Psychiatric Emergencies for the Adult Patient

Authors: Sarah Edwards, Phyllida Roe / Editors: Tim Dickinson, Adam Hickson, Liam Kevern / Reviewer: Mohamed Elwakil / Codes: A4, A5 / Published: 22/12/2017

Description:

Patients with mental health problems often present to the Emergency Department (ED). They will commonly be assessed and then treated, initially, by junior doctors. A recent survey shows that very few doctors have any further training in recognising and managing mental health problems once they leave medical school. Consequently they lack both the skills and confidence in recognising and managing these patients in the ED.

This module is intended to provide some guidance on commonly presenting problems in the acute environment. It will focus on the key elements of history in the context of making an initial assessment but will also provide information on immediate management. Assessments of risk of self-harm and harm to others, as well as potential risk to the doctor when working with a patient with mental health problems, will be included. This module will focus on adult patients only.

Learning Objectives:

  1. You will be more familiar with the components of the Mental State Examination
  2. You will be more familiar the sedation of psychotic or delirious patients
  3. You will be introduced to some of the considerations needed in paracetamol overdoses.
  4. You will be more familiar with management of patients presenting with delirium
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References:

  1. Bergen, H., Hawton, K., Waters, K., Ness, J., Cooper, J., Steeg, S. and Kapur, N., 2012. Premature death after self-harm: a multicentre cohort study. The Lancet, 380(9853), pp.1568-1574.
  2. Biln, K., Ottosson, C., Castrn, M., Ponzer, S., Ursing, C., Ranta, P., Ekdahl, K. and Pettersson, H., 2011. Deliberate self-harm patients in the emergency department: factors associated with repeated self-harm among 1524 patients. Emergency Medicine Journal, 28(12), pp.1019-1025.
  3. Bourke, J. and Castle, M., 2008. Crash Course: Psychiatry. Elsevier Health Sciences.
  4. Cooper, J., Kapur, N., Webb, R., Lawlor, M., Guthrie, E., Mackway-Jones, K. and Appleby, L., 2005. Suicide after deliberate self-harm: a 4-year cohort study. American Journal of Psychiatry, 162(2), pp.297-303
  5. Gordon, J.T., 2012. Emergency department junior medical staffs knowledge, skills and confidence with psychiatric patients: a survey. The Psychiatrist Online, 36(5), pp.186-188.
  6. Haq, S.U., Subramanyam, D. and Agius, M., 2010. Assessment of self harm in an accident and emergency service-the development of a proforma to assess suicide intent and mental state in those presenting to the emergency department with self harm. Psychiatr Danub, 22, pp.S26-32
  7. Hawton, K., Harriss, L. and Zahl, D., 2006. Deaths from all causes in a long-term follow-up study of 11583 deliberate self-harm patients. Psychological medicine, 36(03), pp.397-405.
  8. Hawton, K., Van Heeringen, K. 2009. Suicide. Lancet 373(9672):1372-81
  9. Howson, M.A., Yates, K.M. and Hatcher, S., 2008. Representation and suicide rates in emergency department patients who selfharm. Emergency Medicine Australasia, 20(4), pp.322-327.
  10. Markowitz, J.D. and Narasimhan, M., 2008. Delirium and antipsychotics: a systematic review of epidemiology and somatic treatment options. Psychiatry (Edgmont), 5(10), pp.29-36.
  11. NICE (National Institute for Clinical Excellence). 2004. Self-harm. The short-term physical and psychological managment and secondary prevention of self-harm in primary and secondary care (Quick Reference Guide). London
  12. Prescott, K., Stratton, R., Freyer, A., Hall, I. and Le Jeune, I., 2009. Detailed analyses of selfpoisoning episodes presenting to a large regional teaching hospital in the UK. British journal of clinical pharmacology, 68(2), pp.260-268.
  13. RCPsych (Royal College of Psychiatrists).2010. Self-harm, suicide and risk: helping people who self harm. Final report of a working group. College Report CR158. (accessed on the 20th December 2013)
  14. Sporer, K.A., Solares, M., Durant, E.J., Wang, W., Wu, A.H. and Rodriguez, R.M., 2012. Accuracy of the initial diagnosis among patients with an acutely altered mental status. Emergency Medicine Journal, pp.emermed-2011.
  15. Spurrell, M., Hatfield, B. and Perry, A., 2003. Characteristics of patients presenting for emergency psychiatric assessment at an English hospital. Psychiatric Services.
  16. Steeg, S., Kapur, N., Webb, R., Applegate, E., Stewart, S.L.K., Hawton, K., Bergen, H., Waters, K. and Cooper, J., 2012. The development of a population-level clinical screening tool for self-harm repetition and suicide: the ReACT Self-Harm Rule. Psychological Medicine, 42(11), p.2383.
  17. Unknown. 2011. Suicides in the United Kingdom, 2011. (accessed on 8th November 2016)
  18. Unknown. 2016. ASEPTIC MNEMONIC. (accessed on the 8th November 2016)
  19. Wyatt, J.P., Illingworth, R.N., Graham, C.A., Hogg, K., Robertson, C. and Clancy, M., 2012. Oxford handbook of emergency medicine. OUP Oxford
  20. RCEM Guidance: Paracetamol overdose: new guidance on the use of intravenous acetylcysteine

Related RCEMLearning resources:

Delirium in the Elderly

Acute delirium in the Elderly

Carbon Monoxide Poisoning

A brief guide to Section 136 for Emergency Departments

Module Content

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