Psychiatric Emergency Service Research Articles

1002 – Sociodemographic and psychopathological characteristics in psychiatry emergencies: an observational study

A psichiatric emergency is a situation where disorders of thought, mood or behavior are so disruptive that require immediate assistance. To analyze clinical and sociodemographic characteristics, predictors of hospitalization, and poli-attendance in patients attended in a reference area psychiatric emergency service. All assistances from 01.12.2011 to 31.01.12 were recorded in a database. Patient poly-attendance was defined by two or more assistances during the study period. Logistic regression analysis was performed to find out hospitalization and poli-attendance predictors. N = 219. 50.68% male, 49.32% female; 86.75% between 20-64 years. 45.62% finished primary studies. 80.82% owned social support network. 80.73% unemployed. 71.89% voluntary assistances. 58.97% already tracked by mental health, 24.66% first contact. Reason care: anxiety (24.20%), behavioral disorders (22.57%), suicide (20.55%) and psychosis (12.79%). Final diagnoses: psychosis (24.20%), anxiety (15.48%), depression (10.05%), drugs abuse (9.13%), personality disorders (17.35%), mental retardation (8.22%), social issues (16.89%).26.94% were poly-attendance, assisted by: organic mental disorder (OR= 21,10, IC95%), personality disorders (OR=4,313, IC95%), mental retardation (OR=5,545, IC95%), social issues (OR=2,94, IC95%). 24.20% of the patients hospitalized. Factors associated to risk: age range 15-20 (OR 12.10, IC95%); psychosis (OR = 51.03, IC 95%), depression (OR = 14.61, IC95%), bipolar disorder (OR=20,38, IC 95%). Minor diseases, social issues or stables axis II disorders accomplished most attendances. Hospitalitation was associated with severe mental illness and lower age.Poly-attendance is not associated with axis I patology, but it is with axis II and IV disorders.

1364 – Predictive validity of the crisis triage rating scale in the disposition of patients attending a nigerian psychiatric emergency unit

Introduction In psychiatric emergencies, there is a high premium on rapid assessment, acuity categorization and objectivity in decisions regarding the disposition of patients. The Crisis Triage Rating Scale (CTRS), a 3-item clinician-rated instrument, has demonstrated validity in determining the disposal of patients in psychiatric emergency settings. However, its utility has not been evaluated in Nigeria. Objectives/aim This study aimed to assess the validity of the CTRS in predicting the disposal (need for hospitalisation or out-patient treatment) of patients presenting to a psychiatric emergency unit in Nigeria. Methods The CTRS was administered to consecutively presenting patients (N=247) at the Emergency Unit of the Federal Neuro-Psychiatric Hospital, Yaba, Lagos. Following a comprehensive psychiatric evaluation, clinicians blinded to the CTRS scores made appropriate decisions regarding the disposal of the patients. The ability of the CTRS to predict the need for hospitalisation at different threshold scores, compared with clinical judgement as criterion, was determined statistically. Results The optimal threshold on the CTRS for detecting the need for hospitalisation is a cut-off score of 9 as it has the best trade-off with a sensitivity of 0.94 and specificity of 0.89. At this threshold, the overall misclassification rate is 0.09, while the area under the Receiver operating characteristics curve is 0.95. The positive predictive validity for the assessment of disposal at the optimum threshold is 0.91. Conclusion The CTRS is a useful tool in determining the disposition of patients presenting to psychiatric emergency service in Nigeria

Mental Disorders among Children and Adolescents Admitted to a French Psychiatric Emergency Service.

