Psychiatric Emergency Department Research Articles

Creation and Implementation of a Multi-Disciplinary Clinical Workflow Aimed at Earlier Diagnostic Evaluation for Autoimmune Encephalitis for Patients Presenting With Atypical Psychosis: A Pilot Study

Objective To implement a clinical workflow that facilitates earlier diagnostic evaluation for autoimmune encephalitis (AE) among patients presenting with atypical psychosis (AP). Background Clinical features found to have positive predictive value for AE were recently identified.1 Early identification of "red flag” features was associated with a 58% reduction in time from symptom onset to AE diagnosis.2 “Yellow flag” features, while less specific, were also associated with AE, especially when multiple were present simultaneously.3 A workflow that utilizes these features would be of clinical significance. Design/Methods We created a standardized workflow to triage patients presenting to the psychiatric emergency department with AP using red/yellow flag features. The presence of one or more yellow flags (hyponatremia, first psychotic symptoms at age >40, systemic/infectious prodrome, refractory symptoms, and malignancy history) results in neurology consultation. Following the consultation, there may be a recommendation for more involved testing such as CSF studies, imaging, and/or EEG. The presence of a red flag (seizure, dysautonomia, movement disorder, or focal finding on neurologic exam) results in admission to the neurology service. Results Since the implementation of the workflow in February 2022, 5 patients have been identified. All patients received neurology consultation within 24 hours of presentation, after which 3 underwent diagnostic evaluation for AE. Conclusions The implementation of a multi-disciplinary clinical workflow to triage patients presenting with AP is feasible. Preliminary evidence suggests a significant decrease in time from presentation to diagnostic evaluation for AE compared to the time prior to its implementation.

Predicting Poor Outcomes Among Individuals Seeking Care for Major Depressive Disorder.

To develop and validate algorithms to identify individuals with major depressive disorder (MDD) at elevated risk for suicidality or for an acute care event. We conducted a retrospective cohort analysis among adults with MDD diagnosed between January 1, 2018 and February 28, 2019. Generalized estimating equation models were developed to predict emergency department (ED) visit, inpatient hospitalization, acute care visit (ED or inpatient), partial-day hospitalization, and suicidality in the year following diagnosis. Outcomes (per 1000patients per month, PkPPM) were categorized as all-cause, psychiatric, or MDD-specific and combined into composite measures. Predictors included demographics, medical and pharmacy utilization, social determinants of health, and comorbid diagnoses as well as features indicative of clinically relevant changes in psychiatric health. Models were trained on data from 1.7M individuals, with sensitivity, positive predictive value, and area-under-the-curve (AUC) derived from a validation dataset of 0.7M. Event rates were 124.0PkPPM (any outcome), 21.2PkPPM (psychiatric utilization), and 7.6PkPPM (suicidality). Among the composite models, the model predicting suicidality had the highest AUC (0.916) followed by any psychiatric acute care visit (0.891) and all-cause ED visit (0.790). Event-specific models all achieved an AUC >0.87, with the highest AUC noted for partial-day hospitalization (AUC=0.938). Select predictors of all three outcomes included younger age, Medicaid insurance, past psychiatric ED visits, past suicidal ideation, and alcohol use disorder diagnoses, among others. Analytical models derived from clinically-relevant features identify individuals with MDD at risk for poor outcomes and can be a practical tool for health care organizations to divert high-risk populations into comprehensive care models.

Health care resource utilization and costs in patients receiving long-acting injectable vs oral antipsychotics: A comparative analysis from the Disease Recovery Evaluation and Modification (DREaM) study.

