Preface

Most psychiatric emergencies are treated by nonpsychiatrists in a service located in or adjacent to the emergency department of a general hospital yet psychiatric literature specifically tailored for the non specialist scare. Handbook of Psychiatric Emergencies was written for the non psychiatrist to supplement direct clinical supervision. The book is not meant to be a comprehensive reference on psychiatry or psychiatric emergencies, but rather a concise practical guide to what non psychiatrists or first year psychiatric residents need to know to manage a psychiatric emergency fro a few hours without the assistance of an experienced psychiatrist.

Treatment of any psychiatric emergency involves three primary tasks. The first is to rule out medical illness as a cause of the emergency. When appropriate, we present the medical evaluation and highlight the possible underlying medical causes. Failure to appreciated the role of physical illness in precipitating a psychiatric emergency can have devastating consequences. The second task is to reduce the risk that the patient will harm himself or others; the third, to determine the best treatment setting for the patient; inpatient, outpatient, day hospital or crisis intervention. Establishing a final diagnosis and initiating a delimitative treatment are usually not emergency intervention goals. Instead, the emergency services clinician treats syndromes, such as psychosis violent behavior, or suicidal ideation.

Consequently, each chapter addresses a series of questions from the perspective of an emergency services clinician. What are the patient symptoms? What might be the cause? What is the best intervention?’ Chapter 1 explains how to prepare for the patient interview (planning an appropriate setting anticipating the patients needs, reviewing the elements to document on the clinical record) and how to conduct a thorough mental status examination (assessing the patients behavior thought, emotions, perceptual disturbances orientation and intellect).

Chapter 2 focuses on important medico legal issues that might arise from contract with the patient confidentatiality, documentation competence informed consent, civil commitment, the clinician’s duty to warn and protect a violent patients potential victims, liability and patterns rights.

Chapter 3 to 14 cover the most prevalent psychiatric conditions encountered by clinicians in the emergency setting delirium alcohol and drug emergencies schizophrenia and mania violent and self destructive behavior depression, anxiety domestic abuse, rape child and adolescent emergencies and geriatric emergencies.

Chapter 15 reviews various situations that can prove especially frustrating fro the clinician, including patients who feign illness to obtain drug, attention, or temporary shelter, callers who abuse telephone hotlines, language barriers presented by non-English speaking patients, and disposition difficulties when trying to place patients in hospitals or other agencies.

Chapter 16 highlights appropriate treatment interventions for patients who are experiencing unwanted side effects from antipsychotic antidepressants lithium carbonate anuanziety drug an….ants antihistamine, beta blockers or disaffirm. Where appropriate, information is organized under recurring heading to help the user identify the problem, intervenes safely and effectively and complete the disposition of the patient. Identifying the problem presents information to distinguish the patients condition from others that may mind it thus the section review mental status finding physical fining laboratory studies and differential diagnoses. Interpersonal intervention examines what to say and do during the interview to make the patient feel more comfortable, promote more effective communication and minimize or possibly resolve the rests. Pharmacologic intervention focuses on drug treatment that may prove effective in redoing symptoms when terpersonal interventions fail o resolve the emergency. Educational intervention outlines relevant issues to discuss with the patient and family, such as teaching them to recognize early signs and symptoms of a problem explaining preventive measures they can take to thwart or minimize a recurrence and informing them of appropriate community resource that can provide additional help. Disposition examines options in handling the patients case discharge hospitalization, consultation or referral depending on his physical, psychiatric and socioeconomic needs. Finally, Medico legal considerations summarizes the legal principals that are relevant to the problem being discussed.

References at the end of each chapter provide an excellent source for further investigation of topics and four appendices – signs and symptoms of major psychiatric syndromes a decision tree for psychosis a mini mental state examination and a glossary of street drug names – serve as handy helpful resources for quick reference.

Managing psychiatric emergencies can be stressful, complicated and frustrating responsibility, especially fro the no psychiatrist. The keys to successfully treating patients with various psychiatric problems are sufficient confidence to develop diagnostic, interpersonal and patient teaching skills. Toward that end we hope this handbook prove to be an invaluable source of information and encouragement.

William R Dubin MD
Kenneth J Weiss MD