Clinical Methods Research Articles

Self-poisoning evaluated in the emergency department of a general hospital in the years 2014–2020 and the provision of psychiatric services before and after the index event

BackgroundThe recent literature on self-poisoning (SP) has mainly focused on the type of substances used for SP and the associated variables. Few data are available on psychiatric diagnoses, repeated SP, multiple substances SP, contacts with psychiatric services before the event and after a long follow-up. MethodsA consecutive series of 1.807 subjects evaluated in the emergency department of a large urban university hospital was collected from 2014 to 2020. These subjects were matched with the data of Psyche-Web, a case register collecting all psychiatric contacts of the Lombardia Region, Italy. ResultsThe most used drugs were benzodiazepines (37.8 %), cocaine (24.0 %), cannabis (15.2 %), antipsychotics (10.5 %), antidepressants (9.2 %). Alcohol was associated in 27.0 % of the cases. The most frequent psychiatric diagnoses were substance use (28.8 %), personality disorders (24.5 %), and mood disorders (21.7 %). Subjects who repeatedly self-poisoned were younger, more often suffered from a personality disorder and less often from a substance use disorder. In 38.2 % of the sample SP was the first-time presentation to psychiatric evaluation of a mood, personality, or psychotic disorder. At one-year follow-up 63.3 % were not in contact with psychiatric services. LimitationsThis study could not include children and adolescents because Psyche-Web stores data only for the adult population. Psychiatric diagnoses were given by specialists, but in different settings. ConclusionsA substantial number of subjects with no previous contacts remained out of the reach of psychiatric care after discharge. A subgroup of these patients would probably benefit of a more structured referral.

Utilization of psychiatry services in the emergency department following a terror event in Israel

In October 2023, Israel sustained a massive terror attack, with 1,300 people murdered, over 240 kidnapped, and millions exposed to the horrors. This study's aim is to examine the profile of patients arriving to the emergency department (ED) for psychiatric services during the month following the attack, compared to a similar period the year prior. In this cohort study, we compared patients arriving to the ED of a large general hospital in the center of Tel Aviv for psychiatric services during the month post-attack with the previous year using t-tests and chi-square exams. In 2023, 256 patients arrived in the ED for psychiatric evaluation and/or treatment, 46 % more than in 2022. Of these, 64 % were examined due to symptoms related to the terror attack. In 2023, significantly fewer patients had a prior psychiatric diagnosis (68% vs. 89 %). Significantly more patients were diagnosed with acute stress reaction or acute stress disorder in the ED, compared to almost no such diagnoses in 2022 (14 % and 43% vs. 0 % and 1 %). Major terror incidents profoundly influence psychiatric ED visits. Planning efforts for major emergencies should be adapted accordingly.

Children at Risk of Specific Learning Disorder: A Study on Prevalence and Risk Factors.

Specific learning disorder (SLD) is a neurodevelopmental condition characterised by significant academic difficulties despite normal intelligence and adequate education. The difficulties with reading, writing, and arithmetic may manifest independently or concurrently at different ages. Early symptoms may appear in preschool, including delays in social skills, motor skills, and language development. This study aimed to assess the prevalence of preschool children at risk for SLD and related psychiatric disorders. Data were collected from 515 preschool children in Edirne City, Turkey, using a screening scale for early symptoms of SLD. Socio-demographic information was obtained, and children at risk were invited for a psychiatric evaluation. The mean age of the participants was 72.5 ± 5.6 months. It was determined that 5.7% of the preschool children who participated in the questionnaire were at risk of SLD according to the screening scale scores. Factors such as a father's low education, the mother smoking during pregnancy, a longer stay in the neonatal intensive care unit, longer screen time, and consanguinity between parents were associated with an increased risk of SLD. This study emphasises the importance of early identification and intervention for SLD and the need to consider associated psychiatric comorbidities. Identifying the risk factors in preschool children may facilitate timely intervention and prevent academic and social difficulties in later years.

