Emergency Psychiatry (Primer On)

Psychiatric emergencies are encountered throughout the practice of medicine, in many clinical settings. They may range from a patient expressing suicidal thoughts in an outpatient medical visit to an agitated, threatening patient with psychosis who is acutely intoxicated brought to the Emergency Department by ambulance. Decisions regarding admission, discharge, treatment, and referral are time-sensitive in the emergency setting or when acute safety issues are at stake. A broad knowledge of psychiatry and an understanding of potential medical etiologies of behavioral changes are important, as well as skills navigating what can be a complicated consultation relationship with the emergency department and challenging systems-based issues. In a time when emergency department visits continue to grow, resources for inpatient beds remain scarce and outpatient care can be difficult to access, the demand for psychiatric care and evaluation in the emergency setting is crucial.

This volume, the 12th in the Primer On series, provides a straightforward approach to evaluating and managing common psychiatric emergencies. Blending case examples with up-to-date evidence-based approaches, this book serves as both a reference and introductory text for clinicians who are working in an emergency department or emergency consult setting.

• Diverse set of authors from all across the country encompassing both psychiatrists and emergency medicine physicians
• User friendly format that was specifically constructed to serve a variety of readers
• Applicability to both hospital-based and community-based settings

Section I: The Approach to Emergency Psychiatric Evaluation
1. An Initial Approach to the Emergency Evaluation (Pitfalls, Pearls, and notice of Countertransference)
2. Evaluating and Managing the Agitated Patient
3. Medical Assessment of the Psychiatric Patient
4. Assessing for Suicidality and Overall Risk of Violence
5. Telepsychiatry and Beyond: Future Directions in Emergency Psychiatry
6. Cultural Competence in Emergency Psychiatry
Section II: Specific Disorders, Diagnoses, and Symptoms frequently encountered as Psychiatric Emergencies
1. Altered Mental Status and Neurologic Syndromes
2. Intoxication, Withdrawal, and Symptoms of Substance Use Disorders
3. Psychosis, Psychotic Disorders, and the Schizophrenia Spectrum
4. Emergency Psychiatry Evaluation and Treatment of Mood Disorders
5. Anxiety, PTSD, and other Trauma Related Disorders
6. Personality Disorders
7. Deception in the Emergency Setting: Malingering and Factitious Disorder
8. Eating Disorders and Somatic Symptom Disorders
Section III: Specific Populations frequently encountered as Psychiatric Emergencies
1. Children and Adolescents
2. Geriatrics
3. Developmental Disabilities
4. Perinatal Patients and related Illnesses, Symptoms, and Complications related to Pregnancy
5. Victims of Physical and Sexual Violence (including identification and reporting issues)
Section IV: Disposition, Aftercare, Legal Issues, and Future Directions
1. Tool, Constraint, Liability, Context: Law and Emergency Psychiatry
2. Documenting risk assessments and high acuity discharge presentations
3. Trauma Informed Care, Psychological First Aid, and Recovery Oriented Approaches in the ER
4. Collaborations WITHIN the ED: observation units, consult models, boarding processes, and future directions
5. Collaborations BEYOND the ED: mobile crisis teams, peer services, and working with law enforcement
6. Quality Improvement in Psychiatric Emergency Settings: Making Care Better and Safer

Tony Thrasher

Dr. Tony Thrasher is a board-certified psychiatrist employed as the medical director for the Crisis Services branch of the Milwaukee County Behavioral Health Division. He received his psychiatric training from Washington University in St. Louis, and he is the current President of the American Association for Emergency Psychiatry (AAEP). He is a Distinguished Fellow of the American Psychiatric Association (APA), and he currently serves as the President Elect for both the Wisconsin Psychiatric Association (WPA) and the Wisconsin Association of Osteopathic Physicians and Surgeons (WAOPS). Additionally, he enjoys teaching as a Clinical Associate Professor with the Medical College of Wisconsin (MCW), serving on the NAMI Wisconsin Board of Directors, and working with Psychiatric Times on a series of Mental Health Minute webinars.

Contributors:

Anna K. McDowell, MD
Rocky Mountain Regional Veterans Affairs Medical Center
Aurora, CO

Annaliese Koller Shumate, DO
Milwaukee County Behavioral Health Division
Milwaukee, WI

Arpit Aggarwal, MD
Assistant Professor of Clinical Psychiatry
University of Missouri
Columbia, MO

Benjamin Merotto, MD
Behavioral Health Services
Denver Health and Hospital Authority
Denver, CO

Bernard Biermann MD, Ph. D.
Department of Psychiatry
University of Michigan Medical School
Ann Arbor, MI

Chelsea Wolf, MD, MA
Medical Director
Adult Inpatient Psychiatry
Denver Health Medical Center
Denver, CO

