Behavioral emergencies for the emergency physician / editor-in-chief, Leslie S. Zun ; assistant editors, Lara G. Chepenik, Mary Nan S. Mallory.

Format:

Book

Contributor:

Zun, Leslie S., editor.

Chepenik, Lara Gayle, editor.

Mallory, Mary Nan S., editor.

Series:

Cambridge medicine (Series)

Cambridge medicine

Language:

English

Subjects (All):

Psychiatric emergencies.

Crisis intervention (Mental health services).

Physical Description:

1 online resource (xiii, 400 pages) : digital, PDF file(s).

Edition:

1st ed.

Place of Publication:

Cambridge : Cambridge University Press, 2013.

Language Note:

English

Summary:

Emergency physicians, in all practice settings, care for patients with both undifferentiated psycho-behavioral presentations and established psychiatric illness. This reference-based text goes beyond diagnostics, providing practical input from physicians experienced with adult emergency psychiatric patients. Physicians will increase their understanding and gain confidence working with these patients, even when specialized psychiatric back-up is lacking. Behavioral Emergencies for the Emergency Physician is comprehensive, covering the pre-hospital setting and advising on evidence-based practice; from collaborating with psychiatric colleagues to establishing a psychiatric service in your ED. Sedation, restraint and seclusion are outlined. Potential dilemmas when treating pregnant, geriatric or homeless patients with mental illness are discussed in detail, along with the more challenging behavioral diagnoses such as malingering, factitious and personality disorders. This go-to, comprehensive volume is invaluable for trainee and experienced emergency physicians, as well as psychiatrists, psychologists, psychiatric and emergency department nurses and other mental health workers.

Contents:

Cover

Contents

Contributors

Preface

Section 1 General considerations for psychiatric care in the emergency department

Chapter 1 The magnitude of the problem of psychiatric illness presenting in the emergency department

Introduction

Global burden

Prevalence

Extent of mental illness across the life cycle

Social and physical health impacts

Economic burden: United States

Changes in mental healthcare infrastructure

Overall emergency department visits

Increased mental health visits to emergency departments

The epidemiology of mental health visits to emergency departments

Specific mental disorders

Anxiety disorders

Panic disorder

Post-traumatic stress disorder (PTSD)

Generalized anxiety disorder

Phobic disorders

Mood disorders

Major depression

Bipolar disorder

Dysthymic disorder

Suicidal behavior

Substance use disorders

Alcohol abuse or dependence

Drug abuse or dependence

Schizophrenia and other psychotic disorders

Eating disorders

Impulse control disorders

Personality (Axis II) disorders

Miscellaneous/occult mental health disorders

Conclusion

References

Chapter 2 Delivery models of emergency psychiatric care

Development of psychiatry in emergency settings

Goals of psychiatric care in varied emergency settings

Exclude medical etiologies for symptoms

Rapid stabilization of the acute crisis

Avoid coercion, treat in the least restrictive setting, form a therapeutic alliance

Appropriate disposition and aftercare plan

Models of emergency psychiatry delivery

Psychiatric consultant in a medical emergency department

Pros and cons

Types of mental health consultants in the ED

Dedicated mental health wing of medical emergency department

Pros and cons.

The psychiatric emergency services (PES) model

Structure and design of PES programs

Extended observation

Treatment models in the PES

EMTALA

Alternative crisis treatment modalities

Psychiatric urgent care/voluntary crisis centers

Mobile crisis teams

Acute diversion units

Section 2 Evaluation of the psychiatric patient

Chapter 3 The medical clearance process for psychiatric patients presenting acutely to the emergency department

Areas of consensus

Medical mimics

The role of the history and physical exam in recognizing medical mimics

The role of laboratory testing in recognizing medical mimics

The role of urine drug screens in recognizing medical mimics

Tips to improve the accuracy of medical screening exams

The utility of guidelines and protocols

Conclusions

Chapter 4 Advanced interviewing techniques for psychiatric patients in the emergency department

Case 1: Engagement and psychological guarding of occult medical acuity

Discussion

Case 2: Occult danger to others and the underlying crisis state of mind

Case 3: Interview skills mitigate imperfect working conditions

Chapter 5 Use of routine alcohol and drug testing for psychiatric patients in the emergency department

Reasons for drug testing

Reasons against drug testing

Chapter 6 Drug intoxication in the emergency department

Psychiatric comorbidity

Medical comorbidity

Service utilization

Brief interventions

Drugs of abuse and intoxication

Alcohol

Prevalence and community impact

Management

Opiates

Sedative hypnotics

Benzodiazepines

Barbiturates

Gamma-hydroxybutyrate (GHB)

Stimulants.