Child developmental outcomes associated with postpartum depression and anxiety in low and middle-income countries: a systematic review.

This systematic review aims to summarize the findings of empirical studies conducted in low- and middle-income countries (LMICs) examining the relationship between postpartum depression and anxiety, and child developmental outcomes measured at 24 months of child's age. The study was performed as per PRISMA guidelines for a systematic review. EBESCO, ProQuest, PubMed, Science Direct, Google Scholar, and BMJ databases were examined, along with a forward and backward examination of the citations published. The New Ottawa scales (NOS) was used to assess the quality of the studies. The findings of the studies were integrated using a narrative synthesis approach. The systematic review revealed that there are 14 studies examining the impact of postpartum depression (n=14) and postpartum anxiety (n=2) across different domains of child development in LMICs. Studies varied regarding the severity and duration of maternal depression, the context and nature of evaluation, and motherinfant characteristics which are important to understand the association between postpartum depression and anxiety and infant development. Maternal depression is negatively associated with language development, socio-emotional and behavioural development while its association with motor and cognitive development is inconsistent. The impact of maternal anxiety on infant development was examined in two studies, and both have identified a negative association. However, the results of the current review need to be interpreted within the scope and limitations of the methodologies adopted by each study details of which are elaborated in the manuscript. Postpartum depression and anxiety can have a wide range of effects on child development. Therefore, periodic infant developmental assessments should become part of routine psychiatric evaluation. There is a need for uniform guidelines for conducting studies and reporting data related to postpartum mental health and child development.

Large Epididymal Cyst: A Tale of Three Testes

Background: An epididymal cyst is a benign cystic structure that develops from the epididymis, typically due to a blockage in the epididymis, resulting in fluid accumulation. These cysts are generally harmless and noncancerous. Case Presentation: We examine the case of a 30-year-old male referred by the Psychiatry department for an assessment of the inguinal scrotal region, due to his belief that he had three testicles. Physical examination revealed an extratesticular, fluctuant, and cystic swelling easily palpable and distinct from the body of the left testis. Ultrasound findings showed a 2.3 x 1.7 cm fluid-filled lesion at the head of the epididymis. Intervention: Following a psychiatric evaluation, the patient underwent surgical excision of the cyst. Conclusion: The histopathological examination of the surgically removed cyst confirmed the diagnosis of an epididymal cyst, underscoring the importance of considering such benign conditions in differential diagnoses of scrotal abnormalities.

Multimodal Sensing for Depression Risk Detection: Integrating Audio, Video, and Text Data.

Depression is a major psychological disorder with a growing impact worldwide. Traditional methods for detecting the risk of depression, predominantly reliant on psychiatric evaluations and self-assessment questionnaires, are often criticized for their inefficiency and lack of objectivity. Advancements in deep learning have paved the way for innovations in depression risk detection methods that fuse multimodal data. This paper introduces a novel framework, the Audio, Video, and Text Fusion-Three Branch Network (AVTF-TBN), designed to amalgamate auditory, visual, and textual cues for a comprehensive analysis of depression risk. Our approach encompasses three dedicated branches-Audio Branch, Video Branch, and Text Branch-each responsible for extracting salient features from the corresponding modality. These features are subsequently fused through a multimodal fusion (MMF) module, yielding a robust feature vector that feeds into a predictive modeling layer. To further our research, we devised an emotion elicitation paradigm based on two distinct tasks-reading and interviewing-implemented to gather a rich, sensor-based depression risk detection dataset. The sensory equipment, such as cameras, captures subtle facial expressions and vocal characteristics essential for our analysis. The research thoroughly investigates the data generated by varying emotional stimuli and evaluates the contribution of different tasks to emotion evocation. During the experiment, the AVTF-TBN model has the best performance when the data from the two tasks are simultaneously used for detection, where the F1 Score is 0.78, Precision is 0.76, and Recall is 0.81. Our experimental results confirm the validity of the paradigm and demonstrate the efficacy of the AVTF-TBN model in detecting depression risk, showcasing the crucial role of sensor-based data in mental health detection.

