The significance of nonurgent psychiatric emergencies in an ED: a retrospective study.

BACKGROUND: In emergency departments, patients with mental health conditions are a major concern and make up the third or fourth of the most common diagnosis seen during all consultations. Over the past two decades, there has been a noticeable rise in the number of cases, particularly due to an increase in nonurgent visits for somatic medical issues. The significance of nonurgent visits for psychiatric patients is yet to be determined. This study aims to uncover the significance and identify the characteristics of this group. METHODS: A retrospective analysis of psychiatric emergency visits at an interdisciplinary emergency department of a German general hospital in 2015 was conducted. For this purpose, patient records were reviewed and evaluated. An analysis was conducted based on the German definition of psychiatric emergencies according to the German guidelines for emergency psychiatry. RESULTS: A total of 21,124 emergency patients visited the evaluated Emergency Department. Of this number, 1,735 psychiatric patient records were evaluated, representing 8.21% of the total population. Nearly 30% of these patients did not meet any emergency criteria according to German guidelines. Significant differences were observed between previously treated patients and those presenting for the first time. CONCLUSIONS: The high proportion of nonurgent psychiatric patients in the total volume of psychiatric emergency contacts indicates a possible control and information deficit within the emergency system. Just as prior research has emphasized the importance of investigating nonurgent somatic medical visits, it is equally imperative to delve into studies centered around psychiatric nonurgent presentations.

Factors predicting admission of psychiatric emergency contacts after presenting to the emergency department: results of a regression analysis.

BACKGROUND: Psychiatric emergency patients have great relevance in the interdisciplinary emergency department. Emergency physicians in this setting often have to make decisions under time pressure based on incomplete information regarding the patient's further treatment. The aim of this study was to identify possible predictors associated with an increased likelihood of inpatient psychiatric admission. METHODS: A retrospective cross-sectional study of all psychiatric emergency contacts in an interdisciplinary emergency department (ED) of a general hospital in a large German city was conducted for 2015. A binary regression analysis was performed to identify possible predictors. RESULTS: In 2015, a total of 21421 patient contacts were reported in the emergency department, of which 1733 were psychiatric emergencies. Psychiatric emergency was the fourth most common cause presenting to the ED. The most common diagnosis given was mental and behavioral disorders due to the use of psychotropic substances (F1). Factors associated with an increased probability of inpatient psychiatric admission were previously known patients, patients under a legal care order (guardianship), and previous outpatient medical contact. No association for gender or age was found. Data demonstrated a negative relationship between a neurotic, stress-related and somatoform disorder diagnosis and admission. CONCLUSIONS: The present study shows some significant characteristics associated with an increased likelihood of emergency admission. Independent of the health care system, the predictors found seem to be relevant with regard to the probability of admission, when compared internationally. To improve the treatment of patients in emergency units, these factors should be taken into account.

["Is there a Link Between Heat Waves and Mental Health Emergencies in the Emergency Department?"] / "Gibt es einen Zusammenhang zwischen Hitzeperioden und dem psychiatrischen Notfall in einer Zentralen Notaufnahme?".

OBJECTIVE: There is evidence suggesting that climate change, coupled with an increase in the frequency and severity of heatwaves, affects mental health. The aim of this study was to investigate potential associations between high temperature and the utilization of an emergency department (ED) by individuals with psychiatric disorders. METHODS: A retrospective analysis of all psychiatric emergency patients from 2015 to 2022 (N=15478) was conducted and compared with local temperature data. RESULTS: Particularly during heatwaves, more psychiatric emergency patients presented to the ED. CONCLUSION: Beyond the results identified during heatwaves, our extensive analysis of the examined ED revealed no additional significant effects of heat on psychiatric emergencies. This contradicts findings from other studies. Other systemic influences, such as the utilization of the ED during the Covid-19 pandemic, could have modified the results.

[Impact of the 2020 lockdown on prehospital psychiatric emergencies in a large city]. / Auswirkungen des Lockdowns 2020 auf präklinische psychiatrische Notarzteinsätze in einer Großstadt.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic represented a serious challenge for healthcare systems worldwide. Special psychiatric patients represent a vulnerable group and are particularly affected by lockdown interventions. Knowledge on the possible effects for this group of patients in an emergency physician setting is low. OBJECTIVE: The aim of this paper is to investigate the impact of the first lockdown during the COVID-19 pandemic in 2020 on emergency ambulance services for psychiatric patients in a large German city. MATERIAL AND METHODS: A retrospective analysis was conducted on all prehospital psychiatric emergencies in a large German city during the first pandemic-related lockdown from 22 March 2020 to 4 May 2020, with the same period in 2019 serving as a reference. RESULTS: During the first lockdown there was a significant increase in the number of emergency missions with respect to psychiatric cases. A substantial rise in substance-associated deployments was observed. Moreover, there was an increase in the proportion of psychiatric patients who did not meet emergency criteria. Suicidal tendencies and agitation status played a minor role during the lockdown. CONCLUSION: The lockdown had a notable impact on the frequency and profile of emergency physician calls in the metropolitan area studied. The substantial increase in substance-associated callouts can be interpreted as both a deterioration in access to the healthcare system and an expression of the increased stress faced by the general population and vulnerable groups in particular.

[What Influence did the Lockdown 2020 have on the Use of a Central Emergency Room by Psychiatric Emergency Patients]. / Welchen Einfluss hatte der Lockdown 2020 auf die Inanspruchnahme einer zentralen Notaufnahme durch psychiatrische Notfallpatienten.

OBJECTIVE: The current coronavirus pandemic (Covid-19 disease) poses major challenges to healthcare systems worldwide. The aim of this work was to identify the impact on psychiatric emergency presentations in an ED during the implemented lockdown. METHODS: A retrospective survey of all psychiatric emergency presentations in the ED during the lockdown was conducted. The same period in 2019 served as the reference year. RESULTS: There was a decrease in psychiatric patients. Changes were observed in the age and diagnoses. CONCLUSION: Some clear effects of the lockdown on psychiatric emergencies in an ED setting can be described. However, the changes were smaller than in other countries with other health care systems.