The aim of this study was to describe the characteristics of children and adolescents admitted to the psychiatric emergency department (ED) of a French public teaching hospital over a six-year study period (2001–2006). Data for all episodes of care in the psychiatric ED from January 1, 2001, to December 31, 2006, delivered to adolescents aged less than 18 years were retrospectively analyzed. During the six-year study period, 335 episodes of care in the psychiatric ED were experienced by 264 different adolescents. They accounted for 2.0% of the 16,754 care episodes of the ED; 164 patients (62.1) were female and the average age was 16.5 (SD = 1.6). The neurotic, stress-related, and somatoform disorders were the most frequent (25.4%) and concerned mainly anxiety disorders (15.2%). The frequency of the absence of psychiatric diagnosis (22.7%) was high. A total of 48 children and adolescents (18.2%) benefited from more than one episode of care. Several factors were associated to a higher number of visits to the ED: substance use, schizophrenia, disorders of adult personality and behaviour, disorders occurring in childhood and adolescence, and dual diagnosis. In conclusion, mental health disorders in children and adolescents are a serious problem associated with several potentially modifiable factors.

Factors Associated with Readmission of Patients at a University Hospital Psychiatric Ward in Iran

Objectives. Readmission has a major role in the reduction of the quality of life and the increase in the years of lost life. The main objectives of this study were to answer to the following research questions. (a) What was the readmission rate? (b) What were the social, demographic, and clinical characteristics of patients admitted to the Psychiatric Emergency Service at Nour University Hospital, affiliated to Isfahan University of Medical Sciences, Isfahan, Iran? (c) What were the effective factors on readmission? Method. This cross-sectional study was conducted on a total number of 3935 patients who were admitted to Isfahan University Hospital Psychiatric Ward in Isfahan, Iran, from 2004 to 2010. Gender, age, marital status, education, self-report history of previous admission, type of psychiatric disorder, substance misuse, suicide, and the length of the current psychiatric disorder were collected from the registered medical files of patients. The data were analysed using the negative binomial regression model. Results. We found that factors such as psychiatric anxiety disorder, bipolar I, bipolar II, psychotic disorder, depression, and self report history of previous admission were statistically significant in the number of readmissions using the negative binomial model. Conclusion. Readmission to the psychiatric ward is mainly predictable by the type of diagnosis and psychosocial supports.

Treatment costs for depression with pain and cardiovascular comorbidities

ObjectiveAs depressive disorders are highly heterogeneous, and as patients exhibit wide differences in clinical characteristics and comorbidities, we aim to examine whether and how demographic and clinical correlates affect healthcare costs for patients with depression in a real-world setting. MethodA national cohort of adult patients (n = 216,557) who received treatment for depression was identified from the National Health Insurance Research Database in Taiwan. Factors associated with service use and healthcare costs over a 12-month period were explored, with a particular focus on past treatment history, comorbid physical illnesses, painful physical symptoms, and choice of initial antidepressants. ResultsDepression severity, past treatment history, comorbid mental/physical illnesses, painful physical symptoms, and choice of initial antidepressants were found to be associated with healthcare costs in the following year, although the nature of the associations differed across cost categories. The presence of comorbid cardiovascular disease or certain painful physical symptoms at baseline was associated not only with higher non-psychiatric but also with higher psychiatric costs; moreover, patients with these comorbidities were shown to have increased use of psychiatric emergency and inpatient services. ConclusionHealthcare costs for depression are affected by a number of clinical characteristics and comorbidities of patients. The importance of comorbid pain and cardiovascular conditions warrants further research.

Adolescents et urgences pédopsychiatriques : revue de la littérature et réflexion clinique