Cocaine

Methamphetamine

Ecstasy (3,4-methylenedioxymethamphetamine - MDMA)

"Bath salts"

Methylphenidate

Hallucinogens and dissociative agents

Phencyclidine (PCP)

Ketamine

Lysergic acid (LSD)

Dextromethorphan

Inhalants

Cannabinoids

Chapter 7 Drug withdrawal syndromes in psychiatric patients in the emergency department

Ethanol withdrawal

Treatment

Disposition of patients with ethanol withdrawal

Sedative hypnotic drugs withdrawal

Overview

Gamma-hydroxybutyrate (GHB) withdrawal

Opioid withdrawal

Section 3 Psychiatric illnesses

Chapter 8 The patient with depression in the emergency department

Clinical features

Major depressive disorder

Mood

Psychomotor activity

Vegetative function

Cognition

Special considerations

Depression in the elderly

Children and adolescents

Postpartum depression

Bipolar disorders

Bipolar depression

Manic episode

Mood disorders caused by a general medical condition

Mood disorders caused by medications or other substances

Diagnostic strategies

Emergency department stabilization

Suicide risk management

Chapter 9 Assessment of the suicidal patient in the emergency department

Epidemiology

Risk factors for suicide

Gender

Age

Psychiatric illness

Previous suicide attempt

Access to firearms

Marital status

Chronic medical illnesses

Sexual orientation

Family history and genetics

History of childhood abuse

Other risk factors

Protective factors

The SADPERSONS scale

The patient evaluation

Suicidal ideation

Suicide attempts

Determination of risk

Key indicators of a high-risk suicidal patient

Management of the suicidal patient.

Safety planning

Documentation

Summary

Chapter 10 The patient with somatoform disorders in the emergency department

Clinical characteristics

Somatization disorder

Undifferentiated SD

Conversion disorder

Pain disorder

Hypochondriasis

Body dysmorphic disorder

Somatoform disorder not otherwise specified

Assessment

Emergency department evaluation

Consultation

Diagnosis

Cognitive-based therapy

Pharmacotherapy

Chapter 11 The patient with anxiety disorders in the emergency department

Definition and diagnosis of various anxiety disorders

Cause of anxiety disorders

Differential diagnosis

Evaluation of anxiety disorders

Treatment of anxiety disorders

Appendix 11.1 DSM-IV-TR

Appendix 11.2 ICD-10 criteria

Appendix 11.3

Differential diagnosis of anxiety disorders

Appendix 11.5 Management plans (adopted from Fast Facts: Anxiety, Panic, and Phobias)

Appendix 11.6 Evaluation and management of patients presenting to the ED with anxiety symptoms

Chapter 12 The patient with post-traumatic stress disorder in the emergency department

History

Diagnostic criteria

Diseases associated with psychiatric trauma

Presentations and recognition

Subthreshold presentations and delayed onset PTSD

Chapter 13 The patient with psychosis in the emergency department

Features of psychosis

Conditions presenting as psychosis

Organic causes of psychosis

Functional causes of psychosis

Children with psychosis

Organic psychosis in children

Functional psychosis in children

Geriatric patients with psychosis

Pregnant/postpartum psychosis.

Psychosis during pregnancy

Postpartum psychosis

Management of psychosis in the emergency department

Disposition

Chapter 14 Personality disorders in the acute setting

Prevalence of personality disorders

Etiology of personality disorders

Diagnosis of personality disorders

Comorbid addictive illness

Comorbid mental illness

Comorbid medical illness

Interpersonal issues in the personality disordered patient

A psychodynamic perspective

The approach to a successful interview

Alliance building with the personality disordered patient

Management of borderline personality disorder

Life events' importance in risk assessment

Risk assessment

Mobilization of social supports

Medication

Referral and aftercare

Documentation and risk management

Summary and discussion

Chapter 15 The patient with factitious disorders or malingering in the emergency department

Case examples

Malingering

Factitious disorder

Definitions

Chapter 16 The patient with delirium and dementia in the emergency department

Approach to the cognitively impaired patient

Delirium

Background

Diagnostic evaluation

Dementia

Chapter 17 The patient with excited delirium in the emergency department

Diagnosis and etiology

Initial approach and workup

Treatment options for ExDS

First-generation antipsychotics

Second-generation antipsychotics

Initial combination therapy.

Other treatment modalities.

Notes:

Title from publisher's bibliographic system (viewed on 05 Oct 2015).

Includes bibliographical references at the end of each chapters and index.

ISBN:

1-316-08970-3

1-107-06502-X

1-107-05552-0

1-107-05663-2

1-107-05899-6

1-107-05771-X

1-139-08807-6

OCLC:

855019753