Serum proteomic analysis uncovers novel serum biomarkers for depression.

The identification of depression primarily relies on the clinical symptoms and psychiatric evaluation of the patient, in the absence of objective and quantifiable biomarkers within clinical settings. This study aimed to explore potential serum biomarkers associated with depression. Serum samples from a training group comprising 48 depression patients and 48 healthy controls underwent proteomic analysis. Magnetic bead-based weak cation exchange (MB-WCX) and MALDI-TOF-MS were used in combination. To screen the differential peaks, ClinProTools software was employed. The proteins were identified using LC-MS/MS. ELISA was employed to confirm the expression of entire protein in the serum of the verification cohort, which encompassed 48 individuals who had been diagnosed with Depression and 48 healthy controls who were collected prospectively. Subsequently, logistic regression analysis was conducted to determine the diagnostic efficacy of the aforementioned predictors. Five potential biomarker peaks indicating depression were identified in serum samples (peak 1, m/z: 1868.21; peak 2, m/z: 1062.35; peak 3, m/z: 1452.12; peak 4, m/z: 1208.72; peak 5, m/z: 1619.58). All of these peaks had higher expression in the pre-therapy group and were confirmed to be Tubulin beta chain (TUBB), Inter-alpha-trypsin inhibitor heavy chain H4 (ITIH4), Complement component 3 (C3), and Complement C4A precursor (C4A) by ELISA validation. Multivariate logistic regression analysis revealed that serum levels of TUBB, ITIH4, C3, and C4A were significant independent risk factors for the development of depression. Depression is a prevalent psychiatric condition. Timely detection is challenging, resulting in poor prognoses for patients. Our study on plasma proteomics for depression demonstrated that TUBB, ITIH4, C3, and C4A differentiate between depression patients and healthy controls. The proteins that were identified could potentially function as biomarkers for the diagnosis of depression. Pinpointing these biomarkers could enable early identification of depression, which would advance precise treatment.

Case Report: Thalamic Stroke Patient with Neuropsychiatric Symptoms

Vascular dementia presents a complex clinical picture when compounded by rare vascular events of such as thalamic stroke. This case report highlights the pivotal role of early psychiatric consultation and neuropsychological testing in the management of vascular dementia, particularly in the context of a thalamic stroke. A 81-year-old male presented with cognitive decline, depressive symptoms, and functional impairment following a vascular stroke. Prompt psychiatric evaluation and comprehensive neuropsychological assessment revealed concurrent vascular dementia and geriatric depression along with localization of vascular stroke. Early intervention with tailored pharmacotherapy targeting both cognitive and mood symptoms yielded significant improvement in cognitive function, mood, management of delirium and overall functional status. Moreover, the incorporation of psychiatric rehabilitation strategies facilitated enhanced recovery and long-term prognosis. This case underscores the critical importance of multidisciplinary collaboration involving psychiatrists, neurologists, and rehabilitation specialists in the holistic management of vascular dementia. Early identification of psychiatric symptoms through thorough evaluation and timely intervention not only improves short-term outcomes but also holds promise for mitigating long-term disability and optimizing the quality of life in patients with vascular dementia and associated thalamic stroke. Further research is warranted to delineate optimal treatment approaches and rehabilitation strategies in this vulnerable population

Assessment of Executive Function Skills in Children with Isolated Growth Hormone Deficiency: A Cross-sectional Study