ObjectivesWhile the reception arrangements for child psychiatric emergencies seem increasingly frequented by adolescents, we sought to identify clinical and sociodemographic characteristics of these patients, yet poorly explored and understood. MethodsWe conducted an analysis of the literature review listed from the major search engines. ResultsAttendance at child psychiatric emergencies is increasing for over 20 years, with a predominance of adolescents and accompaniment by an overrepresentation of social assistance to children (child welfare): 22,7% to 43% of patients. The first emergency department visit patterns are agitation and violence. The main diagnoses that are registered are mood disorders and conduct disorders, including oppositional defiant disorder. A significant proportion of these adolescents come back to emergencies procedures within the year: nearly one third of adolescents, including a history of child welfare monitoring as a risk factor. DiscussionIn the different studies, the same proportion of internalizing problems and externalizing problems are registered by clinician investigators. The most striking characteristics relate more to the environment of these teenagers, including a significant proportion who are followed by child welfare. For those teenagers consulting in an emergency service, a therapeutic issue is to reintegrate them into a sufficient long-term care, thanks to disponibility, accessibility and an essential preliminary work and partnership coordination between the various professionals who accompany them. ConclusionBased on literature data, knowledge about clinical and sociodemographic adolescents referred for “psychiatric emergency services” need to be developed in order to better understand an important issue and to propose care projects closer to the needs of this high-risk population.

Successful Use of Oxazepam in the Treatment of Delirium Tremens

To the Editor: Delirium tremens is a manifestation of alcohol withdrawal syndrome that occurs in about 5% of patients and has a high mortality rate.1 The withdrawal state involves reduced brain γ-aminobutyric acid (GABA) levels and GABA receptor sensitivity and activation of glutamate systems, which leads to neuronal overactivity in the absence of alcohol.2,3 Longer-acting benzodiazepines such as diazepam with active metabolites are preferred over shorter-acting ones for detoxification because they are associated with a lesser chance of recurrent withdrawal.4 Benzodiazepines with a short half-life (eg, oxazepam and lorazepam) have potential benefit for patients with liver disease, which is a common comorbid medical condition in alcohol-dependent individuals. The efficacy and safety of the short-acting benzodiazepine oxazepam in alcohol withdrawal–related delirium are not clear. To our knowledge, this is the only case reported in the literature of the use of oxazepam in the treatment of delirium tremens. Case report. Mr A, a 42-year-old man, presented to the psychiatric emergency services with a 15-year history of alcohol use. He met DSM-IV-TR criteria for alcohol dependence with a history suggestive of craving, tolerance, salience, loss of control, and withdrawal symptoms for the past 5 years. After being abstinent from alcohol for 4 days, he had developed symptoms characterized by disorientation to time, place, and person; tactile hallucinations; severe tremulousness; and autonomic instability signs. On the day of admission in July 2010, the patient’s Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar)5 score was 42, corresponding to severe withdrawal. Mr A did not have a history of seizures, loss of consciousness, or significant head injury. Neurologic examination revealed no focal deficits, and there were no signs or symptoms suggestive of neuroinfection. Computed tomographic scanning of the brain was normal except for mild cerebral atrophy. Biochemical investigations revealed abnormal liver function values, while the results of other tests including sugar levels, renal function parameters, and electrolyte levels were within normal range. In view of the patient’s liver function values, we started treatment with the shorter-acting benzodiazepine oxazepam 90 mg/d in 3 divided doses of 30 mg each, with the dose tapered every 3 days. With tapering doses of oxazepam, Mr A showed improvement, with reduction of CIWA-Ar score to less than 10 by the fifth day. In this case, oxazepam, which is a shorter-acting benzodiazepine, was used to treat delirium tremens. Most benzodiazepines have active metabolites, and hence their duration of action seems to exceed their plasma half-life.4 Oxazepam has no cytochrome P450 interactions and no active metabolites. It does not have initial euphoric effects because of its slow resorption, and therefore there is less risk of misuse. The half-life of oxazepam is 4–10 hours, and it has a better therapeutic window compared to other short-acting agents. Oxazepam has been used in the treatment of uncomplicated alcohol withdrawal syndrome.6 Safety data on the use of oxazepam in medical emergencies such as delirium tremens would be of benefit in cases with associated impaired liver functioning. The outcome of this case, as well as the pharmacokinetics of oxazepam, suggests that it may be a good alternative to lorazepam for patients with significant comorbid hepatic illnesses.

