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Definitive treatment in the psychiatric emergency service

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Abstract

This article briefly reviews the history of psychiatric emergency services (PES) in the United States and concludes that the dominant model, the triage model, unnecessarily limits modern PES. Trends in the mental health system and the corresponding development of compensatory PES structures are described. These include observation units, outreach, and crisis residential treatment and other innovations. These new structures have had the effect of increasing the length of stay in emergency services, increasing the number and complexity of services provided in the PES and professionalizing emergency service personnel. A new model, the treatment model, is proposed for this type of PES. Strategies for the rapid initiation of definitive treatment of bipolar disorder, schizophrenia, major depression and opiate addiction are outlined for services with this capability.

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References

  1. Wellin E, Slesinger DP and Hollister CD: Psychiatric Emergency Services: Evolution, Adaptation and Proliferation. Social Science Medicine 24:475–482, 1987.

    Google Scholar 

  2. Emergency Psychiatry broadens services beyond traditional emergency room. Psychiatric News, August 5, 1994, p. 10.

  3. Kiesler C: Mental Hospitals and Alternative Care. American Psychologist 138:349–360, 1982.

    Google Scholar 

  4. Oldham JM, Lin A and Breslin L: Comprehensive Psychiatric Emergency Services. Psychiatric Quarterly 61:57–66, 1990.

    Google Scholar 

  5. Gerson S and Bassuk E: Psychiatric Emergency Services: An Overview. American Journal of Psychiatry 137:1–11, 1980.

    Google Scholar 

  6. Torrey EF: Violent Behavior by Individuals With Serious Mental Illness. Psychiatric Services 45:653–62, 1994.

    Google Scholar 

  7. Ellison JM and Wharff EA: More Than a Gateway: The Role of the Emergency Psychiatry Service in the Community Mental Health Network. Hospital and Community Psychiatry 36:180–185 1985.

    Google Scholar 

  8. Forster P and King J: Definitive Treatment of Patients with Serious Mental Disorders in an Emergency Service, Part II. Hospital and Community Psychiatry 45:1177–1179, 1994.

    Google Scholar 

  9. Sateia MJ, Gustafson DH and Johnson SW: Quality Assurance for Psychiatric Emergencies. Psychiatric Clinics of North America 13:35–48, 1990.

    Google Scholar 

  10. Comstock BS: Psychiatric Emergency Intensive Care. Psychiatric Clinics of North America 6:305–316, 1983.

    Google Scholar 

  11. Gillig P: The Spectrum of Mobile Outreach and Its Role in the Emergency Service. In The Growth and Specialization of Emergency Psychiatry, Edited by Allen MH. San Francisco, Jossey-Bass Publishers, 1995.

    Google Scholar 

  12. Geller JL, Fisher WH and McDermeit M: A National Survey of Mobile Crisis Services and Their Evaluation. Psychiatric Services 46:893–897, 1995.

    Google Scholar 

  13. Stroup TS and Dorwart RA: Impact of a Managed Mental Health Program on Medicaid Recipients With Severe Mental Illness. Psychiatric Services 46:885–889, 1995.

    Google Scholar 

  14. Bengelsdorf H and Alden DC: A Mobile Crisis Unit in the Psychiatric Emergency Room. Hospital and Community Psychiatry 38:662–665, 1987.

    Google Scholar 

  15. Allen MH and Dacpano G: The Emergency Evaluation. Emergency Psychiatry 1:78–79, 1996.

    Google Scholar 

  16. Warner MD and Peabody CA: Reliability of Diagnoses Made by Psychiatric Residents in a General Emergency Department. Psychiatric Services 46:1284–6, 1995.

    Google Scholar 

  17. Robins E, Gentry KA, Munoz RA and Marten S: A Contrast of the Three More Common Illnesses With the Ten Less Common in a Study and 18 Month Follow-up of 314 Psychiatric Emergency Room Patients. Archives of General Psychiatry 34:285–91, 1977.