BACKGROUND: Given relapse frequency early in the course of schizophrenia, recently diagnosed patients may benefit from longacting injectable antipsychotics, which are associated with reduced risk of relapse and hospitalization compared with oral antipsychotics (OAPs). OBJECTIVE: To compare health care resource utilization (HCRU) and costs in patients with recent-onset schizophrenia treated with continuous paliperidone palmitate (PP) or continuous OAP or who switched from OAP to PP. METHODS: In this analysis, we combined the 2 randomized phases of the prospective, open-label Disease Recovery Evaluation and Modification (DREaM) clinical study using the principal stratification method to generate 3 treatment strategies: continuous PP for 18 months (PP-PP), continuous OAP for 18 months (OAP-OAP), and initial OAP switched to PP after 9 months (OAP-PP). HCRU metrics included psychiatric hospitalizations, psychiatric and nonpsychiatric emergency department visits, and ambulatory visits. Costs were analyzed using generalized linear models with inverse-probability weighting based on time-varying probabilities of exposure. Robust SEs were estimated using individual-level clustered bootstrapping. Subgroup analyses were performed by region and prior antipsychotic use (< 6 vs ≥ 6 months). RESULTS: A total of 181 patients were included in the PP-PP (n = 61), OAP-OAP (n = 61), and OAP-PP (n = 59) groups. The majority of patients (73%) were enrolled at study sites in the United States, and 48% had received an antipsychotic for less than 6 months prior to study entry. Baseline characteristics were well balanced, and no significant differences in discontinuation rates were observed across treatment strategies. Compared with OAP-OAP, significantly lower cumulative HCRU and costs were apparent before 9 months in the PP-PP group and after 9 months in the OAP-PP group. The cumulative 18-month effects of PP-PP and OAP-PP vs OAP-OAP on the number of psychiatric hospitalizations were ‒0.28 (95% CI = ‒0.51 to ‒0.08) and ‒0.27 (95% CI = ‒0.50 to 0.04), respectively, and those on cumulative mean per-patient total health care costs (in 2020 USD) were -$2,867 (95% CI = ‒$5,133 to ‒$750) and ‒$2,789 (95% CI = ‒$5,155 to ‒$701), respectively. Subgroup analyses indicated a greater reduction in psychiatric hospitalizations and costs with PP-PP or OAP-PP relative to OAP-OAP in patients with less than 6 vs 6 or more months of prior antipsychotic therapy. CONCLUSIONS: Continuous early use of PP in adults with recentonset schizophrenia significantly reduced psychiatric hospitalizations and associated estimated costs compared with OAP; these effects were particularly notable for patients with a shorter duration of prior antipsychotic use. As this was a post hoc analysis of a study that was not powered for HCRU assessments, future studies calibrating these effects to larger real-world populations will be useful. DISCLOSURES: Dr Basu reports consulting fees through Salutis Consulting LLC related to this work. Ms Benson, Dr Turkoz, Ms Patel, Dr Baker, and Dr Brown are employees of Janssen Scientific Affairs, LLC, and stockholders of Johnson & Johnson, Inc. This research was funded by Janssen Scientific Affairs, LLC. The sponsor was involved in the study design; collection, analysis, and interpretation of data; development and review of the manuscript; and decision to submit the manuscript for publication.

2.128 Psychiatric Emergency Department Chief Complaints and Wait Times in Children, Adolescents, and Young Adults During the COVID-19 Pandemic: A Retrospective Review of a Large Massachusetts Hospital System

The COVID-19 pandemic has presented an unprecedented impact on global mental health, with children, adolescents, and young adults noted to be particularly vulnerable to its effects. We aimed to evaluate COVID-19’s impact on the mental health of this population within a large Massachusetts hospital system.

Factors associated with a borderline personality disorder diagnosis in the emergency department.

IntroductionResearch on borderline personality disorder (BPD) has shown that less intensive care is especially effective when patients have been told about their condition. However, problems with diagnosing the disorder are also described in the literature. This study thus aims to explore the factors associated with the challenges of identifying and then communicating a BPD diagnosis to patients.MethodsWe analyzed a database of 202 patients of Toulouse University Hospital (France) who had a CIM−10 F60.3 diagnosis. This data was used to identify the sociodemographic and clinical benchmarks associated with patients who had received an established BPD diagnosis prior to their attendance at the hospital's emergency department (ED) in the study period.ResultsSixty-three percentage of the patients admitted to our psychiatric ED had been given an earlier diagnosis of BPD. Those who had not been diagnosed were more likely to: not have undergone any psychiatric follow-up; not have been hospitalized in the psychiatry department; and not have previously attended at the ED. Patients with BPD and a comorbidity of MDD were also less likely to have received a BPD diagnosis before their ED admission.ConclusionThis study found that patients without an established BPD diagnosis who present at the ED are more likely to not be known to the psychiatric care system. This suggests that EDs have a specific role to play in making a diagnosis and the subsequent orientation of care.