Psychiatry Emergency Service Can Do More Than Triage

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessPsychiatry Emergency Service Can Do More Than TriageAaron LevinAaron LevinSearch for more papers by this authorPublished Online:2 Nov 2012https://doi.org/10.1176/pn.47.21.psychnews_47_21_16-aAbstractRecovery—isn’t that something that takes lots of time to bring to reality for a patient? Mark Winfrey/ShutterstockNot when it happens in the emergency department (ED), Anthony Ng, M.D., said last month at APA’s Institute on Psychiatric Services in New York.“The ED is the gateway to care,” said Ng, chief medical officer of Acadia Hospital and chief of the psychiatry service at Eastern Maine Medical Center in Bangor, Maine. “This is where they’ll get their first impression of psychiatry, so even if they’re not ready to accept treatment, we can prepare them for that moment.”Traditionally, ED psychiatry worked on a “triage-and-refer” model. Now an alternative approach (at least for some patients) involves receiving the first stages of treatment there, although not without some adjustments.For instance, the practical concerns of operating an ED—urgency, safety, and throughput—create an ethos at odds with the usual paradigm of psychiatric care, said Ng.“You have to do recovery work in minutes or hours versus days or months,” he said. But there can be a payoff if that effort reduces use of restraints or leads to fewer readmissions and return trips.Psychoeducation, case management, and even a little cognitive-behavioral therapy can all happen in the ED, said Ng. “These are possible with many patients, but not all.”Engaging patients long enough to figure out what they really want when they approach the hospital may reveal that alternatives like day hospitals, crisis teams, or even phone calls may meet their needs and cut unnecessary usage. That can open up beds needed for other patients in the ED.“Needing a medication refill is not a crisis,” said Ng. “We try creating a ‘crisis card’ for each patient, giving him or her a list of alternatives to the ED. We also try to involve families and the patient’s other medical professionals in treatment planning. There is a dynamic relationship, in flux all the time, between partnership and paternalism” that needs adjustment with each patient and at different times.Making a decision to hospitalize or discharge patients after an examination in the ED is a careful balancing act that benefits from experience in the emergency setting, said Jon Berlin, M.D., recently retired as director of the psychiatric emergency services in Milwaukee.“We can help long-term practitioners with cases when their patients are in crisis,” said Berlin. “We put much weight on their point of view if they request that a patient be hospitalized, and we can also serve to consult them about risk tolerance.”In fact, emergency-service psychiatrists have very high risk tolerance and are less risk averse than their community psychiatric colleagues, he said. “We’re less likely to hospitalize.”Treating patients in the hospital can go a long way toward mitigating the risks of coercive care and the damage to the therapeutic alliance, said Berlin. “But not a lot is being done now in the hospital when stays are short and patients are quickly released on medications.”The ED evaluation should not only weigh risk and protective factors and ways to eliminate risk, but also document the reasoning process behind a decision to admit to the hospital or discharge to other forms of care, he said.Berlin also discussed how peer support in the ED can help patients and staff. “Peer specialists remind staff on a daily basis of the patient’s point of view,” he said. “They are role models for patients, instilling hope of recovery. Peers are ready to engage the patient right away, even in the waiting room, lessening hostility.” To access an audio interview with Ng, go to www.psychnews.org/update/audio/IPS-12-TonyNg.mp3. ISSUES NewArchived

Clinical outcome and length of stay in an Italian Psychiatric Emergency Service

The aims of the present study were to analyze outcome and to evaluate diagnosis-specific pattern of improvement during a brief hospitalization in a Psychiatric Emergency Service (PES) in a catchment area in Turin, Italy. A sample of 848 acute patients, consecutively hospitalized between January 2007 and December 2008 in the PES of the San Giovanni Battista Hospital, with diagnoses of non-affective psychosis-affective psychosis, depressive disorder and mania-and personality disorder (DSM-IV-TR) was recruited. All patients were assessed with the Brief Psychiatric Rating Scale (BPRS). One-way analysis of variance was used to measure patients' individual reliable and clinically significant change speed between BPRS assessments, in which change speed was referred to the division of the gap between admission and discharge scores over the number of days of length of stay (LOS). The overall sample showed a significant improvement of BPRS total score and each domain during a brief hospitalization (mean LOS 10.5days), with a different pattern between the diagnostic groups. A significant difference in change speed of BPRS resulted in the whole sample and in each diagnostic groups; patients with mania showed a significantly faster improvement. A brief hospitalization in our service was shown to be highly effective. A different and diagnosis-specific patients' individual reliable and clinically significant change speed was observed, with a significantly faster improvement in patients with mania.

