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1.
Actas esp. psiquiatr ; 47(4): 127-136, jul.-ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185163

RESUMO

Introducción. Existe una fuerte asociación entre quienes repiten un intento de suicidio (IS) y quienes lo consuman. Por ello el seguimiento de la intervención de estos pacientes es fundamental. En este estudio: se establece el perfil sociodemográfico y clínico de personas atendidas en urgencias psiquiátricas por un IS, en función del sexo; se determina la prevalencia de reintentos en un periodo de seis meses; se compara el perfil de los pacientes que repiten o no el IS; y se evalúan variables predictoras de la repetición. Metodología. Se entrevistó a 207 pacientes (122 mujeres y 85 hombres) que acudieron a urgencias psiquiátricas por un IS (enero-octubre de 2015), y se revisó su historia clínica a los 6 meses. Resultados. Las mujeres presentaron una menor letalidad en la conducta suicida. Un 14% de la muestra (n=29) repitió un IS en los 6 meses siguientes y 2 personas fallecieron por suicidio; 3 fallecieron por otras causas. Los pacientes ingresados en la Unidad de Hospitalización Psiquiátrica presentaron más reintentos (X2=4,1; g.l.=1; p=0,043). En el análisis multivariable, de todas las variables analizadas, la única asociada a la repetición del intento fue encontrarse en tratamiento en salud mental al incluirse en el estudio (OR=3,504; p=,009; I.C.95%=1,361-9,018). En el periodo de seguimiento se incrementó un 21,7% los pacientes tratados en salud mental. Conclusiones. El riesgo de repetición tras ser tratado en urgencias psiquiátricas por IS es crítico los meses posteriores, siendo necesario mejorar los programas de prevención e intervención destinados a mejorar estas cifras


Introduction. There is a strong association between those who re-attempt a suicide attempt and those who complete it. Therefore, follow-up on the interventions car-ried out for suicidal patients is essential. This study investigated the sociodemographic and clinical profiles of individuals admitted as psychiatric emergencies after a suicide attempt according to sex, determined the prevalence of re-attempts in a period of six months, compared the profiles of patients who engaged in repeated suicide attempts to those who did not, and evaluated predictive variables for repeated suicide attempts. Methodology. A total of 207 patients (122 women and 85 men) who went to the psychiatric emergency room for a suicide attempt (January-October 2015) were interviewed, and their clinical histories were reviewed at 6 months. Results. Lethal suicidal behaviour was lower in women. Fourteen percent of the sample (n=29) repeated a suicide attempt in the following 6 months, and 2 people died by suicide; 3 died from other causes. The patients admitted to the Psychiatric Hospitalization Unit presented with more re-attempts (X2=4.1; d.f.=1; p=0.043). In the multivariate analysis, of all the variables analysed, the only one associated with repeated suicide attempts was having been in mental health treatment upon inclusion into the study (OR=3.504, p=0.009, CI95%: 1.361-9.018). In the follow-up period, the percentage of patients who engaged in mental health treatment increased 21.7%.Conclusions. The risk of recurrence after being treated for a suicide attempt psychiatric emergency is high in the months following an attempt, and it is necessary to improve prevention and intervention programmes aimed at improving these figures


Assuntos
Humanos , Masculino , Feminino , Tentativa de Suicídio/psicologia , Seguimentos , Recidiva , Intervenção na Crise/métodos , Serviços de Emergência Psiquiátrica/métodos , Saúde Mental , Estudos Longitudinais
2.
Psiquiatr. biol. (Internet) ; 26(1): 1-6, ene.-abr. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185020

RESUMO

El manejo del trastorno límite de personalidad puede ser un reto para el clínico, especialmente en el servicio de urgencias hospitalarias, donde se hacen necesarias decisiones rápidas que deben ser además las más beneficiosas y en conjunto con el paciente, favoreciendo su autonomía y participación en la resolución de la crisis. En este artículo pretendemos revisar el manejo de la crisis de una forma práctica y, basándonos en las guías clínicas más recientes, proporcionar una serie de pautas a los clínicos que se enfrentan a estas situaciones para manejar adecuadamente las crisis con recomendaciones basadas en la evidencia científica que tenemos hasta ahora y claves para la valoración de la conducta suicida, que es uno de los motivos más frecuentes por lo que estos pacientes acuden a los servicios de urgencias. Finalmente revisaremos los diferentes manejos y encuadres, repasando las indicaciones de ingreso hospitalario, así como los objetivos del mismo


