Psychiatric Emergency Room Patients Research Articles

Drug detection in a suburban psychiatric emergency room.

This study evaluated the yield and utility of urine toxicological screening (UTS) in psychiatric emergency room patients. We also assessed the effect of race, gender, and cocaine and/or alcohol detection on clinical symptoms and diagnoses. The study's null hypothesis is that recent use of cocaine and/or alcohol in psychiatric emergency patients does not change rates of psychiatric symptoms at evaluation. We did a retrospective chart review of 325 consecutive psychiatric emergency room patients and of 112 consecutive patients with benzoylecgonine (BE; major metabolite of cocaine) on UTS. At assessment clinicians were blind to the results of UTS in most cases. UTS was positive in about one-fourth of cases who submitted urine for toxicological testing. Alcohol, cocaine, and cannabis accounted for the majority of positive cases, and simultaneous detection of these drugs was common. Very few patients with BE on UTS were younger than 18 and none was older than 45. In patients with BE on UTS, substance use was missed in about one out of seven cases, and cocaine use in about one out of four cases. Patients with BE on UTS showed decreased rates of aggressive and bizarre behavior. Cocaine use increased rates of suicidality in males and rates of paranoia in black male patients. Black patients had more hallucinatory experiences than white patients, regardless of cocaine use. Principal diagnoses of psychotic disorders were frequently assigned to black patients with cocaine use, and principal diagnoses of affective disorders rarely. Patients with both BE and alcohol on UTS and patients with only BE on UTS had low rates of aggression, but patients with only alcohol on UTS were frequently aggressive. This study's findings show distinct clinical effects of cocaine and/or alcohol use on psychiatric emergency room patients, contrary to the null hypothesis. These effects differed according to race and gender. We conclude that there is little support to advocate routine toxicological testing in the psychiatric emergency room. Instead, selective testing based on empirical evaluation of risk factors might be more profitable to improve detection rates of cocaine and alcohol.

Suicidal behavior and history of substance abuse.

Substance abuse is frequently associated with suicidal behavior. However, it is unclear to what degree substance abuse in a family member is related to suicide. In the present study, personal and family histories of substance abuse were examined in 716 psychiatric emergency room patients. Suicide attempters, suicide ideators, and nonsuicidal controls were compared across demographic, clinical, and substance abuse variables. Results showed that suicidal patients differed from nonsuicidal controls on many of the dependent variables. Suicidal patients were more likely to be depressed and report a history of previous suicidal tendencies. Also, alcohol and drug abuse occurred more frequently in suicidal patients. Furthermore, a family history of alcohol abuse was reported more often by suicidal than nonsuicidal patients. These patterns of substance abuse in suicidal patients were especially prominent among older subjects. Results are discussed in terms of the implications for identifying psychiatric emergency room patients at risk for suicide.

Characteristics of Psychiatric Emergency Room Patients With Alcohol- or Drug-Induced Disorders

Although emergency room psychiatrists are often faced with evaluating and planning treatment for patients who abuse substances, there is limited information about the characteristics of emergency room patients with alcohol- or drug-induced disorders. The authors describe the demographic and clinical characteristics of 343 consecutive patients referred to a general hospital's emergency psychiatry service. The 114 patients diagnosed as having an alcohol- or drug-induced disorder were younger and were more often male, unemployed, and homeless than patients with disorders not induced by substance abuse. They also demonstrated increased suicidality. Alcohol was the predominant substance that contributed to psychiatric emergencies, but a surprising number of patients were diagnosed as having amphetamine-induced disorders, possibly representing an important trend.

Outpatient compliance of psychiatric emergency room patients by presenting problems.

In the present study, a cohort of patients who came to a psychiatric emergency room in a general hospital, and were not referred for hospitalization, were analyzed in regard to the amount and rate of subsequent contact with community mental health and substance abuse agencies. Patterns of service receipt and the differential impact of service use on hospitalization and/or return visits were analyzed by three major problem types: (1) psychiatric; (2) psychiatric/substance abuse; and (3) substance abuse. The analysis of these subgroups yielded valuable information about how the service system and/or different groups of patients in crisis respond to the system.

