BOOK
Psychiatric and Behavioral Emergencies, An Issue of Emergency Medicine Clinics of North America, E-Book
(2016)
Additional Information
Book Details
Abstract
Guest editors Dr. David Kuo and Dr. Veronic Tucci have assembled an expert team of authors on the topic of Psychiatric and Behavioral Emergencies. Articles include: The Emergency Physician's role in the Medical Clearance of the Psychiatric Patient, Stabilization and Management of the Acutely Agitated or Psychotic Patient, Stabilizing and Managing Patients with Altered Mental Status and Delirium, Depression and Suicidal Patients, The New Drugs of Abuse and Withdrawal Syndromes, Strategies for Managing Patients with Personality and Somatoform Disorders, Special Considerations in the Trauma Patient, and more!
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Psychiatric and Behavioral Emergencies \r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITORS | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Foreword: Behavioral and Psychiatric Emergencies\r | vii | ||
| Preface: The Hidden Costs of Behavioral and Psychiatric Emergencies\r | vii | ||
| Down the Rabbit Hole: Emergency Department Medical Clearance of Patients with Psychiatric or Behavioral Emergencies\r | vii | ||
| Stabilization and Management of the Acutely Agitated or Psychotic Patient\r | vii | ||
| Stabilizing and Managing Patients with Altered Mental Status and Delirium\r | vii | ||
| Depression and the Suicidal Patient\r | viii | ||
| New Drugs of Abuse and Withdrawal Syndromes\r | viii | ||
| Shift, Interrupted: Strategies for Managing Difficult Patients Including Those with\rPersonality Disorders and Somatic Symptoms in the Emergency Department\r | viii | ||
| Special Considerations in Pediatric Psychiatric Populations\r | viii | ||
| Psychiatric Emergencies in the Elderly\r | ix | ||
| Psychiatric Emergencies in Pregnant Women\r | ix | ||
| Special Considerations in Trauma Patients\r | ix | ||
| Ethical Issues in Emergency Psychiatry\r | ix | ||
| Health Policy Considerations in Treating Mental and Behavioral Health Emergencies in the United States\r | x | ||
| EMERGENCY MEDICINE\rCLINICS OF NORTH AMERICA\r | xi | ||
| FORTHCOMING ISSUES | xi | ||
| February 2016 | xi | ||
| May 2016 | xi | ||
| August 2016 | xi | ||
| RECENT ISSUES | xi | ||
| August 2015 | xi | ||
| May 2015 | xi | ||
| February 2015 | xi | ||
| PROGRAM OBJECTIVE | xiii | ||
| LEARNING OBJECTIVES | xiii | ||
| ACCREDITATION | xiii | ||
| DISCLOSURE OF CONFLICTS OF INTEREST | xiii | ||
| UNAPPROVED/OFF-LABEL USE DISCLOSURE | xiii | ||
| TO ENROLL | xiii | ||
| METHOD OF PARTICIPATION | xiv | ||
| CME INQUIRIES/SPECIAL NEEDS | xiv | ||
| Foreword: Behavioral and \x0BPsychiatric Emergencies | xv | ||
| Preface : The Hidden Costs of Behavioral and Psychiatric Emergencies\r | xvii | ||
| REFERENCES | xviii | ||
| Down the Rabbit Hole | 721 | ||
| Key points | 721 | ||
| INTRODUCTION | 721 | ||
| Impact of Psychiatric Disease on the Emergency System | 722 | ||