Suicidality in psychiatric emergency department situations during the first and the second wave of COVID-19 pandemic

Psychiatric patients are prone to mental health deterioration during the Covid-19 pandemic. Little is known about suicidality in psychiatric patients during the Covid-19 pandemic. This study is a retrospective chart review of psychiatric emergency department (pED) presentations with present or absent suicidality (5634 pED attendances, 4110 patients) in an academic pED in Berlin, Germany. Poisson regression analysis was performed on the effect of Covid-19 period on suicidality (suicidal ideation (SI), suicide plans (SP) or suicide attempt (SA)) during the first (3/2/2020–5/24/2020 “first-wave”) and second (9/15/2020–3/1/2021 “second-wave”) wave of the Covid-19 pandemic compared to the same periods one year earlier. During the first-wave the number of pED visits per person with SI, SP and SA was higher compared to one year earlier (SI RR = 1.614; p = 0.016; SP RR = 2.900; p = 0.004; SA RR = 9.862; p = 0.003). SI and SP were predicted by interaction between substance use disorder (SUD) and second-wave (SI RR = 1.305, p = 0.043; SP RR = 1.645, p = 0.018), SA was predicted by interaction between borderline personality disorder (BPD) and second-wave (RR = 7.128; p = 0.012). Suicidality increased during the first-wave of Covid-19 pandemic in our sample. In the second-wave this was found in patients with SUD and BPD. These patients may be at particular risk of suicidality during the Covid-19 pandemic.

Long-Term Trends in Psychiatric Emergency Services Delivered by the Boston Emergency Services Team.

Rising psychiatric emergency department (ED) presentations pose significant financial and administrative burdens to hospitals. Alternative psychiatric emergency services programs have the potential to alleviate this strain by diverting non-emergent mental health issues from EDs. This study explores one such program, the Boston Emergency Services Team (BEST), a multi-channel psychiatric emergency services provider intended for the publicly insured and uninsured population. BEST provides evaluation and treatment for psychiatric crises through specialized psychiatric EDs, a 24/7 hotline, psychiatric urgent care centers, and mobile crisis units. This retrospective review examines the sociodemographic and clinical characteristics of 225,198 BEST encounters (2005–2016). Of note, the proportion of encounters taking place in ED settings decreased significantly from 70 to 58% across the study period. Findings suggest that multi-focal, psychiatric emergency programs like BEST have the potential to reduce the burden of emergency mental health presentations and improve patient diversion to appropriate psychiatric care.

Clinical Impact of Functional CYP2C19 and CYP2D6 Gene Variants on Treatment with Antidepressants in Young People with Depression: A Danish Cohort Study.

Background: The clinical impact of the functional CYP2C19 and CYP2D6 gene variants on antidepressant treatment in people with depression is not well studied. Here, we evaluate the utility of pharmacogenetic (PGx) testing in psychiatry by investigating the association between the phenotype status of the cytochrome P450 (CYP) 2C19/2D6 enzymes and the one-year risks of clinical outcomes in patients with depression with incident new-use of (es)citalopram, sertraline, or fluoxetine. Methods: This study is a population-based cohort study of 17,297 individuals who were born between 1981 and 2005 with a depression diagnosis between 1996 and 2012. Using array-based single-nucleotide-polymorphism genotype data, the individuals were categorized according to their metabolizing status of CYP2C19/CYP2D6 as normal (NM, reference group), ultra-rapid- (UM), rapid- (RM), intermediate- (IM), or poor-metabolizer (PM). The outcomes were treatment switching or discontinuation, psychiatric emergency department contacts, and suicide attempt/self-harm. By using Poisson regression analyses, we have estimated the incidence rate ratios (IRR) with 95% confidence intervals (95% CI) that were adjusted for covariates and potential confounders, by age groups (<18 (children and adolescents), 19–25 (young adults), and 26+ years (adults)), comparing the outcomes in individuals with NM status (reference) versus the mutant metabolizer status. For statistically significant outcomes, we have calculated the number needed to treat (NNT) and the number needed to genotype (NNG) in order to prevent one outcome. Results: The children and adolescents who were using (es)citalopram with CYP2C19 PM status had increased risks of switching (IRR = 1.64 [95% CI: 1.10–2.43]) and suicide attempt/self-harm (IRR = 2.67 [95% CI; 1.57–4.52]). The young adults with CYP2C19 PM status who were using sertraline had an increased risk of switching (IRR = 2.06 [95% CI; 1.03–4.11]). The young adults with CYP2D6 PM status who were using fluoxetine had an increased risk of emergency department contacts (IRR = 3.28 [95% CI; 1.11–9.63]). No significant associations were detected in the adults. The NNG for preventing one suicide attempt/suicide in the children who were using (es)citalopram was 463, and the NNT was 11. Conclusion: The CYP2C19 and CYP2D6 PM phenotype statuses were associated with outcomes in children, adolescents, and young adults with depression with incident new-use of (es)citalopram, sertraline, or fluoxetine, therefore indicating the utility of PGx testing, particularly in younger people, for PGx-guided antidepressant treatment.