The compliance to prescribed drug treatment and referral in a psychiatric emergency service: A follow-up study

The compliance to prescribed drug treatment and referral in a psychiatric emergency service: A follow-up study

Crisis Intervention Teams Enhance Safety of Police, Patients

The Crisis Intervention Team model is based on a partnership of psychiatric emergency services, local mental health advocates, and police departments, facilitating treatment in lieu of incarceration.

Compulsory admissions of emergency psychiatric inpatients in Turin: The role of diagnosis

Many studies have found high levels of compulsory admission (CA) among non-affective psychoses. Aims of the present study were to investigate whether there was a mere association between diagnosis and CA in a cohort of 848 patients referring to a Psychiatric Emergency Service in a catchment area in Turin during a 2-year period, independent of socio-demographic features, psychiatric history, and clinical status. Diagnosis as a risk factor for CA was assessed constructing a logistic regression model, using the following steps: first, assessing the association between diagnoses and CA, without controlling for confounding factors; second, entering socio-demographic factors; third, entering socio-demographic factors and psychiatric history; and fourth, entering socio-demographic, psychiatric history, and aspects of clinical presentation into the model. At step 1 patients with Non Affective Psychoses, Mania and Personality Disorders had a significantly higher CA risk, compared to patients with Depressive Disorders. At step 4 diagnosis was no longer associated with CA. History of CAs within past 5years and Brief Psychiatric Rating Scale (BPRS) hostile-suspiciousness were positively associated with CA. Length of illness, history of previous suicidal attempts and BPRS anxiety-depression were negatively associated with CA. Overall, the percentage of correctly predicted cases was 39.8%. The remaining 60% can be explained by inherent variability or unknown, lurking variables. Finally, the study was carried out at a single facility. Much of the increased CA likelihood in diagnostic categories might be attributable to specific symptom patterns, not to patients' severity of illness or diagnosis per se.

Emergency Presentations to an Inner-city Psychiatric Service for Children and Adolescents

Psychiatric emergency services for children and adolescents vary in process, structure and outcome. There are few systematic studies on the type and prevalence of psychiatric problems encountered, related circumstances or resulting interventions. Evidence in these areas is important in evaluation of the function of mental health services in the relevant catchment area. This article presents a cohort study of 466 consecutive consultations that took place in the Amsterdam Child Psychiatric Emergency Service in 2008, with data on clinical, demographic and consultation-related characteristics. A majority of the consultations (51.5%) was related to behavioural problems in the context of heavily strained relationships. A total of 23.4% consultations were related to neglect or abuse. Parental mental illness prompted 12% of the consultations. Psychiatric diagnoses in the child as such were limited. The main Diagnostic and Statistical Manual of Mental Disorders classification was a relational problem (70%). These crises were serious and often necessitated temporary placement. Hospitalisations on a psychiatric ward and/or pharmacological intervention were rare. Regular mental healthcare providers may specifically need to add psychiatric evaluation and treatment strategies when confronted with disruptive disorders. Additional preventive measures and firmer inter-agency collaboration may ameliorate the containment of problems in these children and their families.

Does psychiatric emergency service or outpatient clinic?

Does psychiatric emergency service or outpatient clinic?