Managing patients with borderline personality disorder can pose a substantial challenge for psychiatrists. This is especially the case when patients with this disorder are seen in the emergency room, as clinicians must make rapid decisions that balance clinical benefit and the will of the patient, fostering their autonomy and participation. A review is presented in this article of the strategies for practical management of crises. Based on the most recent clinical guidelines, a series of insights are provided for facing these situations, including recommendations based on scientific evidence, as well as the key steps for assessing suicidal behaviour, which is one of the most frequent causes behind visits to the emergency department in this patient population. Finally, a review is presented on the different management approaches and frameworks, analysing the indications and aims of hospital admission


Assuntos
Humanos , Transtorno da Personalidade Borderline/terapia , Intervenção na Crise/métodos , Suicídio/estatística & dados numéricos , Comportamento Autodestrutivo/epidemiologia , Autólise/epidemiologia , Serviços de Emergência Psiquiátrica/métodos , Tratamento de Emergência/métodos , Fatores de Risco
3.
Hawaii J Med Public Health ; 77(12): 312-314, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30533282

RESUMO

Methamphetamine use has increased throughout the United States in recent years, and is historically prevalent in Hawai'i. This retrospective study aimed to determine the effect of methamphetamine use on emergency department (ED) resources, by examining visits to an emergency department (ED) in an urban hospital in Hawai'i from 2007 - 2011. The rate of patients who tested positive for amphetamine was measured and broken down by year. Primary outcomes included length of ED stay, the administration of medication or physical restraints for safety, and the rate of psychiatric hospitalization. Overall, 15.1% of drug-screened patients (N = 16,018) tested positive for amphetamines over the study period. Amphetamine-positive patients spent more time per visit on average in the ED, and were more likely to require medication and physical restraints, compared to amphetamine-negative patients. Amphetamine positive patients were admitted to inpatient psychiatry less frequently than negative-testing patients. In summary, there is higher resource utilization per psychiatric emergency service visit by amphetamine-positive patients; however if patients can be stabilized in the ED, the increased ED resources utilized may be offset by the reduced burden on inpatient facilities.


Assuntos
Serviços de Emergência Psiquiátrica/métodos , Metanfetamina/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviços de Emergência Psiquiátrica/economia , Feminino , Hawaii , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Metanfetamina/efeitos adversos , Metanfetamina/urina , Pessoa de Meia-Idade , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/economia
4.
J Child Adolesc Psychiatr Nurs ; 31(2-3): 79-86, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30298629

RESUMO

PROBLEM: Emergency care in child and adolescent psychiatry often lacks a coherent treatment model. This study reports on the development and implementation of a salutogenic treatment model at the Child & Adolescent Psychiatric Emergency Unit in Malmö, Sweden. METHODS: The development and implementation involved all staff categories and was guided by a recognized authority on salutogenesis. Generalized resistance resources (GRR) were identified that could be implemented at the unit to improve patients' sense of coherence. FINDINGS: Eight GRR were developed and implemented at the unit. During the 6-month period following the implementation, patients (n = 41) and parents reported satisfaction with the treatment, while mental health improved between admission and discharge, and both treatment length and readmission rates were reduced. CONCLUSION: A salutogenic treatment model involving GRR seems to be a promising approach in child and adolescent psychiatric emergency treatment.