The aim of this study was to evaluate executive function (EF), such as inhibition and working memory, in children with isolated growth hormone deficiency (IGHD) using performance-based tests and parent-report scales. A total of seventy children between the ages of 7 and 12 years were included in the study. Half (n=35) had children with IGHD and half were healthy controls. To evaluate the EF performances of the participants, the Visual Aural Digit Span Test-B Form (VADS-B) and Stroop task were applied. EF was also evaluated using the Behavior Rating Inventory of Executive Function (BRIEF). Children with IGHD scored lower on the VADS-B form for short-term memory (p<0.05) compared to healthy controls. In addition, the completion time for the Stroop-color/word test was significantly longer in children with IGHD (p<0.05). For children with IGHD, their parents reported higher scores on all sub-scales of the BRIEF scale, with statistically significant differences for all sub-scales with the exception of “organization of materials” (p<0.05). In this study, children with IGHD had poorer EF skills compared to unaffected peers. EF skills may influence academic success by affecting children’s language skills, mathematical comprehension, cognitive flexibility, and hypothetical thinking. We believe that psychiatric evaluation of children with IGHD before and during treatment may positively contribute to both their academic performance and social relationships.

Assessment and litigation of ocular injuries by less-lethal weapons.

The main cause of serious ophthalmological injuries, includingviolent eye amputations in the context of so-called less lethalweapons, is the use of blunt objects, such as batons or extendablesticks and the use of kinetic energy projectiles (rubber bullets,pellets, foam projectiles or others). Such injuries in the contextof population control have been considered to constitute cruel,inhuman or degrading treatment or even torture when they arecarried out, intentionally or unintentionally, by State officials(or with their acquiescence or protection) and involve any of thepurposes contemplated in the Convention against Torture. Dueto their special characteristics, they constitute rights violationsthat entail unique difficulties and complexity from both a legaland forensic point of view. This paper addresses some of thesedifficulties with practical legal and forensic recommendations.It is structured in two parts: First, legal, where we considerlegal difficulties and provide suggestions on elements for obtainingevidence are given. Second, medico-psychological andforensic where we review the elements to be considered in theinterview, the medical and ophthalmological evaluation, andthe psychometric, psychological and psychiatric evaluation.

Wernicke Encephalopathy Caused by Avoidance-Restrictive Food Intake Disorder in a Child: A Case-Based Review.

Wernicke encephalopathy (WE) is an acute and potentially fatal neuropsychiatric disorder resulting from thiamine deficiency: its etiology and clinical presentation can be heterogeneous and arduously recognized, especially in children and adolescents. An 8-year-old girl arrived to the emergency room with ataxic gait, nystagmus, and mental confusion after a 10-day history of repeated severe vomiting; her recent clinical history was characterized by restricted nutrition due to a choking phobia, which caused substantial weight loss. Brain magnetic resonance imaging revealed a bilaterally increased T2 signal in the medial areas of the thalami and cerebral periaqueductal region. Diagnosis of WE based on clinical and neuroradiological findings was established and confirmed after labwork showing low serum thiamine. Following psychiatric evaluation, the patient was also diagnosed with avoidance-restrictive food intake disorder (ARFID), which required starting cognitive behavioral therapy and introducing aripiprazole. The patient displayed improvement of the radiological findings after one month and complete resolution of her neurological symptoms and signs. Eating disorders like ARFID might forerun acute signs of WE; this possibility should be considered even in pediatric patients, especially when atypical neurological pictures or feeding issues come out.

Association of problems, coping styles, and preferred online activity with depression, anxiety, and other psychological disorders in Turkish adolescents diagnosed with chronic kidney disease

BackgroundTo assess depression, anxiety, and other psychological disorders in adolescents with chronic kidney disease (CKD) and determine the significant factors and the effect of digital media use on its scores among these patient groups.MethodsThe study was conducted as a cross-sectional study and included 84 adolescents with CKD and 68 healthy controls. The participants completed the Revised Child Anxiety and Depression Scale (RCADS). We recorded their age, gender, the most problematic issue in their lives, coping methods with problems, and online applications they prefer in their leisure time.ResultsElevated rates (scores > 70) of separation anxiety, panic disorder, obsession, depression, total anxiety, and total depression scales were statistically higher in the CKD group. Separation anxiety, panic disorder, obsession, total anxiety, and total depression scales were higher in girls, and panic disorder, obsession, depression, total anxiety, and total depression scores were higher in younger ages in multivariate analysis. In the CKD group, family issues/problems increased panic disorder, obsession, depression, total anxiety, and total depression scales. Crying in tears/yelling response in children while facing a problem was associated with increased separation anxiety and social phobia rates. Also, preferring video applications was associated with separation anxiety and messaging applications with depression, total anxiety, and total depression.ConclusionsAdolescents with CKD are at risk for depression, anxiety, obsession, and panic disorders. Also, crying in tears/yelling response may be at greater risk for anxiety among CKD adolescents. Early psychiatric evaluation and routine psychiatric follow-ups initiated early may improve the mental health of this vulnerable population.Graphical A higher resolution version of the Graphical abstract is available as Supplementary information