The compliance to prescribed drug treatment and referral in a psychiatric emergency service: a follow-up study

To evaluate the compliance to the prescribed drug treatment and referral of patients discharged from a psychiatric emergency service (PES). From a total of 330 patients enrolled in the study, 175 (53%) agreed to a telephone inquiry 60 days after the PES visit regarding the status of the prescribed medication use and the outpatient referral. RESULTS 227 patients (68.8%) received prescription for a psychotropic medication and all patients were referred to an outpatient psychiatry service. Of the 175 patients who agreed to participate, 153 (87.4%) were successfully contacted by phone. Out of these, 97 patients (63.4%) were using the prescribed medication and 83 (54.2%) had scheduled a community appointment after 60 days. Patients who received a prescription had a greater chance of being on psychotropic medications at follow-up (OR 2.88; IC 95% 1.33-6.22; p = 0.007). However, the prescription was not associated with being in regular outpatient treatment (OR 0.76; IC 95% 0.036-1.61; p = 0.475). Psychotropic medications were routinely prescribed for PES patients, but this practice did not increase compliance to outpatient treatment referral after two months.

The compliance to prescribed drug treatment and referral in a psychiatric emergency service: a follow-up study

To evaluate the compliance to the prescribed drug treatment and referral of patients discharged from a psychiatric emergency service (PES). From a total of 330 patients enrolled in the study, 175 (53%) agreed to a telephone inquiry 60 days after the PES visit regarding the status of the prescribed medication use and the outpatient referral. 227 patients (68.8%) received prescription for a psychotropic medication and all patients were referred to an outpatient psychiatry service. Of the 175 patients who agreed to participate, 153 (87.4%) were successfully contacted by phone. Out of these, 97 patients (63.4%) were using the prescribed medication and 83 (54.2%) had scheduled a community appointment after 60 days. Patients who received a prescription had a greater chance of being on psychotropic medications at followup (OR 2.88; IC 95% 1.33–6.22; p = 0.007). However, the prescription was not associated with being in regular outpatient treatment (OR 0.76; IC 95% 0.036–1.61; p = 0.475). Psychotropic medications were routinely prescribed for PES patients, but this practice did not increase compliance to outpatient treatment referral after two months. Avaliar a adesão ao tratamento farmacológico prescrito e ao encaminhamento em pacientes atendidos em um Serviço de Emergências Psiquiátricas (SEP). Foram coletados dados demográficos e clínicos de 330 pacientes atendidos em um SEP durante um ano. Sessenta dias após o atendimento, a adesão ao tratamento farmacológico e a continuidade do tratamento em caráter ambulatorial foram avaliadas através de contato telefônico. 227 pacientes (68,8%) receberam prescrição de medicações psicotrópicas. Todos os pacientes foram encaminhados para serviços psiquiátricos ambulatoriais. Cento e setenta e cinco pacientes concordaram em receber o contato telefônico. Desses pacientes, 97 (63,4%) estavam usando a medicação prescrita e 83 (54,2%) haviam marcado consulta após 60 dias. Os pacientes que receberam uma prescrição tiveram maior chance de estar em uso de medicações psicotrópicas no contato do seguimento (RC 2,88; IC 95% 1,33–6,22; p = 0,007). Entretanto, a prescrição não foi associada ao agendamento de consulta ambulatorial (RC 0,76; IC 95% 0,036–1,61; p = 0,475). Medicações psicotrópicas são prescritas rotineiramente para pacientes atendidos em SEP, mas esta prática não aumentou a adesão ao encaminhamento para tratamento ambulatorial após dois meses.