Assuntos
Serviços de Saúde do Adolescente , Serviços de Saúde da Criança , Serviços de Emergência Psiquiátrica/métodos , Transtornos Mentais/terapia , Psicoterapia/métodos , Senso de Coerência , Adolescente , Criança , Feminino , Hospitais Universitários , Humanos , Masculino , Suécia
5.
Psychiatry ; 81(3): 218-227, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30351238

RESUMO

OBJECTIVE: Previous studies have proposed music therapy (MT) as a useful rehabilitation approach for patients with psychosis, but few studies have focused on acute settings. The aim of the study was to evaluate the effects of a structured MT program on clinical and social functioning indices of patients with psychosis while hospitalized in an emergency psychiatric ward. METHOD: The intervention followed a modified approach to Benenzon's MT model and was delivered biweekly to 61 patients with psychosis consecutively admitted to our ward. Before and after the MT program, all subjects were administered the Brief Psychiatric Rating Scale (BPRS) for assessment of general psychopathology, the Hospital Anxiety and Depression Scale (HADS) for affective symptomatology, the Clinical Global Impression (CGI) scale for severity of symptoms, and the Global Assessment of Functioning (GAF) scale for psychosocial functioning. RESULTS: A repeated-measures analysis of variance revealed that patients who underwent the MT intervention had a statistically significant reduction of BPRS and CGI scores, compared to the control group; furthermore, the BPRS anxiety/depression factor and the HADS scores for affective symptomatology significantly decreased after the observation period compared to controls. CONCLUSION: Our results are in line with previous studies showing favorable effects of MT in patients with psychosis, in particular on affective symptomatology, but extend this observation to an emergency setting with short periods of hospital stay.


Assuntos
Sintomas Afetivos/terapia , Transtorno Bipolar/terapia , Transtorno da Personalidade Borderline/terapia , Serviços de Emergência Psiquiátrica/métodos , Musicoterapia/métodos , Unidade Hospitalar de Psiquiatria , Transtornos Psicóticos/terapia , Esquizofrenia/terapia , Adulto , Feminino , Humanos , Pacientes Internados , Pessoa de Meia-Idade
6.
BMC Psychiatry ; 18(1): 319, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30285661

RESUMO

BACKGROUND: The Columbia-Suicide Severity Rating Scale (C-SSRS) is a relatively new instrument for the assessment of suicidal ideation and behaviour that is widely used in clinical and research settings. The predictive properties of the C-SSRS have mainly been evaluated in young US populations. We wanted to examine the instrument's predictive validity in a Swedish cohort of adults seeking psychiatric emergency services after an episode of self-harm. METHODS: Prospective cohort study of patients (n = 804) presenting for psychiatric emergency assessment after an episode of self-harm with or without suicidal intent. Suicidal ideation and behaviours at baseline were rated with the C-SSRS and subsequent non-fatal and fatal suicide attempts within 6 months were identified by record review. Logistic regression was used to evaluate separate ideation items and total scores as predictors of non-fatal and fatal suicide attempts. Receiver operating characteristics (ROC) curves were constructed for the suicidal ideation (SI) intensity score and the C-SSRS total score. RESULTS: In this cohort, the median age at baseline was 33 years, 67% were women and 68% had made at least one suicide attempt prior to the index attempt. At least one non-fatal or fatal suicide attempt was recorded during follow-up for 165 persons (20.5%). The single C-SSRS items frequency, duration and deterrents were associated with this composite outcome; controllability and reasons were not. In a logistic regression model adjusted for previous history of suicide attempt, SI intensity score was a significant predictor of a non-fatal or fatal suicide attempt (OR 1.08; 95% CI 1.03-1.12). ROC analysis showed that the SI intensity score was somewhat better than chance in correctly classifying the outcome (AUC 0.62, 95% CI 0.57-0.66). The corresponding figures for the C-SSRS total score were 0.65, 95% CI 0.60-0.69. CONCLUSIONS: The C-SSRS items frequency, duration and deterrents were associated with elevated short term risk in this adult psychiatric cohort, as were both the SI intensity score and the C-SSRS total score. However, the ability to correctly predict future suicidal behaviour was limited for both scores.