Do we know the mind of others? Suspicion of malingering in emergency psychiatry

Introduction Malingering can be divided into simulation and exaggeration of symptoms. Malingering has traditionally been considered rare in general psychiatry. In contrast to earlier estimates, more recent studies report that doctors suspect malingering frequently in psychiatric emergency departments. The aim of this study is to survey how often doctors in psychiatric emergency units in a public, free-of-charge, mental health service suspect that patients are malingering, and which diagnoses, symptom complaints and suspected reasons for malingering doctors ascribe to their patients. Methods Questionnaires were distributed in three psychiatric emergency departments in Denmark. Suspected simulation and exaggeration were rated with a 5-point scale. Doctors were encouraged to write down the symptoms and perceived causes for suspected malingering. Results 362 questionnaires were filled in. 25% of all patients were suspected of simulating to some degree. 8% of patients were highly suspected or definitely believed to be simulating. Patients complaining of suicidal ideation were most frequently suspected of malingering. ‘Attention seeking’ was the most common suspected reason for malingering. Patients with diagnoses of substance use and personality disorder were the most suspected of malingering. Conclusion This is the first study to investigate doctors’ suspicions of psychiatric malingering in a European setting. Patients with established personality and substance use disorder are at higher risk of being suspected of malingering, which potentially affects the course of treatment significantly. The rise in suspected malingering is conspicuous and requires further investigation. Doctors are encouraged to act conservatively upon suspicion of malingering in emergency psychiatry.

Urgent care and suicidal behavior in the child and adolescent population in a psychiatric emergency department in a Spanish province during the two COVID-19 states of alarm.

IntroductionThe COVID-19 outbreak and lockdown may have an impact in mental health among youth, but reports of psychiatry emergency department encounters in young Spanish population are scarce. The aim of this study is to characterize the reasons for psychiatric urgent care of youth during COVID-19 pandemic in our hospital.Material and methodsThis cross-sectional study compare visits to the psychiatry emergency department and their characteristics in young patients in the province of Lleida before and after the pandemic with special attention to the two states of alarm and suicidal behavior. Information regarding sociodemographic status, chief complaints, diagnosis, characteristics of suicidal behavior, and other data were obtained from the electronic medical records.ResultsWithin the total psychiatric emergency attendances, youth patients increased a 83.5% in the second state of alarm (p = 0.001). In this period patients were younger (p = 0.006), had less psychiatric history (p = 0.017) and their living conditions changed with an increase of those living with relatives (p = 0.004). Suicidal ideation care increased without statistical significance (p = 0.073). Multiple logistic regression identifies independent risk factors for suicidal behavior being female (OR: 2.88 [1.39–5.98]), living with relatives (OR: 3.49 [1.43–8.54]), and having a diagnosis of depression (OR: 6.34 [3.58–11.24]).ConclusionsThe number of young people seen in psychiatric emergencies during the chronic stage of the pandemic increased, and these were getting younger and without previous psychiatric contact. The trend to higher rates of suicidal ideation indicates that youth experienced elevated distress during these periods, especially women, living with relatives and presenting depression.

Pediatric Mental Health Emergency Visits During the COVID-19 Pandemic.