Deadly Shooting Shocks Psychiatric Hospital

Back to table of contents Next article Professional NewsFull AccessDeadly Shooting Shocks Psychiatric HospitalAaron LevinAaron LevinSearch for more papers by this authorPublished Online:6 Apr 2012https://doi.org/10.1176/pn.47.7.psychnews_47_7_1-aAbstractA man wearing two wristwatches and carrying two 9mm handguns entered the Western Psychiatric Institute and Clinic (WPIC) in Pittsburgh on March 8, killing one employee and wounding seven other people before being shot to death by university police.Police officers walk out of Western Psychiatric Institute and Clinic March 8. A gunman opened fire at the psychiatric facility at the University of Pittsburgh in a shooting that killed two people, including the gunman, and wounded seven others. AP Photo/Pittsburgh Tribune-Review, Justin MerrimanThe dead employee was identified as Michael Schaab, 25, a therapist working on the geriatric unit. Names of the other wounded individuals and their affiliation, if any, with the clinic had not been released by hospital officials at press time. Four of the injured required surgery but all were expected to survive, said Donald Yealy, M.D., a professor and chair of emergency medicine at the University of Pittsburgh Medical Center (UPMC), in a news conference.“We are all deeply saddened by the tragic events yesterday and in particular the loss of one of our dedicated staff members and the injuries to others,” said Jeffrey Romoff, UPMC president and CEO, in a statement to employees.The incident began around 1:40 p.m. when the gunman entered the building lobby and began firing. University of Pittsburgh police in the area responded and exchanged fire with the suspect before killing him.UPMC Police Chief Tim Delaney credited his department’s community emergency response training, developed in the wake of the 2007 Virginia Tech shooting, for the prompt action by his officers.After some delay, the gunman was identified as John Shick, but as of press time, his motives were still unknown.He was a 2004 graduate of Carleton College in Minnesota with a degree in chemistry and was banned from the Duquesne University graduate program in biology after harassing female students last fall, according to the Pittsburgh Post-Gazette.Other news reports said that Shick had a violent encounter with police at the Portland, Ore., airport in 2009 that resulted in several assault charges and a commitment hearing there. He was ordered into psychiatric treatment for 180 days, but how long he remained in treatment has not been revealed.A UPMC spokeswoman would not disclose whether Shick had ever been a patient at the clinic, citing privacy laws. She also would not confirm news reports that a “doctor or psychiatrist” was among the injured. APA members who were asked for comment on the event referred Psychiatric News to UPMC’s media relations office, which declined to permit interviews.“Security will be reviewed thoroughly” in light of the shooting, said WPIC President Claudia Roth, Ph.D., at a news conference. The 310-bed hospital has 2,000 clinical staff members, she said.The facility now uses a metal detector at the entrance to its emergency department but not at the general entrance, where the incident began.Some psychiatric facilities use hand-held, metal-detecting wands to check patients and visitors for weapons or other contraband, said Scott Zeller, M.D., chief of psychiatric emergency services at the Alameda County Medical Center in Oakland, Calif., and president of the American Academy for Emergency Psychiatry.“At our dedicated psychiatric campus we wand all patients on arrival to the hospital and also wand all visitors prior to entry into patient-care areas,” said Zeller in an interview.However, it is not clear if such precautions would have stopped Shick, since he started shooting almost immediately after he entered the building.Shortly after the event, WPIC began providing support for staff, patients, and families in work areas and the lobby, with other teams circulating throughout the building, said Roth in a statement.About 300 staff members took part in group support sessions in the first five days. A drop-in support center for families and visitors of WPIC patients was set up and was staffed by members of the National Alliance on Mental Illness. The Web site for Western Psychiatric Institute and Clinic is www.upmc.com/HospitalsFacilities/Hospitals/wpic/Pages/default.aspx. ISSUES NewArchived

P-573 - Analysis of diagnostic agreement among psychiatric assessment in emergency service and inpatient setting