A qualitative survey on factors affecting depression and anxiety in patients with rheumatoid arthritis: a cross-sectional study in Syria

Depression and anxiety often coexist with rheumatoid arthritis (RA) and affect the course of the disease. These mental health conditions can be overlooked or underdiagnosed in people with RA. There is conflicting evidence in previous studies regarding this topic, indicating that further research is necessary to provide a thorough understanding of the relationship between anxiety, depression, and RA. This study aims to determine the factors correlated with depression and anxiety symptoms in RA patients by evaluating disease activity at the same time. This cross-sectional study was conducted at four outpatient rehabilitation centers in four Syrian provinces: Damascus, Homs, Hama, and Latakia. The study included RA patients who attended the RA department of rehabilitation centers from January 1 to June 31, 2023. RA patients who presented at a rheumatology clinic were selected consecutively. RA patients were included in the study in accordance with the ACR/EULAR classification criteria, disease activity was assessed by disease activity score based on the 28-joint count (DAS28), and patients with DAS28 > 2.6 were considered to have active RA. The demographic data, as well as disease duration, educational status, Disease Activity Score with 28-joint counts (DAS28), health assessment questionnaire (HAQ) score, and the hospital anxiety and depression scale (HADS), were the parameters used in the analysis. Two hundred and twelve patients (female, 75%) with a mean age of 49.3 ± 13.1 years and a mean disease duration of 8.3 ± 6.9 years were studied. Depression was diagnosed in 79 (37.3%) patients and anxiety in 36 (16.9%) patients. Patients with depression and/or anxiety had higher HAQ and DAS28 scores compared to other RA patients. Blue-collar workers exhibited a higher prevalence of anxiety, whereas females, housewives, and individuals with lower educational attainment demonstrated a higher prevalence of depression. The current study found high rates of anxiety and depression in RA patients, highlighting the significant burden of these mental health conditions compared to the general population. It is essential for healthcare providers not to overlook the importance of psychiatric evaluations, mental health assessments, and physical examinations of RA patients.

Need for education of psychiatric evaluation of offenders with mental disorders: A questionnaire survey for Japanese designated psychiatrists.

The management of offenders with mental disorders has been a significant concern in forensic psychiatry. In Japan, the introduction of the Medical Treatment and Supervision Act in 2005 addressed the issue. However, numerous psychiatric patients at risk of violence still find themselves subject to the administrative involuntary hospitalization (AIH) scheme, which lacks clarity and updated standards. To explore current as well as optimized learning strategies for risk assessment in AIH decision making. We conducted a questionnaire survey among designated psychiatrists to explore their experiences and expectations regarding training methods for psychiatric assessments of offenders with mental disorders. The findings of this study's survey suggest a prevalent reliance on traditional learning approaches such as oral education and on-the-job training. This underscores the pressing need for structured training protocols in AIH consultations. Moreover, feedback derived from inpatient treatment experiences is identified as a crucial element for enhancing risk assessment skills.

Prisoners' Perceptions and Satisfaction with Telepsychiatry Services in Greece and the Effects of Its Use on the Coercion of Mental Healthcare.

