatient access to tele-mental health, crisis hotline and on-line psychotherapeutic services, as well as psychiatric inpatient services with capacity to safely care for COVID-19 patients.

Characterization of Ambulant Emergency Contacts in an Emergency Room at a General Hospital

Scientific interest in emergency psychiatric patients has increased significantly over the last two decades. Nevertheless, current knowledge of this group of patients in the setting of an interdisciplinary emergency department is surprisingly low. A retrospective examination of all ambulatory psychiatric emergency contacts in the emergency room of a regional hospital in 2015 took place. Solely F4 diagnoses accounted for 48.1 % of all first-time patients. Female patients younger than 25 years used the ER twice as often as their male control-group. Almost half of all outpatients fulfilled no emergency criteria. There are specific age and gender differences. The proportion of patients without any emergency criteria was surprisingly high. More scientific research is needed in order to scrutinize this possible inappropriate use of an ER by psychiatric patients.

Utilizing YouTube as platform for psychiatric emergency patient outreach in Chinese Americans.

Chinese Americans significantly underutilize mental health resources, which leads to delayed diagnosis, suboptimal management, and can be contributing to the large number of psychiatric emergencies seen in the ED. The goal of this study is to understand the role of using YouTube as a platform for psychiatric emergency outreach among Chinese Americans. We posted three videos about psychiatric emergencies in Cantonese on YouTube. We collected viewing data during a five-year period. The recorded parameters include watch time, number of views, average view duration, traffic source, search terms, and watch device type. The videos generated 40,608 min of watch time and 5976 views, with an average view duration of 6.80 min. The top three traffic sources are YouTube suggested videos, direct YouTube search, and browse features. The three most used viewing devices are mobile phones (25,068 min of watch time, 3491 views, and 7.18 min of average view duration), computer/TV (9222 min of watch time, 1717 views, and 5.37 min of average view duration), and tablets (6318 min of watch time, 768 views, and 8.23 min of average view duration). Majority of the viewers used mobile phones, and mobile phones and tablets had significantly longer average view durations as compared to computer/TV. YouTube and wireless devices may have potential as internet based psychiatric emergency outreach platform. This study calls for further research to explore the effectiveness of using social media and wireless devices for psychiatric emergency education prior to ED arrival, particularly in minority populations with cultural barriers to health care.

Prospective Associations of Coping Styles With Depression and Suicide Risk Among Psychiatric Emergency Patients

Suicide is the second leading cause of death for those ages 13–25 in the United States. Coping is a mediator between stressful life events and adverse outcomes, and coping skills have been incorporated into interventions (e.g., cognitive-behavioral therapy, dialectical behavior therapy, safety-planning interventions) for suicidal populations. However, longitudinal research has not directly examined the prospective associations between multiple coping styles and suicide-related outcomes in high-risk samples. This study identified cross-sectional and 4-month longitudinal associations of coping styles with suicide risk factors (i.e., depression, suicidal ideation, suicidal behavior) in a sample of 286 adolescent and young adult psychiatric emergency patients. Positive reframing was the coping style most consistently associated with positive outcomes, whereas self-blame and disengagement were consistently associated with negative outcomes. Active coping protected against suicidal behavior for males, but not for females. This was the first study to examine longitudinal relationships between coping and suicide-related outcomes in a high-risk clinical sample. Findings suggest that clinical interventions with suicidal adolescents and young adults may benefit from a specific focus on increasing positive reframing and reducing self-blame.