Introduction Psychiatric emergencies are usually complex processes rather than discrete events, in which most clinicians have only two tools to deal with: hospital admission or crisis intervention in the emergency department followed by referral to low-intensity outpatient treatment. The triage model for psychiatric emergency services (PES), described by Gerson and Bassuk in the 80s, advocated “rapid evaluation, containment and referral (…), minimizing subtle diagnostic considerations. This model has been replaced by more comprehensive services, capable of providing comprehensive assessment and a broader range of services. This treatment model highlights the importance of establish a diagnosis, even if provisional, that allows a plan for immediate treatment. The literature suggests that reliable diagnostic assessments can be performed in emergency settings. Objectives To evaluate the validity of psychiatric diagnosis made in the PES of an university hospital. Method Retrospective study, in which data from all the patients admitted to Psychiatry Service of Coimbra University Hospitals between January and June of 2010, from the emergency department, were analyzed for socio-demographic and clinical characteristics, namely the diagnosis before psychiatric inpatient hospitalization (PES) and at discharge. Results From the 4.537 psychiatric episodes observed in the PES during this period, 8.1% where admitted to inpatient treatment. The most frequent diagnostics at admission were Major Depression (17.2%), Affective Disorder (17.1%) and Schizophrenia (13.1%). Conclusions Although the study is still running, preliminary results point to a good level of agreement between the diagnostics made in the PES and those established in the inpatient assessment.

P-572 - Descriptive study of the patients attended at the psychiatric emergency service of the complejo hospitalario universitario albacete (CHUA)

Introduction In the last decade has objectified a change in the profile of patients attending psychiatric emergencies in Spain. Research papers published recently on this subject have an overwhelming agreement to maintain a change in the demand for care at psychiatric emergency units, characterized not only by the increase in these, but also by a series experienced as negative aspects: patients frequent repeaterś, demands urgent assistance is not even considered not as a crisis. (Teijeiro 2003, Centeno 2002, Vila Grifoll 2002) Objectives Measure the importance of psychiatric problems in the emergency services of the CHUA. Describe the characteristics of patients who have access to these emergency services. Methods 634 patients (52% females, mean age 35.4 +/-12.8 years) consecutively attended in June-July 2011 in emergency psychiatric service of CHUA were assessed to sociodemographic variables, diagnosis and the treatment plan. Results 62.4% were referred from primary care, 65.4% were domiciled in Albacete, 42.1% had a psychiatric history, 70% lived with a partner, 60.2% were being treated with psychotropic drugs. 21.3% received no diagnosis included in DSM-IV. 9.62% were admitted for observation, 12.61 admitted to an inpatient psychiatric ward. 1.1% came to more than 3 times the psychiatric emergency service. The treatment plan was not significantly related to the sociodemographic variables studied. Conclusions An average of 10.39 patients per day is attended in emergency psychiatry CHUA. 1.1% would qualify as “frequent repeaters”.

P-571 - Patients attended at the psychiatric emergency service of the complejo hospitalario universitario albacete (CHUA)

The psychiatric emergency would be one situation or medical condition that a given moment generates a demand for attention and resolution assistance immediately as requested by the patient, family, other specialists… In the last decade has objectified a change in the profile of patients attending psychiatric emergencies in Spain. Research papers published recently on this subject have an overwhelming agreement to maintain a change in the demand for care at psychiatric emergency units, characterized not only by the increase in these, but also by a series experienced as negative aspects (patients ́frequent repeaterś). (Teijeiro 2003, Centeno 2002, Vila Grifoll 2002). Measure the importance of psychiatric problems in the emergency services of the CHUA and to describe the characteristics of patients who have access to these emergency services for the purpose of psychiatric treatment. 634 patients (52% females, mean age 35.4 +/-12.8 years) consecutively attended in June and July 2011 in emergency psychiatric service were assessed to sociodemographic variables, diagnosis and treatment plan. 62.4% were referred from primary care, 65.4% were domiciled in Albacete, 42.1% had a psychiatric history. 21.3% not included in DSMIV diagnosis. 9.62% were admitted for observation, 12.61% admitted to an inpatient psychiatric ward. 1.1% came to more than 4 times the psychiatric emergency service. Treatment plan was not significantly related to the sociodemographic variables studied. An average of 10.39 patients per day is attended in emergency psychiatry CHUA. 1.1% would qualify as “frequent repeaters”