Prisoners are often associated with mental health and substance use disorders. Coercive measures are widely used in prison settings. The objective of this study was to compare inmates' perceptions and satisfaction with telepsychiatry versus face-to-face consultation and the effects of telepsychiatry on the use of coercive measures. The sample consisted of 100 male inmates from various backgrounds who had experienced both approaches of services (face to face and telepsychiatry). The data were obtained through an interview where the individuals completed a Demographic Data Questionnaire, a Participant Satisfaction Questionnaire to assess satisfaction with face-to-face psychiatric services, and a Participant Satisfaction Questionnaire to assess their satisfaction with services offered via telepsychiatry. Additionally, calculations of time spent waiting for a face-to-face psychiatric evaluation and time spent in handcuffs and in confined spaces were made before and after the introduction of telepsychiatry. Statistically significant improvements (all p-values < 0.001) were noted in waiting times, support for relapse prevention, follow up, quality of mental health care, quality of care in the management of psychiatric problems and related medication, behavior of psychiatrists, duration of the assessment, sense of comfort, and confidentiality. Telepsychiatry led to the elimination of time spent in handcuffs and in confined spaces (transport vehicles). According to the results of this study, telepsychiatry is an acceptable method of service delivery in correctional facilities and was associated with a reduction of coercive practices.

Sleep, executive functions, and functional impairment in children with specific learning disorder: An investigation of the mediating pathways.

Sleep problems and executive dysfunction are associated with functional impairment in children with neurodevelopmental disorders. In this study, we aimed to investigate these aspects in children with Specific Learning Disorders (SLD) and SLD with comorbid Attention-Deficit Hyperactivity Disorder (ADHD), while also evaluating differences with typically developing (TD) children. Our study hypothesizes that children with SLD, especially those with comorbid ADHD, face greater sleep disturbances and executive function challenges compared to TD peers. We also propose that sleep disturbances aggravate functional impairment and that executive functions mediate this relationship. The data obtained from psychiatric evaluations, semi-structured interviews and questionnaires filled out by parents were analyzed. SLD + ADHD group had worse scores in all scales, followed by SLD and TD groups. Mediator analysis demonstrated that executive functions had a mediator role in the relationship between sleep problems and functional impairment. Our findings suggest that children with SLD experience more significant difficulties in daily living than their typically developing peers and having ADHD comorbidity, poor executive functions, and additional sleep problems can further exacerbate impairment. Notably, our mediation analysis suggests that executive functions mediate the relationship between sleep disturbances and the severity of functional impairments.

Migrating foreign bodies of penis: a case report and literature review

BackgroundOnly a few cases have been reported about active foreign body implantation in the cavernous body of the penis.Case presentationA 47-year-old man inserted two needles from the glans penis into the bilateral penile sponge body. Subsequently, two needles migrated through the penile cavernous body into the pelvic cavity. Attempts to remove the needles through the penis were unsuccessful. Eventually, after a duration exceeding one month, the displaced needles were removed in stages from the buttocks.ConclusionA few cases of intracavernosal-injection-therapy-associated needle breakage and retention have been reported globally. And this is the first case in China documenting the migration of foreign bodies within the penile region. In this condition, it is of utmost importance to engage the expertise of experienced andrologists to minimize the risk of excessive manipulation, thereby ensuring that inadvertent deep penetration of the needle into the penile tissue is prevented. In case the foreign body has migrated deeper into the tissues and the patient does not exhibit any specific symptoms or risks of macrovascular injury-related bleeding, close surveillance of its movement can be implemented. Surgical intervention can be initiated once the foreign body has reached a suitable position. Moreover, a psychiatric evaluation should be recommended for patient to discover any underlying mental health disorders.