Accidental and homicidal death in a psychiatric emergency room population.

To identify potentially preventable mortality other than suicide among psychiatric emergency room patients, the authors compared the rates of accidental and homicidal death among 5,284 consecutive psychiatric emergency room patients with those expected for an age-, sex-, and race-matched sample of the general population. The rate of accidental death was two and one-half times and the rate of homicidal death nearly twice the expected rate for the matched general population. Diagnostic and demographic analyses indicated that increased risk of death from either cause was highest among alcoholics, schizophrenic patients, and males. The implications of the findings for clinical care are discussed.

Decision criteria for predicting adherence for psychiatric emergency room patients with referral appointments

This paper describes and evaluates a method of predicting referral appointment-keeping behavior for psychiatric emergency room patients. Studies have shown that referral systems which provide appointments and reminders achieve higher appointment adherence. However, studies have not been conducted of those experiencing a good referral system to predict adherence behavior and indicate further areas for improvement. Discriminant analysis is applied to patient's psychiatric signs and symptoms for selecting variables that predict referral appointment keeping behavior. All patients seen during a 6 week period were selected from a 1,000 bed hospital's Psychiatric Emergency Room. The data were collected during the patient's visit to the psychiatric emergency room and prior to aftercare treatment. The subset of non-psychotic patients requiring outpatient psychiatric care was the focus of this analysis. The model indicates that patient's adherence with referral appointment can be predicted with 76% accuracy using the best three discriminating variables. This prediction per cent increases to 97% with all contributing variables. The non-adherers are identified with 66% and 100% accuracy, respectively. Distressingly, “Suicidal Behavior” and “Potentially Harming Others” relates to non-adherence. If the non-compliant emergency patient, especially those dangerous to themselves and others, can be identified in advance, the care systems can be changed to increase the number of patients following referral recommendations. This reduces both initial treatment cost and avoids cost resulting from more severe illnesses arising for lack of initial treatment.

Suicide in a psychiatric emergency room population.

Twenty-two suicides were identified in a series of 5,284 psychiatric emergency room patients, yielding a suicide rate of 111.1 per 100,000 "patient-years at risk"--more than seven times the age- and sex-adjusted rate for the general population. Subpopulations at high risk were white people, men, depressed and schizophrenic patients, substance abusers, and patients with multiple emergency room visits. No patients had killed themselves immediately after an emergency room visit, but several had killed themselves without following through on a referral from the emergency room to another facility for treatment. The authors discuss the implications of these findings for emergency room practice and for further research.

Restraint use with emergency psychiatric patients: a new perspective on racial bias.

This study examined the use of interventions of physical restraint by a staff of predominantly white therapists ( N = 37) with psychiatric emergency room patients ( N = 697) as a function of patients' race. Evidence of racial “bias” was found but not across all levels of severity of assessed psychopathology. This effect weakened after extended evaluation and treatment but did not disappear. The results question the value of the bias concept as a pervasive, cognitive set variable in its influence upon clinical judgment.

Therapists' recognition of psychopathology: a model for quality review of psychotherapy.

In this study 32 randomly selected psychiatric emergency room patients, who were in concurrent psychotherapy, completed the SCL-90 and a clinically oriented questionnaire. Their therapists independently rated the patients' degree of psychopathology on the nine SCL-90 symptom scales. Therapists were highly efficient in recognizing depression (94% of the cases) and anxiety (89%) but not psychotic (35%) and obsessive-complusive (16%) pathology. Variables significantly associated with the therapists' nonrecognition of psychopathology were the diagnosis of borderline, the patient's expression of inadequacy in comparison to the therapist, the patient's fear of offending the therapist, and the patient wanting but not receiving empathy from the therapist. The authors discuss the implications of these findings for peer review and further research.

Medical symptoms and life stresses in psychiatric emergency-room patients.

Medical symptoms and life stresses in psychiatric emergency-room patients.

Medical symptoms and life stresses in psychiatric emergency-room patients.

Medical symptoms and life stresses in psychiatric emergency-room patients.