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Psychiatric Emergencies: A Complex Case of Overdose and Assessment in the Emergency Department

  • Bruce Fage
  • Jodi Lofchy
Chapter

Abstract

In this chapter, we explore the challenges associated with patients experiencing chronic or recurrent suicidal ideation. We discuss the case of Jennifer, a woman suffering from borderline personality disorder who presents to the emergency department in a time of interpersonal crisis. We review suicide risk assessments in this vulnerable population, highlight key risk factors, and provide an example of risk assessment documentation. We present therapeutic techniques for managing personal and countertransference reactions, drawing from techniques associated with Dialectical Behaviour Therapy. We explore the interface between medical and psychiatric issues in the emergency setting and review recommendations for dealing with these complex patients. Finally, we revisit our case and discuss a trauma-informed approach to managing agitation and distress.

Keywords

Borderline personality disorder Suicide Risk assessment Emergency management 

Abbreviations

BPD

Borderline personality disorder

DBT

Dialectical Behaviour Therapy

ED

Emergency department

Project BETA

Best Practices in Evaluation and Treatment of Agitation

Notes

Disclosure Statement

“The authors have nothing to disclose.”

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of TorontoTorontoCanada
  2. 2.Psychiatry Emergency Services, Department of PsychiatryUniversity Health Network, University of TorontoTorontoCanada

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