IntroductionPaediatric and adult psychiatric emergency department (ED) visits decreased during the initial COVID-19 outbreak. Long-term consequences of the COVID-19 pandemic will include increases in mental healthcare needs, especially among vulnerable groups such as children and adolescents.AimThis study examined changes in the number of overall and diagnosis-specific mental health ED visits among patients aged <18 years following the onset of the COVID-19 pandemic in Madrid, Spain.MethodsUsing clinical records from all psychiatric ED visits at a major teaching hospital between October 2018 and April 2021, we conducted interrupted time-series analyses and compared trends before and after the day of the first ED COVID-19 case (1st March 2020).ResultsA total of 663 patients were included. In March 2020, there was a marked initial decrease of -12.8 (95% CI -21.9, - 7.9) less monthly mental health ED visits. After April 2020, there was a subsequent increasing trend of 3.4 (95% CI 2.6, 4.2) additional monthly mental health ED visits.ConclusionAfter the onset of the COVID-19 pandemic, there was an increase in paediatric psychiatric ED visits, especially due to suicide-related reasons. These data reinforce the crucial role of the ED in the management of acute mental health problems among youth and highlight the need for renovated efforts to enhance access to care outside of and during acute crises during the pandemic and its aftermath.

How Covid-19 changed emergency department access: observational study comparison of patient stage of the day access in the psychiatric emergency department over three years

IntroductionA few studies have analyzed the impact of COVID-19 pandemic on psychiatric Emergency Department (ED) accesses. The pandemic may indeed have influenced the phase of day accesses for patients with psychiatric disorders.ObjectivesAim of this cross-sectional study is to analyze how COVID-19 weighed on psychiatric patients daily accesses over the course of three years.MethodsData on 219 patients were retrospectively collected from the ED in the Policlinico Tor Vergata, Rome. According to the stage of the day, accesses were divided into 4 groups: between 00:00 and 6:00; between 6:00 a.m. and 12:00 a.m.; between 12:00 a.m. and 18:00 p.m.; between 18:00 p.m. and 00:00 p.m.ResultsPerforming a regression analysis, a relation was found between psychiatric symptoms, stage of the day admission and year. In 2019 the admissions seem to be homogeneously distributed, however during 2021 and 2020 the admissions rates have a delayed evening trend.ConclusionsDespite the low number of accesses considered, the Covid-19 pandemic appears to exert an effect that still lasts in terms of both accesses and worsening or new onset of psychiatric symptoms. Measures taken to prevent the spread of infections may have affected access in the ED of patients in various ways. However, the trend of increasing evening accesses could be related to a saturation of territorial psychiatric services that work mainly until the afternoon. Thus, an enhancement of territorial psychiatric services seems highly necessary to cope with what could be an increase in psychopathology in patients without previous diagnosis.DisclosureNo significant relationships.

Comparison between haloperidol decanoate and oral haloperidol on seeking psychiatric emergency care

IntroductionHaloperidol is a first generation, high potency, low cost and widely used antipsychotic. There are inconsistencies in the literature about comparison of effectiveness between long-acting injectable haloperidol (HDLAI) with oral haloperidol (OH), as well as the combined use of both formulations (HDLAI+OH).ObjectivesTo verify whether HDLAI reduces the number of emergency visits and hospitalizations when compared to oral OH, or in combination therapy HDLAI+OH.MethodsRetrospective observational study on a Psychiatric Emergency department, including patients aged 18 to 60 years, both genders, under continuous treatment for at least 5 months with Haloperidol for any psychiatric illness, divided into 3 groups of patients (HDLAI, OH, HDLAI+OH). Dependent variables: visits and admissions. Independent variables: sex and age. Data were checked for normality (Kolmogorov-Smirnov test) and homoscedasticity (Bartlett test). For comparison of average number of visits and hospitalizations of patients Kruskal-Wallis test followed by Dunn’s multiple comparison test was used. It was considered statistically significant if p &lt; 0.05. This study was approved by the Ethics Committee of Maringá State University.ResultsNo statistical difference between groups HDLAI and OH was found. The HDLAI+OH group presented higher means of emergency visits and hospitalizations with statistical significance.ConclusionsIt suggests the use of HDLAI can be considered an alternative as effective as oral intake. Prolonged use of associated HDLAI and oral supplementation leads to worst outcomes.DisclosureNo significant relationships.