    Google Scholar 

  18. Jefferson JW: Lithium: A Therapeutic Magic Wand. Journal of Clinical Psychiatry 50:81–86, 1989.

    Google Scholar 

  19. Keck PE Jr, McElroy SL, Tugrul KC and Bennett JA. Valproate Oral Loading in the Treatment of Acute Mania. Journal of Clinical Psychiatry 54:305–308, 1993.

    Google Scholar 

  20. Prien RF, Caffey EM and Klett CJ: Comparison of Lithium Carbonate and Chlorpromazine in the Treatment of Mania. Archives of General Psychiatry 26:146–153, 1972.

    Google Scholar 

  21. Chou J C-Y: Recent Advances in Treatment of Acute Mania. Journal of Clinical Psychopharmacology 11:3–21, 1991.

    Google Scholar 

  22. Rifkin A, Doddi S, Karajgi B Borenstein M and Munne R: Dosage of Haloperidol for Mania. British Journal of Psychiatry 165:113–116, 1994.

    Google Scholar 

  23. Nelson JC, Mazure CM, Bowers MB and Jatlow PI: A Preliminary, Open Study of the Combination of Fluoxetine and Desipramine for Rapid Treatment of Major Depression. Archives of General Psychiatry 48:303–307, 1991.

    Google Scholar 

  24. Guelfi JD, White C, Hackett D, Guichoux JY and Magni G: Effectiveness of Venlafaxine in Patients Hospitalized for Major Depression and Melancholia. Journal of Clinical Psychiatry 56:450–458, 1995.

    Google Scholar 

  25. Schweitzer E, Weise C, Clary C Fox I and Rickels K: Placebo Controlled Trial of Venlafaxine for the Treatment of Major Depression. Journal of Clinical Psychopharmacology 11:233–236, 1991.

    Google Scholar 

  26. Allen MH and Frances RJ: Varieties of Psychopathology found in Patients with Addictive Disorders: A Review. In Psychopathology and Addictive Disorders Edited by Meyer RE. New York, Guildford Press, 1986.

    Google Scholar 

  27. Brewer C, Rezae H and Bailey C: Opioid Withdrawal and Naltrexone Induction in 48–72 Hours with Minimal Drop-out, Using Modification of the Naltrexone-Clonidine Technique. British Journal of Psychiatry 153:340–343, 1988.

    Google Scholar 

  28. Brown SA, Inaba RK, Gillin JC, Schuckit MA, Stewart MA and Irwin MR: Alcoholism and Affective Disorder. American Journal of Psychiatry 152:45–52, 1995.

    Google Scholar 

  29. Elangovan N, Berman S, Meinzer A, Gianelli P, Miller, H and Longmore W: Sustance Abuse among Patients Presenting at an Inner-City PsychiatricEmergency Room. Hospital & Community Psychiatry 44:782–4, 1993.

    Google Scholar 

  30. Breslow RE, Klinger BI and Erickson BJ: Crisis Hospitalization in a Psychiatric Emergency Service in the Growth and Specialization of Emergency Psychiatry. Edited by Allen MH. San Francisco, Jossey-Bass Publishers, 1995.

    Google Scholar 

  31. Schneider SE and Ross IM: Ultra-Short Hospitalization for Severely Mentally Ill Patients. Psychiatric Services 47:137–38, 1996.

    Google Scholar 

  32. Dubin WR: Rapid Tranquilization: Antipsychotics or Benzodiazepines? Journal of Clinical Psychiatry 49 [12 Supp]:5–11, 1988.

    Google Scholar 

  33. Umbricht D and Kane JM: Risperidone: Efficacy and Safety. Schizophrenia Bulletin 21:593–606, 1995.

    Google Scholar 

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Authors and Affiliations

  1. Comprehensive Psychiatric Emergency Program, Bellevue Hospital Center, 462 First Avenue, GS11, 10016, New York, NY

    Michael H. Allen M.D. (Director)

  2. NYU School of Medicine and President, American Association for Emergency Psychiatry, USA

    Michael H. Allen M.D. (Director)

Authors
  1. Michael H. Allen M.D.
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Allen, M.H. Definitive treatment in the psychiatric emergency service. Psych Quart 67, 247–262 (1996). https://doi.org/10.1007/BF02238956

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