| Pediatric Patients with Psychiatric Complaints | 723 | ||
| Medical Clearance Definition and Background | 724 | ||
| CLINICAL EVALUATION | 725 | ||
| Approach to the Patient with Psychiatric Complaints | 725 | ||
| History | 727 | ||
| MEDICAL PROBLEMS PRESENTING AS PSYCHIATRIC COMPLAINTS | 727 | ||
| Review of Systems | 729 | ||
| Physical Examination | 729 | ||
| Deficiencies in the Initial Assessment | 730 | ||
| LABORATORY AND ANCILLARY TESTING | 732 | ||
| Importance and Usefulness | 732 | ||
| Ancillary Testing in Pediatric Patients | 733 | ||
| Cost | 734 | ||
| SUMMARY | 734 | ||
| REFERENCES | 734 | ||
| Stabilization and Management of the Acutely Agitated or Psychotic Patient | 739 | ||
| Key points | 739 | ||
| INTRODUCTION | 739 | ||
| PATHOPHYSIOLOGY | 740 | ||
| ASSESSMENT | 741 | ||
| MANAGEMENT GOALS | 743 | ||
| NONPHARMACOLOGIC STRATEGIES | 743 | ||
| Environmental Intervention | 743 | ||
| Seclusion and Mechanical Restraints | 743 | ||
| De-Escalation Techniques | 744 | ||
| PHARMACOLOGIC STRATEGIES | 744 | ||
| Benzodiazepines | 745 | ||
| Antipsychotics | 746 | ||
| Novel Agents | 746 | ||
| SUMMARY | 747 | ||
| REFERENCES | 748 | ||
| Stabilizing and Managing Patients with Altered Mental Status and Delirium | 753 | ||
| Key points | 753 | ||
| INTRODUCTION | 753 | ||
| RECOGNIZING DELIRIUM | 754 | ||
| DIFFERENTIATING PSYCHIATRIC PRESENTATION FROM DELIRIUM | 755 | ||
| HISTORY | 755 | ||
| PHYSICAL EXAMINATION | 757 | ||
| WORK UP FOR ALTERED MENTAL STATUS | 758 | ||
| STABILIZATION AND MANAGEMENT | 758 | ||
| First Steps | 758 | ||
| Laboratory Testing | 758 | ||
| Is Head Computed Tomography Scan Indicated for All Cases of Altered Mental Status? | 760 | ||
| Lumbar Puncture | 760 | ||
| What About Urine Drug Screen? | 761 | ||
| Managing Agitation in the Emergency Department | 761 | ||
| SUMMARY | 762 | ||
| REFERENCES | 763 | ||
| Depression and the Suicidal Patient | 765 | ||
| Key points | 765 | ||
| BACKGROUND AND EPIDEMIOLOGY | 765 | ||
| DEFINITION OF DEPRESSION | 766 | ||
| DIFFERENTIAL DIAGNOSIS | 766 | ||
| ROLE OF EMERGENCY DEPARTMENT PHYSICIAN IN EVALUATING PATIENTS WITH DEPRESSION | 768 | ||
| THE EMERGENCY DEPARTMENT INTERVIEW OF DEPRESSED PATIENTS | 769 | ||
| THE ROLE OF COLLATERAL AND FAMILY SUPPORT | 769 | ||
| SCREENING TOOLS FOR DEPRESSION | 769 | ||
| ASSESSMENT OF SUICIDE | 771 | ||
| Suicidality | 771 | ||
| Methods of Suicide | 771 | ||
| Suicide Risk Factors and Assessment: High Versus Low/Moderate Risk | 771 | ||
| Suicide Protective Factors | 772 | ||
| Suicide Prevention Contract and Lack of Effectiveness | 773 | ||
| SAD PERSONS | 773 | ||
| DISPOSITION IN THE EMERGENCY DEPARTMENT | 773 | ||
| Access to Specialist or Psychiatric Hospitalization | 773 | ||
| When to Admit | 774 | ||
| When to Discharge | 774 | ||
| When to Initiate Antidepressants in the Emergency Department | 775 | ||
| Relationship Between Antidepressant Initiation and Suicide Risk | 775 | ||
| SUMMARY | 775 | ||
| REFERENCES | 776 | ||
| New Drugs of Abuse and Withdrawal Syndromes | 779 | ||
