Transcript Emergency Psychiatry

INTRODUCTION TO
EMERGENCY PSYCHIATRY
Brian E. Wood, D.O.
Associate Professor and Chair
Department of Neuropsychiatry and Behavioral Sciences
Edward Via Virginia College of Osteopathic Medicine
Assistant. Professor of Clinical Psychiatric Medicine.
University of Virginia School of Medicine
Definition
A psychiatric emergency is a
disturbance in thoughts, feelings, or
actions that requires immediate
treatment.
(Kaplan and Sadock, 1996)
Properties
• Can happen at any time either outside or
during a treatment episode.
• Can happen anywhere
– Not confined to the Emergency Room
– May happen on other services or involve other
disciplines.
The Patient in the Emergency
Setting
Central Principles
• Assessment of Acuity
• Assessment of Risk
– Risk to self
– Risk to others
• Disposition to address risk factors
• Documentation.
Acuity
• Acuity is often “in the eye of the beholder”
• Acute conditions or symptoms may exist
within the context of chronic illnesses.
• Often acuity needs to be assessed within the
context of available support mechanisms.
– May also be resolved with appropriate support
mechanisms.
Risk
• Should be viewed as existing along a
continuum.
– There is no black or white
• Risk varies with time.
• Prediction of likely behavior may be made
utilizing risk assessment
Disposition
• Application of problem solving strategies.
• Should address identified areas of acuity
and risk.
• Should encompass the “least restrictive
care”doctrine.
– Care should be provided in the least restrictive
setting possible while still providing protection
for the patient.
Documentation
• Purpose
– To summarize the assessment and care of the
emergency patient
– To provide a roadmap which can be continued by
follow up care providers.
• Should follow a logical progression of thought
(problem solving strategy) and logical conclusions
based on assessment.
• Should not include conclusions that can not be
substantiated. (ie. Diagnoses, etc.)
The Care provider in the
Emergency Setting
Risks
• Violence in the emergency setting
– Generally more risk than in non-emergent
settings.
• Secondary gain issues
• Legal exposure
Protection in the emergency
setting
• Knowledge of historical risk factors etc. prior to
seeing the patient.
– Careful review of the record is time well spent.
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Be alert to risks of impending violence.
Careful attention to therapeutic alliance issues.
Attention to safety of physical surroundings.
Include others if needed ( ex. Police, etc.)
– Confidentiality ends where there is risk of injury
Protection in the emergency
Setting
• Be aware of secondary gain issues
– May help in prediction of behavior including
violence.
• Document, document, document
– Does not refer to volume of documentation but
rather quality of documentation.
Summary
• Psychiatric emergencies can occur anywhere at any
time.
• Important issues include protection of the patient as
well as of the practitioner and staff.
• Central principles guiding assessment and treatment in
the emergency setting include assessment of risk and
acuity, plan and disposition, and appropriate
documentation.
• Central principles guiding protection of practitioners in
the emergency setting include appropriate knowledge,
remaining alert, including others, and documentation.