Use of verbal de-escalation in reducing need for mechanical restraint in patients with psychotic disorders during non-voluntary transfers from home to the psychiatric emergency department

IntroductionLittle is known about the need for mechanical restraint during non-voluntary transfers from patient’s homes to the psychiatric emergency department in patients diagnosed with Paranoid Schizophrenia. Although there is no evidence of its efficacy, one of the main tools used for the reduction of mechanical restraints is verbal de-escalation training.ObjectivesThe aim is to describe which symptoms predispose to mechanical restrain in patients with Paranoid Schizophrenia transferred in a non-voluntary manner from home to the psychiatric emergency department, and the effect on reducing mechanical restraints after receiving verbal de-escalation training.MethodsAll patients with Paranoid Schizophrenia who, after being visited by a home psychiatry team, have required non-voluntary transfer from their homes to the psychiatric emergency department were selected (N = 442).ResultsYoung age, being male, having a poor adherence to treatment, higher scores for de following variables; Excitement, Grandiosity, Suspiciousness, Hostility, Abstract thinking, Motor tension, Uncooperativeness, Poor attention, Lack of insight and Poor impulse control as well as lower scores in motor retardation on the PANSS, are related to a higher frequency of mechanical restrain (P&lt;0,005). Before the verbal de-escalation training, 43.9% of the transferred patients required mechanical restraint, after the training, the need for restraints was reduced to 25.5% (P&lt;0.001).ConclusionsTraining in verbal de-escalation has allowed an important reduction in mechanical restraints in patients with schizophrenia who have required non-voluntary transfers from home to the psychiatric emergency department.DisclosureNo significant relationships.

Child psychiatric emergency visits during the COVID-19 pandemic

IntroductionPaediatric and adult psychiatric emergency department (ED) visits decreased during the initial COVID-19 pandemic outbreak. Long-term consequences of the pandemic will include increases in mental healthcare needs especially among especially vulnerable groups such as children and adolescents.ObjectivesThis study examined changes in the number of overall and diagnosis-specific mental health ED visits among patients aged &lt;18 years following onset of the COVID-19 pandemic in Madrid, Spain.MethodsWe used electronic health records to extract the monthly numbers of total and diagnosis-specific mental health ED visits among patients aged &lt;18 years, between October 2018 and April 2021, to La Paz University Hospital. We conducted interrupted time-series analyses and compared trends before and after the day of the first ED COVID-19 case (1st March 2020).ResultsIn March 2020, there was a marked initial decrease of -12.8 (95%CI -21.9, -7.9) less monthly mental health ED visits. After April 2020, there was a subsequent increasing trend of 3.4 (95%CI 2.6, 4.2) additional monthly mental health ED visits.ConclusionsAfter onset of the COVID-19 pandemic, there was an increase in paediatric psychiatric ED visits, especially due to suicide-related reasons. These data reinforce the crucial role of the ED in the management of acute mental health problems among youth and highlight the need for renovated efforts to enhance access to care outside of and during acute crises during the pandemic and its aftermath.DisclosureNo significant relationships.

Frequent visitors in a university psychiatric emergency department in Greece

IntroductionBackground :The profile of “frequent visitors” at the psychiatric emergencies (PE) has not been sufficiently investigated in Greece.ObjectivesIn this study we aimed to investigate the prevalence and relevant parameters of frequent PE visits in a Greek University Psychiatric Hospital for the year 2017.MethodsIn a retrospective study, we analyzed data of patients who presented in the PE of Eginition University Hospital in Athens during 2017. Frequent visitors were grouped under this category if they had at least five visits per year. Clinical and sociodemographic data of the patients were further related to number of visits.Results84 patients were characterized as frequent visitors carrying out 9.8% of the total number of visits. 50% were women and 70% of them were living with family members. Anxiety, depressive and psychotic symptoms were the most frequent major complaints at the time of their visit, whereas psychosocial problems were associated with increased number of visits. Moreover, in terms of the underlying diagnosis substance use disorders significantly related to more frequent visitsConclusionsPsychosocial problems and the diagnosis of substance use disorders significantly correlated to the number of visits at the PE of a university hospital setting in Greece for 2017.DisclosureNo significant relationships.