| Key points | 779 | ||
| NBOME | 779 | ||
| STIMULANTS | 781 | ||
| SYNTHETIC CANNABINOIDS | 782 | ||
| EVALUATION AND MANAGEMENT IN THE EMERGENCY DEPARTMENT SETTING | 786 | ||
| EVALUATION AND MANAGEMENT IN THE OUTPATIENT SETTING | 788 | ||
| REFERENCES | 791 | ||
| Shift, Interrupted: Strategies for Managing Difficult Patients Including Those with Personality Disorders and Somatic Sympt ... | 797 | ||
| Key points | 797 | ||
| INTRODUCTION | 797 | ||
| What Makes a Patient Difficult? | 798 | ||
| SOMATOFORM DISORDERS: DIAGNOSTIC DIFFICULTY AND POOR RESPONSE TO ROUTINE TREATMENTS | 799 | ||
| Definitions and Alternate Terminology | 799 | ||
| The Mind-Body Connection: Which Symptoms Present to the Emergency Room? | 802 | ||
| Common Somatic Symptom: Chest Pain | 802 | ||
| Common Somatic Symptom: Abdominal Pain | 804 | ||
| Challenging Somatic Symptom: Blindness | 804 | ||
| Management and Diagnostic Considerations | 804 | ||
| PATIENTS WITH DIFFICULT PERSONALITIES | 805 | ||
| DIFFICULTY CAUSED BY PROVIDER FEELINGS—BIAS AND COUNTERTRANSFERENCE | 806 | ||
| Countertransference | 806 | ||
| Management Goals | 807 | ||
| Pharmacologic Strategies | 807 | ||
| Nonpharmacologic Strategies | 808 | ||
| SUMMARY | 809 | ||
| REFERENCES | 809 | ||
| Special Considerations in Pediatric Psychiatric Populations | 811 | ||
| Key points | 811 | ||
| INTRODUCTION | 811 | ||
| TRIAGE OF THE PEDIATRIC EMERGENCY PATIENT | 812 | ||
| DEPRESSION AND SUICIDAL IDEATION | 813 | ||
| PATIENT EVALUATION OVERVIEW | 813 | ||
| PHARMACOLOGIC TREATMENT | 814 | ||
| DISPOSITION | 814 | ||
| THE AGGRESSIVE OR VIOLENT PEDIATRIC PATIENT | 815 | ||
| General Guidelines for Treatment of Agitation | 815 | ||
| TREATMENT | 815 | ||
| Definitions for Reference | 816 | ||
| Restraint Specifications for Children per Latest Guidelines | 817 | ||
| Pharmacologic Strategies | 819 | ||
| AUTISM SPECTRUM DISORDERS AND ATTENTION DEFICIT HYPERACTIVITY DISORDER INTRODUCTION | 819 | ||
| PATIENT EVALUATION OVERVIEW | 819 | ||
| Autism | 819 | ||
| Associated presentations | 819 | ||
| Behavioral interventions | 820 | ||
| Language | 820 | ||
| Attention Deficit Hyperactivity Disorder | 820 | ||
| Associated presentations | 820 | ||
| OPPOSITIONAL-DEFIANT DISORDER AND CONDUCT DISORDER | 821 | ||
| EFFECT OF SOCIAL MEDIA AND INTERNET ON PEDIATRIC PSYCHIATRIC PRESENTATIONS | 821 | ||
| SUMMARY | 822 | ||
| REFERENCES | 822 | ||
| Psychiatric Emergencies in the Elderly | 825 | ||
| Key points | 825 | ||
| INTRODUCTION | 825 | ||
| DELIRIUM | 826 | ||
| DEMENTIA | 827 | ||
| DEPRESSION | 828 | ||
| Feature 1: Acute-onset and fluctuating course | 828 | ||
| Feature 2: Inattention | 828 | ||
| Feature 3: Disorganized thinking | 828 | ||
| Feature 4: Altered level of consciousness | 828 | ||
| SUICIDE | 832 | ||
| ALCOHOL DEPENDENCE AND SUBSTANCE ABUSE | 832 | ||
| POLYPHARMACY | 833 | ||
| ELDER ABUSE AND NEGLECT | 834 | ||
| ALTERED MENTAL STATUS | 836 | ||
| SUMMARY | 836 | ||
| REFERENCES | 836 | ||