Assuntos
Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Escalas de Graduação Psiquiátrica/normas , Comportamento Autodestrutivo/epidemiologia , Comportamento Autodestrutivo/psicologia , Tentativa de Suicídio/psicologia , Adulto , Estudos de Coortes , Serviços de Emergência Psiquiátrica/métodos , Serviços de Emergência Psiquiátrica/tendências , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de Risco , Comportamento Autodestrutivo/diagnóstico , Índice de Gravidade de Doença , Ideação Suicida , Tentativa de Suicídio/tendências , Suécia/epidemiologia , Fatores de Tempo
7.
J Emerg Med ; 55(4): 522-529.e2, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30170836

RESUMO

BACKGROUND: Psychiatric presentations are common in emergency departments (EDs), but the standard of care for treatment remains poorly defined. We introduced standards for emergency psychiatric evaluations that included obtaining collateral information, writing a safety plan for discharging patients, identifying the next best provider, and alerting that provider to the patient's visit. OBJECTIVE: We sought to demonstrate the feasibility and clinical impact of implementing standards for emergency psychiatric evaluations. METHODS: To evaluate feasibility, physicians attested to completion in the electronic health record. To evaluate the effect on clinical outcomes, we compared admission rates, 30-day return rates, and median length of stay from a 4-month pre-implementation period to a 4-month post-implementation period. Data were extracted from a quality-improvement database. RESULTS: There were 1896 patient encounters in the pre-implementation period and 1937 encounters post-implementation. Pre-and post-cohorts were similar demographically. Collateral was obtained for 1035 (86%) encounters, a written safety plan was completed for 793 (77%) eligible patients, the next-best provider was identified for 1094 (91%), and that provider was contacted for 837 (70%). There was no difference from pre to post periods in admission rates (17% vs. 18%; p = 0.36), median length of stay (13.3 ± 0.6 vs. 12.5 ± 1.4; p = 0.35), or 30-day return rates (15% vs. 16%; p = 0.66). CONCLUSIONS: This standard work for emergency psychiatric evaluations was feasible even in a highly acute patient population. However, the benefits of this intervention are less clear. We question the utility of prevailing metrics in emergency psychiatry.


Assuntos
Serviços de Emergência Psiquiátrica/normas , Padrão de Cuidado/normas , Adulto , Estudos de Coortes , Colorado , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviços de Emergência Psiquiátrica/métodos , Serviços de Emergência Psiquiátrica/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade
9.
Theor Med Bioeth ; 39(4): 283-299, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30120696

RESUMO

Violence in psychiatric clinics has been a consistent problem since the birth of modern psychiatry. In this paper, I examine current efforts to understand and reduce both violence and coercive responses to violence in psychiatry, arguing that these efforts are destined to fall short. By and large, scholarship on psychiatric violence reduction has focused on identifying discrete factors that are statistically associated with violence, such as patient demographics and clinical qualities, in an effort to quantify risk and predict violent acts before they happen. Using the work of Horkheimer and Adorno, I characterize the theoretical orientation of such efforts as identity thinking. I then argue that these approaches lead to epistemic imperceptiveness and a subtle form of conceptual restraint on patients. I suggest a reorientation in psychiatric research, away from identity thinking and toward a more productive and just approach to the problem of violence in psychiatric clinics.


Assuntos
Serviços de Emergência Psiquiátrica/tendências , Violência/estatística & dados numéricos , Coerção , Serviços de Emergência Psiquiátrica/métodos , Humanos , Violência/psicologia
11.
Clin Geriatr Med ; 34(3): 469-489, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30031428

RESUMO

Behavioral health disorders are common among older adults and, owing to limited access to resources for mental health care in the community, emergency department providers are often on the front lines of mental health crises. This article reviews the available literature regarding the care of behavioral health emergencies in older adults and provides a framework for navigating the evaluation and management of older adults presenting to the emergency department with behavioral health concerns.


Assuntos
Serviço Hospitalar de Emergência , Serviços de Emergência Psiquiátrica/métodos , Idoso , Avaliação Geriátrica/métodos , Humanos , Saúde Mental , Administração dos Cuidados ao Paciente/métodos , Escalas de Graduação Psiquiátrica
12.
Eur Psychiatry ; 51: 20-24, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29510297

