General psychiatric approach - Revision history

Cole Ettingoff: /* Disposition */

2025-05-05T16:51:26Z

Disposition

← Older revision		Revision as of 16:51, 5 May 2025
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	==Disposition==		==Disposition==
			Disposition should be guided by clinical stability, psychiatric risk, support systems, and local resources. Consider:

			=== Admit to Inpatient Psychiatry ===
			* Active suicidal or homicidal ideation with intent or plan
			* Severe psychosis, mania, or behavioral dysregulation that poses danger to self/others
			* Unable to care for self due to psychiatric decompensation (gravely disabled)
			* Failure of outpatient or partial hospitalization treatment with acute worsening
			* Severe withdrawal or detox needs (e.g., alcohol or benzodiazepine)
			*
			=== Medical Admission ===
			* Unstable vital signs, toxic ingestion, or altered mental status from organic cause
			* Requiring ongoing medical treatment (e.g., infection, injury, metabolic derangement)

			=== Observation or Crisis Stabilization Unit ===
			* Milder psychiatric symptoms needing short-term containment
			* Awaiting collateral or outpatient placement/clearance
			* Requires reassessment after sobering, medication trial, or de-escalation

			=== Potentially Safe for Discharge ===
			* No suicidal/homicidal ideation, stable mental status
			* Good insight and follow-up plan in place
			* No grave disability and clear understanding of safety plan
			* Collateral contact and outpatient psychiatric follow-up confirmed

			==== Key Considerations Before Discharge ====
			* Evaluate safety at home: living situation, family support
			* Review access to weapons or harmful substances
			* Provide printed discharge instructions and crisis resources (e.g., suicide hotline)
			* Consider short-term outpatient bridge prescriptions if appropriate
			* Document clearly: capacity, decision-making, and risk assessment

	==See Also==		==See Also==

Cole Ettingoff: /* Evaluation */

2025-05-05T16:49:00Z

Evaluation

← Older revision		Revision as of 16:49, 5 May 2025
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	*Pending results should not delay transfer or evaluation		*Pending results should not delay transfer or evaluation
	*Patient’s cognitive abilities, rather than specific blood alcohol level, should dictate initiation of psychiatry evaluation		*Patient’s cognitive abilities, rather than specific blood alcohol level, should dictate initiation of psychiatry evaluation

			===Risk Assessment===
			Use clinical judgment along with structured tools (e.g., SAD PERSONS, Columbia Suicide Severity Rating Scale) to assess:
			* Suicide risk (plan, means, intent)
			* Homicidal ideation or violent behavior
			* Gravely disabled or unable to care for self
			* Risk to others (e.g., psychosis, [[Hallucinations\|command hallucinations]])
			* Access to firearms or lethal means

	==Management==		==Management==

Cole Ettingoff: /* Evaluation */

2025-05-05T16:47:05Z

Evaluation

← Older revision		Revision as of 16:47, 5 May 2025
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	{{General ED Psychiatric Workup}}		{{General ED Psychiatric Workup}}

	~~===Evaluation===~~
	*[[Sad person's score]]		*[[Sad person's score]]

ClaireLewis: /* Background */

2019-10-11T14:37:45Z

Background

← Older revision		Revision as of 14:37, 11 October 2019
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	*Be wary of diagnostic overshadowing (e.g. erroneously attributing symptoms of ''medical'' illness to psychiatric disease)		*Be wary of diagnostic overshadowing (e.g. erroneously attributing symptoms of ''medical'' illness to psychiatric disease)
	**Compared to overall population, patients with mental illness have significantly higher rates of stroke<ref>Leucht S, Burkand T, Henderson J, Maj M, Sartorius N (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 116: 317– 333</ref>, CAD<ref>Leucht S, Burkand T, Henderson J, Maj M, Sartorius N (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 116: 317– 333. </ref>, DM<ref>Mai Q, D’Arcy C, Holman J, Sanfilippo FM, Emery JD, et al. (2011) Mental illness related disparities in diabetes prevalence, quality of care and outcomes: a population-based longitudinal study. BMC Med 9: 118.		**Compared to overall population, patients with mental illness have significantly higher rates of stroke<ref>Leucht S, Burkand T, Henderson J, Maj M, Sartorius N (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 116: 317– 333</ref>, CAD<ref>Leucht S, Burkand T, Henderson J, Maj M, Sartorius N (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 116: 317– 333. </ref>, DM<ref>Mai Q, D’Arcy C, Holman J, Sanfilippo FM, Emery JD, et al. (2011) Mental illness related disparities in diabetes prevalence, quality of care and outcomes: a population-based longitudinal study. BMC Med 9: 118.
	</ref>, cancer<ref>https://www.cdc.gov/mentalhealth/data_stats/mental-illness.htm</ref>, HIV, HCV</ref>Disability Rights Commission (2006) Equal Treatment: Closing the Gap. A Formal Investigation into Physical Health Inequalities Experienced by People with Learning Disabilities and/or Mental Health Problems. Disability Rights Commission. London.</ref>		</ref>, cancer<ref>https://www.cdc.gov/mentalhealth/data_stats/mental-illness.htm</ref>, HIV, HCV<ref>Disability Rights Commission (2006) Equal Treatment: Closing the Gap. A Formal Investigation into Physical Health Inequalities Experienced by People with Learning Disabilities and/or Mental Health Problems. Disability Rights Commission. London.</ref>

