Clinical Manual of Emergency Psychiatry

Contents......Page 6
Contributors......Page 20
Preface......Page 26
Acknowledgments......Page 28
1 Approach to Psychiatric Emergencies......Page 30
A General Approach to the Emergency Psychiatric Patient......Page 31
The Emergency Psychiatric Interview......Page 41
Medical Clearance......Page 45
Substance Abuse and Withdrawal Syndromes......Page 46
Documentation......Page 50
Special Situations......Page 52
Key Clinical Points......Page 58
References......Page 59
Suggested Readings......Page 61
2 The Suicidal Patient......Page 62
Demographics......Page 63
Risk Factors......Page 65
Assessment......Page 69
Psychiatric Management of Suicidal Behaviors......Page 75
Documentation and Risk Assessment......Page 81
Conclusion......Page 84
Key Clinical Points......Page 85
References......Page 86
Suggested Readings......Page 88
3 Violence Risk Assessment......Page 90
Violence and Mental Illness......Page 91
Clinical Assessment of Risk for Violence......Page 93
Legal Precedents for Violence Risk Assessment......Page 98
Conclusion......Page 101
Key Clinical Points......Page 102
References......Page 103
Suggested Readings......Page 105
4 The Catatonic Patient......Page 106
Presentation......Page 107
Differential Diagnosis......Page 109
Management......Page 113
Key Clinical Points......Page 119
References......Page 120
Suggested Readings......Page 121
General Approach to Mood States......Page 122
Depressed Mood States......Page 123
Elevated Mood States......Page 131
Angry and Irritable Mood States......Page 135
Key Clinical Points......Page 140
References......Page 141
Suggested Readings......Page 142
Definitions......Page 144
Initial Survey of the Patient......Page 145
Evaluation of the Psychotic Patient......Page 151
Differential Diagnosis......Page 154
Risk Assessment: Important Risk Factors in the Psychotic Patient......Page 161
Making a Decision About Appropriate Treatment......Page 164
Key Clinical Points......Page 167
References......Page 168
Suggested Readings......Page 169
7 The Anxious Patient......Page 170
Panic Attacks......Page 173
Panic Disorder......Page 178
Acute Trauma......Page 185
Other Anxiety and Anxiety-Related Conditions......Page 189
Key Clinical Points......Page 190
References......Page 191
Suggested Readings......Page 192
8 The Cognitively Impaired Patient......Page 194
Evaluation of the Patient......Page 196
Psychiatric Disorders Characterized by Cognitive Impairment......Page 199
Clinical Management......Page 209
References......Page 213
Suggested Readings......Page 215
9 Substance-Related Psychiatric Emergencies......Page 216
Epidemiology, Prevalence, and Impact of Substance-Related Emergencies......Page 217
Initial Evaluation of Patients......Page 218
Syndromes of Substance-Related Emergencies......Page 219
Disposition Issues......Page 231
Key Clinical Points......Page 232
References......Page 233
Suggested Readings......Page 235
10 Child and Adolescent Emergency Psychiatry......Page 236
Basics......Page 237
Initial Assessment......Page 239
Psychiatric Evaluation......Page 243
Common Presentations......Page 244
Key Clinical Points......Page 259
References......Page 260
Suggested Readings......Page 261
11 Seclusion and Restraint in Emergency Settings......Page 262
Definitions......Page 263
Patient Assessment......Page 265
Choosing Seclusion or Chemical or Physical Restraint......Page 266
Contraindications to Seclusion and Restraint......Page 267
Procedure......Page 269
Forced Chemical Restraints: Indications and Controversy......Page 270
Observation (Including the 1-Hour Rule)......Page 278
Release From Restraint and Debriefing......Page 279
Death and Other Adverse Effects......Page 280
Documentation and Legal Considerations......Page 282
Key Clinical Points......Page 283
References......Page 284
Suggested Readings and Web Sites......Page 287
12 Legal and Ethical Issues in Emergency Psychiatry......Page 290
Confidentiality......Page 291
Hospitalization......Page 294
Capacity to Make Medical Decisions......Page 298
Informed Consent......Page 300
Transfer of Care......Page 302
Liability Management......Page 304
Managed Care......Page 306
Key Clinical Points......Page 308
References......Page 309
Suggested Readings......Page 310
13 Disposition and Resource Options......Page 312
Discharge to Inpatient Treatment......Page 313
Discharge to Outpatient Treatment......Page 317
Disposition of Challenging Populations......Page 324
Key Clinical Points......Page 329
References......Page 330
Suggested Readings......Page 332
14 Getting Patients From the Clinic to the Emergency Department......Page 334
Preincident Preparation......Page 335
Acute In-Office Evaluation......Page 337
Immediate Management......Page 338
Disposition......Page 340
Key Clinical Points......Page 341
Suggested Readings......Page 342
15 Supervision of Trainees in the Psychiatric Emergency Service......Page 344
Diagnose and Treat the Patient......Page 347
Diagnose and Treat the Learner......Page 350
Diagnose and Treat the Supervision......Page 364
Conclusion......Page 370
References......Page 372
Suggested Readings......Page 376
16 Working With Medical Students in Psychiatric Emergency Settings......Page 378
Medical Student Orientation......Page 379
Approaches to Integrating Medical Students Into Psychiatric Emergency Care......Page 380
Intended Learning Goals and Objectives for Medical Students......Page 385
Conclusion......Page 387
Key Clinical Points......Page 388
References......Page 389
Suggested Readings......Page 390
17 Afterword......Page 392
A......Page 396
B......Page 401
C......Page 402
D......Page 407
E......Page 410
F......Page 412
H......Page 413
I......Page 415
L......Page 416
M......Page 417
O......Page 420
P......Page 421
R......Page 425
S......Page 426
T......Page 432
V......Page 433
W......Page 434
Z......Page 435