RESUMO

BACKGROUND: Suicide Prevention is an ongoing task for mental health services. This article describes a pilot program for suicide prevention that took place in two districts in Israel from 2009 to 2012. The program targeted specific population, patients in high-risk for suicide, without major mental illness or previous association with the mental health system. In that group many suicide attempts were due to stressful life events. METHODS: Patients who performed a suicide attempt or were considered high-risk for suicide were referred to the project. The first contact took place up to 24 h after the referral and included a phone call with suggestion for further intervention. If he was willing, the patient was invited to a serious of 8-12 meetings with a therapist that focused on "crisis intervention" techniques. RESULTS: 212 subjects were referred to the project. Three quarters of the referrals were females. Most of them were of Jewish nationality, however, the percentage of Druze in the program's population was higher than their percentage of general population. Only 137 continued participation after the initial phone call, people of Jewish nationality were more willing to continue the intervention. During the intervention there was a decline in suicide rates in the participating districts. CONCLUSIONS: The pilot program exhibits promising preliminary results, it is interesting to examine the difference in participation between different ethnic groups. Since the sample size is small, there is a need to continue the program on a larger scale.


Assuntos
Intervenção na Crise , Tentativa de Suicídio , Suicídio/prevenção & controle , Adulto , Intervenção na Crise/métodos , Intervenção na Crise/estatística & dados numéricos , Serviços de Emergência Psiquiátrica/métodos , Feminino , Humanos , Israel/epidemiologia , Masculino , Saúde Mental/etnologia , Pessoa de Meia-Idade , Projetos Piloto , Psiquiatria Preventiva/métodos , Encaminhamento e Consulta , Medição de Risco , Suicídio/psicologia , Tentativa de Suicídio/etnologia , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos
13.
J Emerg Med ; 54(4): 500-506, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29500048

RESUMO

BACKGROUND: Behavioral emergencies account for a significant portion of emergency department (ED) visits in the United States. Substance abuse is common in this population and may precipitate or exacerbate preexisting psychiatric illness. Contrary to ED policy guidelines, many behavior health centers (BH) require a urine drug screen (UDS) in stable patients prior to transfer. OBJECTIVE: We sought to determine the role of the UDS in ED length of stay (LOS), cost, and charges to patients and inpatient psychiatric care. METHODS: We performed a retrospective chart review of all patients transferred to an in-network BH from September 1-30, 2014. Clinical data were extracted and analyzed from our electronic medical record, including records from both the ED visit and the BH stay. RESULTS: There were 205 patient encounters identified; 89 patients had a UDS performed in the ED and 89% were obtained after the ED medical clearance. LOS were similar between the two groups, however, time to ED departure from time of medical clearance was delayed in the UDS group. BH providers mentioned UDS results < 25% of the time and no confirmatory tests were performed. There was no difference in BH LOS or discharge diagnosis of substance-abuse disorder. Patient charges for UDS over the month totaled $21,093. CONCLUSION: The UDS did not seem to have any significant effect on inpatient psychiatric care; whereas ED LOS and cost were both negatively affected. Based on these results, the UDS seems to be of little-to-no benefit in the setting of acute psychiatric illness.


Assuntos
Serviços de Emergência Psiquiátrica/normas , Programas de Rastreamento/normas , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Urinálise/normas , Adolescente , Adulto , Medicina do Comportamento/instrumentação , Medicina do Comportamento/métodos , Medicina do Comportamento/normas , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviços de Emergência Psiquiátrica/métodos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Programas de Rastreamento/métodos , Transtornos Mentais/complicações , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/economia , Estados Unidos , Urinálise/economia , Urinálise/estatística & dados numéricos
15.
Soc Sci Med ; 197: 87-94, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29222999

RESUMO

While mental illness is a significant health challenge worldwide, the availability of specialists is limited, especially in rural areas and for psychiatric emergencies. Although tele-psychiatry, via real-time videoconferencing (VC), is used to provide consultative services in areas that lack psychiatrists, there are a paucity of studies on the use of VC for psychiatric emergencies. We examine how VC matters for patient involvement and professional practice in the first Norwegian emergency tele-psychiatric service. Through a decentralised on-call system, psychiatrists are accessible 24/7 by telephone and VC for patients and nurses in regional psychiatry centres. Based on 29 interviews with patients, psychiatrists and nurses, this article addresses how participation is fostered by VC, and how it may change the social dynamics of therapeutic emergency encounters. We identified four contributions of the 'video-mediated gaze' in the therapeutic encounter including those of the: (1) immediacy of assessment, (2) increased transparency, (3) sense of access to the 'real' expert, and (4) fostering of the patient's 'voice' in therapeutic decisions. These VC inflections of the therapeutic encounter are a mix of the pragmatic (1 and 2) and the symbolic (3 and 4), assembling in these contexts to foster patient-centeredness. With a sociological approach to video-conferenced emergency psychiatry, the identification of symbolic affordances adds necessary nuances to the application of new technologies into fragile therapeutic communication.