Psychiatric exemptions at call-up and during military service: A comparative study

ABSTRACT Background: Military conscription is a legal obligation in many countries. Different psychiatric disorders may result in exemptions from compulsory military service. The study aimed to compare psychiatric diagnoses, and demographic and clinical characteristics of individuals exempted from conscription between the call-up and military service groups. Methods: The study analyzed exemption reports based on psychiatric evaluations conducted between 2016 and 2020 at a regional military hospital in Türkiye. Exemptions from conscription at the call-up stage and during military service were compared regarding sociodemographic characteristics, clinical information, and psychiatric diagnoses. Results: The study included 1225 exemption reports. The most common psychiatric diagnoses were intellectual disability and adjustment disorder. The exemption at the call-up group showed higher rates of psychiatric disability reports, intellectual disability, antisocial personality disorder, and depressive disorders. In contrast, the exemption during military service group had a higher history of substance use and prevalence of adjustment disorder. At the call-up, intellectual disability, antisocial personality disorder, and psychiatric medication predicted exemption. Adjustment disorder was the predictive factor for exemption during military service Conclusion: The study delineated crucial clinical and psychiatric distinctions among those exempted from conscription during call-up versus military service. Awareness of exemptions during military service can significantly contribute to improving the roll call examination during the call-up. The findings emphasize the need for targeted assessments and strategies for managing psychiatric disorders in the military context.

An Unusual Case Report of Cotard’s Syndrome with Depressive Delusions

Cotard’s Syndrome, also known as nihilistic delusion or Cotard’s delusion, is an exceptionally rare psychiatric condition characterized by delusional beliefs ranging from a sense of being dead to the conviction of bodily decay or nonexistence. This case report of a male patient, aged 21 years, with Cotard’s Syndrome highlights the difficulties in diagnosis, the course of therapy, and the clinical ramifications of this illness. The patient exhibited symptoms of severe depression along with nihilistic delusions, expressing the belief that he was deceased and experiencing bodily decay. Nihilistic delusions and depressed symptoms compatible with Cotard’s syndrome in the setting of major depressive disorder were found during the patient’s mental state evaluation, despite the absence of a serious physical disease or drug addiction. Treatment consisted of antidepressant and antipsychotic medication, along with individual psychotherapy sessions focusing on cognitive restructuring. Over time, the patient demonstrated gradual improvement in delusional beliefs and depressive symptoms, highlighting the importance of comprehensive psychiatric evaluation and individualized treatment planning.

Emergency Physicians' Knowledge, Attitudes, and Practices Related to Psychiatric Emergencies in Makkah's General Hospitals in Saudi Arabia: A Cross-Sectional Study.

This study aims to assess the knowledge, attitudes, and practices of emergency physicians (EPs) related to psychiatric emergencies (PEs) in Makkah's general hospitals. This study was an observational cross-sectional study using an online survey distributed to 138 EPs in the emergency departments (EDs) of six public hospitals in Makkah City, Saudi Arabia, between March 15 and May 1, 2023. A convenience sample was used for data collection.The questionnaire was developed after related surveys in the literature were reviewed. 59.9% of the physicians were aged 20-30 years. Most (68.8%) worked in hospitals that had psychiatric facilities. Regarding knowledge, only 30% of the emergency doctors were considered knowledgeable: the majority could identify PEs (79.7%), perform mental status examinations (71.0%), distinguish physical and mental symptoms (66.7%), and communicate with psychiatric patients (58.0%). However, only 52.9% could initiate management plans by prescribing psychiatric medication to patients. In relation to attitude, most physicians disagreed with the idea that healthcare practitioners do not need to advocate for psychiatric patients (67.4%), but many (62.3%) assumed that they do not have the responsibility to manage psychiatric patients, and they felt that conducting psychiatric evaluations in public hospitals is challenging because of the busy environment there. As regards practice, mentally ill patients (60.9%) were managed or referred by practices, and 56.5% of the EPs advised these patients upon discharge. The study showed that EPs have positive attitudes toward psychiatric patients, but their knowledge varied based on age, occupation levels, and years of experience. There were significant knowledge gaps, particularly regarding effective communication with psychiatric patients. Additionally, many EPs manage psychiatric patients without being aware of the psychiatric resources in their hospital. Improving medical school curricula and postgraduate training can enhance care. However, more research in this field is needed.