Tunisian’s largest Psychiatric emergency department in the context of the COVID-19 lockdown

IntroductionGeneral Lockdown was first declared in Tunisia from March 20th to May 4th 2020 to contain the spread of COVID19 pandemic, the last sanitary lockdown period was declared from July 12th to august 1st in 2021. Psychiatric emergency access and consultation has been affected by the confinement. RAZI Hospital Emergency Department (RHED) is the only emergency department in Tunisia specialized in psychiatry. Thus making it the most representative psychiatric emergency health care service in Tunisia.ObjectivesTo assess changes in patients flow and admission rates in RHED in the context of the COVID-19 lockdownMethodsWe examined emergency room records and the hospital’s computer admission database during the first and the last COVID19 lockdowns and compared it to the same period of the previous year.ResultsThe number of consultations was significantly lower in 2020 lockdown (N = 577) compared the same period in 2019 (N = 1525) (p&lt;10−3). We observed a drop in RHED emergency hospitalization rate from 45.57% to 29.81% during this study period. The number of consultations per day was significantly lower during the first lockdown (N= 12.44) compared to the last lockdown (N=26.61) (p&lt;10−3), the hospitalization rate rose from 29.81% during the first lockdown to 44.36% during the last.ConclusionsFear of COVID19 contamination and lockdown limitation had a huge impact on RHED visits and admissions. Medical team had to adjust in order to prevent further delay in acute psychiatric care.DisclosureNo significant relationships.

A 6-year retrospective review of psychiatric emergency service utilization by school-age children.

To explore utilization patterns and associated clinical factors of school-age children who present to a psychiatric emergency department. This was a 6-year retrospective chart review study of children 5-12years of age who presented to a psychiatric emergency service from July 2012 to June 2018 (n = 1654 patients). Demographic variables, clinical diagnoses, lifetime adverse events (physical abuse, sexual abuse, and bullying), and history of self-harm were documented for each visit. We performed a chi square analysis to identify association between demographic and clinical features with key outcomes. Increased service utilization as defined by inpatient psychiatric admission, recurrent visits, or increased length of stay were found in patients who were adopted, presented with suicidal ideation or self-harm behaviors, had a history of abuse, and had a diagnosis of depression or autism. Trends over the course of the study indicated a significantly increased percentage of patients presenting with suicidal ideation, bullying, and self-harm behaviors. The data add to the limited literature regarding school-age children with a psychiatric emergency. Increased emergency service utilization for certain subgroups of children and trends over the course of the study underscore the need for enhanced treatment options for individuals with certain demographic or clinical features, and increased outpatient, intermediate, and inpatient treatment options, as well as preventative care.

Psychiatric Emergency Department Presentations Requiring Intensive Care Unit Hospitalization

Psychiatric Emergency Department Presentations Requiring Intensive Care Unit Hospitalization

Identification of unhealthy alcohol use by self-report and phosphatidylethanol (PEth) blood concentrations in an acute psychiatric department

BackgroundThe use of standard screening methods could improve the detection rate of unhealthy alcohol use in patients admitted to psychiatric acute and emergency departments. The aim of the present study was to investigate the ability of the alcohol biomarker phosphatidylethanol (PEth) to identify patients with high levels of alcohol consumption prior to admission.MethodsThe data were prospectively collected at admittance to an acute psychiatric department in the period January 2016 to June 2017. A blood sample for the analysis of PEth was available from 177 patients. We compared the PEth concentrations with the Alcohol Use Disorders Identification Test (AUDIT) scores during the hospital stay, and psychiatric diagnoses at discharge.ResultsA total of 45.8% of the patients had a PEth concentration ≥ 0.03 μmol/L, indicating significant alcohol consumption. AUDIT scores consistent with unhealthy alcohol use were present in 51.7%. There was a significant positive correlation between PEth concentrations and AUDIT scores (r = 0.631, p < 0.001). PEth was above the detection limit of 0.03 μmol/L in 19% of those reporting an average daily intake of zero alcohol units per day during the last week before admission. PEth concentrations were significantly higher among those with an alcohol diagnosis than among those without such a diagnosis (0.82 μmol/L vs. 0.09 μmol/L, p = 0.001).ConclusionPEth provides supplementary information on recent alcohol consumption in a psychiatric population and would be particularly helpful in patients unable or unwilling to give such information at admission.