	==Clinical Features==		==Clinical Features==

ClaireLewis: /* Background */

2019-10-11T14:37:31Z

Background

← Older revision		Revision as of 14:37, 11 October 2019
Line 2:		Line 2:
	*Be wary of diagnostic overshadowing (e.g. erroneously attributing symptoms of ''medical'' illness to psychiatric disease)		*Be wary of diagnostic overshadowing (e.g. erroneously attributing symptoms of ''medical'' illness to psychiatric disease)
	**Compared to overall population, patients with mental illness have significantly higher rates of stroke<ref>Leucht S, Burkand T, Henderson J, Maj M, Sartorius N (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 116: 317– 333</ref>, CAD<ref>Leucht S, Burkand T, Henderson J, Maj M, Sartorius N (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 116: 317– 333. </ref>, DM<ref>Mai Q, D’Arcy C, Holman J, Sanfilippo FM, Emery JD, et al. (2011) Mental illness related disparities in diabetes prevalence, quality of care and outcomes: a population-based longitudinal study. BMC Med 9: 118.		**Compared to overall population, patients with mental illness have significantly higher rates of stroke<ref>Leucht S, Burkand T, Henderson J, Maj M, Sartorius N (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 116: 317– 333</ref>, CAD<ref>Leucht S, Burkand T, Henderson J, Maj M, Sartorius N (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 116: 317– 333. </ref>, DM<ref>Mai Q, D’Arcy C, Holman J, Sanfilippo FM, Emery JD, et al. (2011) Mental illness related disparities in diabetes prevalence, quality of care and outcomes: a population-based longitudinal study. BMC Med 9: 118.
	</ref>, cancer<ref>https://www.cdc.gov/mentalhealth/data_stats/mental-illness.htm</ref>, HIV, HCV</ref>Disability Rights Commission (2006) Equal Treatment: Closing the Gap. A Formal Investigation into Physical Health Inequalities Experienced by People with Learning Disabilities and/or Mental Health Problems. Disability Rights Commission. London.		</ref>, cancer<ref>https://www.cdc.gov/mentalhealth/data_stats/mental-illness.htm</ref>, HIV, HCV</ref>Disability Rights Commission (2006) Equal Treatment: Closing the Gap. A Formal Investigation into Physical Health Inequalities Experienced by People with Learning Disabilities and/or Mental Health Problems. Disability Rights Commission. London.</ref>

	==Clinical Features==		==Clinical Features==

ClaireLewis at 14:37, 11 October 2019

2019-10-11T14:37:16Z

← Older revision		Revision as of 14:37, 11 October 2019
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	==Background==		==Background==
			*Be wary of diagnostic overshadowing (e.g. erroneously attributing symptoms of ''medical'' illness to psychiatric disease)
			**Compared to overall population, patients with mental illness have significantly higher rates of stroke<ref>Leucht S, Burkand T, Henderson J, Maj M, Sartorius N (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 116: 317– 333</ref>, CAD<ref>Leucht S, Burkand T, Henderson J, Maj M, Sartorius N (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 116: 317– 333. </ref>, DM<ref>Mai Q, D’Arcy C, Holman J, Sanfilippo FM, Emery JD, et al. (2011) Mental illness related disparities in diabetes prevalence, quality of care and outcomes: a population-based longitudinal study. BMC Med 9: 118.
			</ref>, cancer<ref>https://www.cdc.gov/mentalhealth/data_stats/mental-illness.htm</ref>, HIV, HCV</ref>Disability Rights Commission (2006) Equal Treatment: Closing the Gap. A Formal Investigation into Physical Health Inequalities Experienced by People with Learning Disabilities and/or Mental Health Problems. Disability Rights Commission. London.