Claire F. Drom, MD
CentraCare
St. Cloud, MN

Daniel Cho, MD
University of Hawai'i at Mānoa
John A. Burns School of Medicine
Honolulu, HI

Earl Hishinuma, PhD
University of Hawai'i at Mānoa
John A. Burns School of Medicine
Honolulu, HI

Eileen P. Ryan, DO
Assistant Professor of Psychiatry and Behavioral Health
The Ohio State University Wexner Medical Center
Columbus, OH

Heidi Burns, MD
Department of Psychiatry
University of Michigan Medical School
Ann Arbor, MI

Helena Winston, MD, MS
Denver Health Medical Center
Denver, CO

Ian Steele, MD
Assistant Professor of Psychiatry and Behavioral Medicine
Medical College of Wisconsin
Milwaukee, WI

Ishmael Gomes, B. A.
Chaminade University of Honolulu
Honolulu, HI

Janet Richmond, MSW
Emergency Psychiatry Clinician
McLean Hospital
Belmont, MA

Jennifer Baumhauer, MD
Clinical Assistant Professor
Department of Psychiatry
University of Michigan
Ann Arbor, MI

Jennifer Goldman
Medical Director
OMH, Crisis & Community Services at Office of Mental Health
Albany, NY

Jessica Tse, DO
General Psychiatry Resident at Rocky Vista University/HealthONE
Behavioral Health and Wellness Center of Aurora
Aurora, CO

John S. Rozel
Associate Professor of Psychiatry and Adjunct Professor of Law
University of Pittsburgh
Pittsburgh, PA

Joseph B. Bond, MD, MPH
Massachusetts General Hospital
Harvard Medical School
Cambridge, MA

Julie Ruth Owen, MD, MBA
Medical College of Wisconsin
Milwaukee, WI

Junji Takeshita, MD
Professor and Associate Chair of Clinical Services
Geriatric Psychiatry Program Director
University of Hawai'i at Mānoa
John A. Burns School of Medicine

Justin Kuehl, PsyD
Milwaukee County Behavioral Health Division
Milwaukee, WI

Katherine Maloy, MD
Assistant Clinical Professor
NYU School of Medicine
New York, NY

Kristie Ladegard, MD
Assistant Professor
University of Colorado
Denver, CO

Laura W. Barnett, DO
Assistant Professor of Psychiatry and Behavioral Health
The Ohio State University Wexner Medical Center
Columbus, OH

Layla Soliman
Atrium Health Behavioral Health Charlotte, Carolinas Medical Center
Charlotte, NC

Margaret E. Balfour, MD, PhD
Associate Professor of Psychiatry
University of Arizona
Tucson, AZ

Matthew Goldman, MD, MS
Medical Director for Comprehensive Crisis Services, San Francisco Department of Public Health
Clinical Assistant Professor, UCSF Department of Psychiatry and Behavioral Science
San Francisco, CA

Megan B Schabbing, MD
System Medical Director
Psychiatric Emergency Services, OhioHealth
Columbus, OH

Michael Riddle
Chief Medical Officer
Connections Health Solution
Phoenix, AZ

Nasuh Malas MD, MPH
Department of Psychiatry
University of Michigan Medical School
Ann Arbor, MI

Nicole R. Smith, MD
National Institute of Mental Health
Bethesda, MD

Oluwole Popoola, MD, MPH
Assistant Professor of Clinical Psychiatry
University of Missouri, Columbia
Columbia, MO

Richard Rhoads, MD
Assistant Professor of Psychiatry
University of Arizona
Tucson, AZ

Sara Brady, MD
Assistant Professor of Psychiatry and Behavioral Medicine
Medical College of Wisconsin
Milwaukee, WI

Sarah Slocum, MD
Dartmouth Health Staff Psychiatrist
New Hampshire Hospital
Exeter, NH

Scott A. Simpson, MD, MPH
Behavioral Health Services
Denver Health and Hospital Authority
Denver, CO

Seth Thomas, MD, F. A. C. E. P.
Director of Quality & Performance, Vituity
Emergency Medicine, Mercy San Juan Medical Center
Carmichael, CA

Shafi Lodhi
Forensic Psychiatry Fellow
Stanford University School of Medicine
Stanford, CA

Stephen Leung, MD, PGY-IV
House Officer, Department of Psychiatry
University of Michigan
Ann Arbor, MI

Thomas W. Heinrich, MD, FACLP
Professor of Psychiatry and Behavioral Medicine
Medical College of Wisconsin
Milwaukee, WI

Victor Hong, MD
Clinical Assistant Professor
Department of Psychiatry
University of Michigan
Ann Arbor, MI

Victor Huynh, DO
Mindful Health Solutions
Walnut Creek, CA

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