[Necessity for treatment of psychiatric emergencies in the emergency medical service. Evaluation of the "indicator for psychiatric pharmacotherapy"]. / Behandlungsbedürftigkeit psychiatrischer Notfälle im Notarztdienst. Evaluierung des "Indikator für psychiatrische Pharmakotherapie"

BACKGROUND: Psychiatric emergency situations (PES) are common in the physician-based emergency medical system (EMS) in Germany. However, many emergency physicians (EP) feel insecure in assessing the necessity for treatment of these patients. The aim of this investigation was to evaluate whether a short, newly developed questionnaire (Indicator for Psychiatric Pharmacotherapy, IPP) is able to help EPs in deciding for or against pharmacological treatment. PATIENTS AND METHODS: The protocols of the EMS at the Saarland University Hospital were prospectively collected over a 1-year period and PESs were identified and analyzed in detail. The 7-item IPP, which focuses on the most relevant psychiatric symptoms, was to be completed for each PES. RESULTS: Among all calls for an EP (2,114) 250 (11.8%) were classified as a PES. The most frequent diagnoses were alcoholic intoxication, state of agitation and suicide attempts. Of the IPP questionnaires 193 could be evaluated and in 31.2% of all PESs a specific psychiatric medication was administered. These patients scored significantly higher in the IPP compared to those who did not receive medication (8.0 ± 3.9 compared to 5.6 ± 3.2, p < 0.001). The IPP items "anxiety", "agitation/aggression", "mood" and "physical symptoms/disorders" had the highest impact on the administration of psychotherapeutic drugs. DISCUSSION: The IPP can be a valuable tool to assess the necessity of pharmacological treatment for patients in PESs. The assessment of the symptom categories "anxiety", "agitation/aggression", "mood" and "physical symptoms/disorders" seems to be sufficient to estimate a need for treatment.

Effects and side-effects of a brief overcorrection procedure in reducing multiple self-stimulatory behaviour: a single case analysis.

The use of positive practice overcorrection to reduce the classroom self-stimulatory behaviour of a mentally retarded child is described. An initial attempt to reduce four stereotyped hand movements through reinforcement of incompatible behaviour resulted in a decrease in three types of behaviour and an increase in the fourth. When one minute of positive practice overcorrection was then made contingent upon the increased behaviour, it was immediately reduced to near-zero levels with accompanying low occurrences of all other behaviour forms. Response suppression was durable following the evaluation of the overcorrection procedure at 2- and 3.5-month follow-ups.