Assuntos
Serviços de Emergência Psiquiátrica/métodos , Transtornos Mentais/terapia , Psiquiatria , Videoconferência/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Participação do Paciente/psicologia , Serviços de Saúde Rural , Recursos Humanos , Adulto Jovem
16.
Pediatr Emerg Med Pract ; 15(1): 1-28, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29261480

RESUMO

Behavioral health emergencies most commonly present as depression, suicidal behavior, aggression, and severe disorganization. Emergency clinicians should avoid relying solely on past medical history or previous psychiatric diagnoses that might prematurely rule out medical pathologies. Treatments for behavioral health emergencies consist of de-escalation interventions aimed at preventing agitation, aggression, and harm. This issue reviews medical pathologies and underlying causes that can result in psychiatric presentations and summarizes evidence-based practices to evaluate, manage, and refer patients with behavioral health emergencies.


Assuntos
Serviços de Emergência Psiquiátrica/métodos , Transtornos Mentais/diagnóstico , Adolescente , Criança , Emergências , Humanos , Transtornos Mentais/terapia , Guias de Prática Clínica como Assunto
18.
Psychiatr Clin North Am ; 40(3): 363-377, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28800795

RESUMO

Depression is the leading cause of disability globally, and more than one-half of those suffering with depression are not receiving effective treatment. Untreated or undertreated depression poses a significant risk for suicide. Suicide is the 10th leading cause of death in the United States. The emergency room provides an essential opportunity to screen for depression as well as suicide and to provide important and evidence-based interventions. The Basic Suicide Assessment Five-step Evaluation (B-SAFE) model provides a structure for all physicians to assess suicide risk and intervene.


Assuntos
Depressão/diagnóstico , Serviços de Emergência Psiquiátrica/métodos , Ideação Suicida , Tentativa de Suicídio , Depressão/tratamento farmacológico , Depressão/terapia , Serviço Hospitalar de Emergência , Humanos , Medição de Risco , Fatores de Risco
19.
Psychiatr Clin North Am ; 40(3): 425-433, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28800799

RESUMO

Patients who present to the emergency department (ED) with mental illness or behavioral complaints merit workup for underlying physical conditions that can trigger, mimic, or worsen psychiatric symptoms. However, there are wide variations in quality of care for these individuals. Psychiatry and emergency medicine specialty guidelines support a tailored, customized approach to patients. Our group has long advocated a dynamic comanagement approach for medical clearance in the ED, and this article summarizes best-practice approaches to the medical clearance of patients with psychiatric illness, tips on history taking, system reviews, clinical/physical examination, and common pitfalls in the medical clearance process.


Assuntos
Serviço Hospitalar de Emergência/normas , Serviços de Emergência Psiquiátrica/métodos , Transtornos Mentais/diagnóstico , Liberação de Cirurgia/normas , Humanos
20.
Psychiatr Clin North Am ; 40(3): 435-448, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28800800

RESUMO

This article describes psychiatric emergencies in pregnant women. The perinatal period is a time of psychiatric vulnerability. Up to 1 in 6 pregnant women experience major depressive disorder, and 1 in 4 pregnant women with bipolar disorder experience mood exacerbation. We discuss the management of severe mental illness in pregnancy, risk to mother and child of untreated psychiatric illness in pregnancy, risk of relapse of psychiatric disorders in pregnancy with medication discontinuation, psychopharmacologic considerations of teratogenicity and other fetal adverse effects, acute agitation in the pregnant patient, suicidality in pregnancy, and emergency considerations related to substance use disorders.


Assuntos
Serviços de Emergência Psiquiátrica/métodos , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/terapia , Feminino , Humanos , Gravidez
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