	==Clinical Features==		==Clinical Features==
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	==Evaluation==		==Evaluation==
			*Rule out medical pathology as cause or exacerbating factor for presentation

	{{General ED Psychiatric Workup}}		{{General ED Psychiatric Workup}}

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	===ACEP Guidelines 2005===		===ACEP Guidelines 2005===
	*Class B recommendations		*Class B recommendations
	*Routine laboratory testing is of low yield and ~~unneccesary~~		*Routine laboratory testing is of low yield and unnecessary
	*Routine urine toxicology need not be performed		*Routine urine toxicology need not be performed
	*Pending results should not delay transfer or evaluation		*Pending results should not delay transfer or evaluation

Adamhaag: /* ACEP Guidelines */

2017-08-23T13:55:03Z

ACEP Guidelines

← Older revision		Revision as of 13:55, 23 August 2017
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	*[[Sad person's score]]		*[[Sad person's score]]

	===ACEP Guidelines===		===ACEP Guidelines 2005===
	*Class B recommendations		*Class B recommendations
	*Routine laboratory testing is of low yield and unneccesary		*Routine laboratory testing is of low yield and unneccesary

Adamhaag at 13:54, 23 August 2017

2017-08-23T13:54:41Z

← Older revision		Revision as of 13:54, 23 August 2017
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	===Evaluation===		===Evaluation===
	*[[Sad person's score]]		*[[Sad person's score]]

			===ACEP Guidelines===
			*Class B recommendations
			*Routine laboratory testing is of low yield and unneccesary
			*Routine urine toxicology need not be performed
			*Pending results should not delay transfer or evaluation
			*Patient’s cognitive abilities, rather than specific blood alcohol level, should dictate initiation of psychiatry evaluation

	==Management==		==Management==

Humanguy: Linked to General ED Psychiatric Management template

2016-11-10T22:12:45Z

Linked to General ED Psychiatric Management template

← Older revision		Revision as of 22:12, 10 November 2016
Line 23:		Line 23:

	{{General ED Psychiatric Management}}		{{General ED Psychiatric Management}}
	*Non-pharmacologic
	**Verbal de-escalation
	**Offer comforting items: blanket, meal, pillow, etc
	**Quiet room
	**Physical restraints
	***should administer medications if restraints used (decreases restraint time)
	*Pharmacologic: Goal is to calm patient without oversedation
	**'''No history of psychosis'''
	***[[Haloperidol]] 0.5mg-5mg + lorazepam 0.25-2mg (PO/IM/IV)
	***Consider adding [[benztropine]] 0.5-2mg '''or''' [[diphenhydramine]] 25-50mg (PO/IV/IM)
	****reduces dystonia or [[extrapyramidal reaction]]
	***Consider [[risperidone]] 0.5-2mg PO '''or''' olanzapine 2.5-20mg (PO/IM/SL) '''or''' ziprasidone 10-20mg IM
	**'''Known or suspected underlying psychotic illness'''
	***Continue treatment with previous antipsychotic '''or'''
	***PO: olanzapine 5-10mg '''or''' risperidone 0.5-2mg +/- lorazepam: 0.5-2mg
	***IM: olanzapine 2.5-20mg ""or"" ziprasidone 10-20mg '''or'''
	***(PO/IM/IV) Haloperidol 0.5-5mg +/- lorazepam 0.5-2mg

	==Disposition==		==Disposition==

Humanguy: /* Management */

2016-11-10T22:11:39Z

Management

← Older revision		Revision as of 22:11, 10 November 2016
Line 21:		Line 21:

	==Management==		==Management==

			{{General ED Psychiatric Management}}
			*Non-pharmacologic
			**Verbal de-escalation
			**Offer comforting items: blanket, meal, pillow, etc
			**Quiet room
			**Physical restraints
			***should administer medications if restraints used (decreases restraint time)
			*Pharmacologic: Goal is to calm patient without oversedation
			**'''No history of psychosis'''
			***[[Haloperidol]] 0.5mg-5mg + lorazepam 0.25-2mg (PO/IM/IV)
			***Consider adding [[benztropine]] 0.5-2mg '''or''' [[diphenhydramine]] 25-50mg (PO/IV/IM)
			****reduces dystonia or [[extrapyramidal reaction]]
			***Consider [[risperidone]] 0.5-2mg PO '''or''' olanzapine 2.5-20mg (PO/IM/SL) '''or''' ziprasidone 10-20mg IM
			**'''Known or suspected underlying psychotic illness'''
			***Continue treatment with previous antipsychotic '''or'''
			***PO: olanzapine 5-10mg '''or''' risperidone 0.5-2mg +/- lorazepam: 0.5-2mg
			***IM: olanzapine 2.5-20mg ""or"" ziprasidone 10-20mg '''or'''
			***(PO/IM/IV) Haloperidol 0.5-5mg +/- lorazepam 0.5-2mg

	==Disposition==		==Disposition==