| Psychiatric Emergencies in Pregnant Women | 841 | ||
| Key points | 841 | ||
| INTRODUCTION | 841 | ||
| MEDICAL SCREENING OF PSYCHIATRIC ILLNESS IN PREGNANCY | 842 | ||
| Defining an Adequate Medical Examination | 842 | ||
| The Role of Routine Laboratory and Drug Screen Testing | 843 | ||
| AGITATION IN PREGNANCY | 843 | ||
| SPECIFIC DISORDERS DURING PREGNANCY | 846 | ||
| Mood Disorders During Pregnancy | 846 | ||
| Psychotic Disorders During Pregnancy | 847 | ||
| SUMMARY | 848 | ||
| REFERENCES | 848 | ||
| Special Considerations in Trauma Patients | 853 | ||
| Key points | 853 | ||
| INTRODUCTION | 853 | ||
| EVALUATION AND TREATMENT | 854 | ||
| Initial Stabilization | 854 | ||
| Secondary Evaluation | 854 | ||
| Specific Conditions | 856 | ||
| Delirium | 856 | ||
| Traumatic Brain Injury | 856 | ||
| CHRONIC TRAUMATIC ENCEPHALOPATHY | 857 | ||
| ACUTE STRESS DISORDER AND POSTTRAUMATIC STRESS DISORDER | 858 | ||
| SUMMARY | 859 | ||
| REFERENCES | 859 | ||
| Ethical Issues in Emergency Psychiatry | 863 | ||
| Key points | 863 | ||
| INTRODUCTION | 863 | ||
| CAPACITY AND CONSENT | 864 | ||
| Assessing Capacity | 864 | ||
| Managing Psychiatric Patients with Uncertain Capacity | 865 | ||
| PRIVACY AND CONFIDENTIALITY | 866 | ||
| What to Do When Patients Make Threats Against Specific Persons | 866 | ||
| Maintaining the Confidentiality of Psychiatric Patients | 867 | ||
| INVOLUNTARY TREATMENT | 868 | ||
| Involuntary Admission | 868 | ||
| What to Do When a Patient Refuses Standard Medical Clearance Testing | 869 | ||
| Ethical Issues in Forced Medication, Restraint, and Seclusion | 870 | ||
| SUMMARY | 871 | ||
| REFERENCES | 871 | ||
| Health Policy Considerations in Treating Mental and Behavioral Health Emergencies in the United States | 875 | ||
| Key points | 875 | ||
| HISTORY OF MENTAL HEALTH SERVICES IN THE UNITED STATES | 875 | ||
| EMERGENCY MENTAL HEALTH DELIVERY IN THE UNITED STATES TODAY | 876 | ||
| Emergency Department Boarding with Psychiatric Consultation | 876 | ||
| Designated Psychiatric Area Within the Emergency Department | 877 | ||
| Psychiatric Emergency Service | 878 | ||
| EMERGENCY PSYCHIATRIC CARE: A TATTERED SYSTEM | 878 | ||
| TREATING MENTAL AND BEHAVIORAL HEALTH EMERGENCIES: MENTAL HEALTH SYSTEM CONSIDERATIONS | 880 | ||
| Inadequate Mental Health Coverage | 880 | ||
| Diminished Investment in Psychiatric Care | 882 | ||
| Diminished Access to Psychiatric Care | 883 | ||
| TREATING MENTAL AND BEHAVIORAL HEALTH EMERGENCIES: EMERGENCY DEPARTMENT POLICY CONSIDERATIONS | 883 | ||
| Boarding of Psychiatric Patients in the Emergency Department | 884 | ||
| Lack of Specialized Staff for Psychiatric Patients in the Emergency Department | 885 | ||
| TREATING MENTAL HEALTH EMERGENCIES: POLICY CONSIDERATIONS BEYOND THE HOSPITAL | 885 | ||
| Drug Abuse and Dependence in Mental Illness | 885 | ||
| Mental Illness and Homelessness | 886 | ||
| Incarceration of the Mentally Ill | 887 | ||
| SUMMARY | 887 | ||
| REFERENCES | 888 | ||
| Index | 893 |