Skip to main content
Book cover

Handbook of Consultation-Liaison Psychiatry pp 39–62Cite as

Psychiatric Consultation in the Emergency Setting

  • 2022 Accesses

Abstract

Consultants may be called to an emergency department for a variety of reasons. Most requests are like those from a general hospital ward. However, two issues are notable: a broader definition of psychiatric emergencies and greater concern about patient rights. These issues stem from an emergency department’s lack of a buffer from its surrounding community: patients come as they are, whether pushed, or just so inclined, whether in crisis, or just avoiding clinic appointment delays. There is little or no time for patients and emergency department staff to come to any understanding. In this absence of a traditional physician–patient relationship, consultants may be forced to change their usual approach.

Keywords

  • Emergency Department
  • Emergency Department Visit
  • Medical Illness
  • Alcohol Withdrawal
  • Psychiatric Evaluation

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

This is a preview of subscription content, access via your institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-319-11005-9_5
  • Chapter length: 24 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   74.99
Price excludes VAT (USA)
  • ISBN: 978-3-319-11005-9
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   99.00
Price excludes VAT (USA)
Hardcover Book
USD   139.00
Price excludes VAT (USA)
Learn about institutional subscriptions

References

  • Alexander, J., Tharyan, P., Adams, C., John, T., Mol, C., & Philip, J. (2004). Rapid tranquillisation of violent or agitated patients in a psychiatric emergency setting. Pragmatic randomised trial of intramuscular lorazepam v. haloperidol plus promethazine. British Journal of Psychiatry, 185, 63–69.

    PubMed  CrossRef  Google Scholar 

  • Allen, M. H., Currier, G. W., Carpenter, D., Ross, R., & Docherty, J. P. (2005). Treatment of behavioral emergencies. Journal of Psychiatric Practice, 11(suppl 1), 5–108.

    PubMed  CrossRef  Google Scholar 

  • American Academy of Emergency Medicine. (2006). http://www.aaem.org/emtala/.

  • American Psychiatric Association. (2013). Practice guideline for the assessment and treatment of patients with suicidal behaviors. The American Journal of Psychiatry, 160(11 suppl), 1–60.

    Google Scholar 

  • Andrezina, R., Josiassen, R. C., Marcus, R. N., et al. (2006). Intramuscular aripiprazole for the treatment of acute agitation in patients with schizophrenia or schizoaffective disorder: A double-blind, placebo-controlled comparison with intramuscular haloperidol. Psychopharmacology, 188, 281–292.

    CAS  PubMed  CrossRef  Google Scholar 

  • Battaglia, J., Moss, S., Rush, J., et al. (1997). Haloperidol, lorazepam, or both for psychotic agitation? A multicenter, prospective, double-blind, emergency department study. American Journal of Emergency Medicine, 15, 335–340.

    CAS  PubMed  CrossRef  Google Scholar 

  • Breier, A., Meehan, K., Birkett, M., et al. (2002). A double-blind, placebo-controlled dose-response comparison of intramuscular olanzapine and haloperidol in the treatment of acute agitation in schizophrenia. Archives of General Psychiatry, 59, 441–448.

    CAS  PubMed  CrossRef  Google Scholar 

  • Breitbart, W., Marotta, R., Platt, M. M., et al. (1996). A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. The American Journal of Psychiatry, 153, 231–237.

    CAS  PubMed  Google Scholar 

  • Broderick, K. B., Lerner, E. B., McCourt, J. D., Fraser, E., & Salerno, K. (2002). Emergency physician practices and requirements regarding the medical screening examination of psychiatric patients. Academic Emergency Medicine, 9, 88–92.

    PubMed  CrossRef  Google Scholar 

  • Brook, S., Lucey, J. V., Gunn, K. P., & Ziprasidone, I. M. (2000). Study Group. Intramuscular ziprasidone compared with intramuscular haloperidol in the treatment of acute psychosis. Journal of Clinical Psychiatry, 61, 933–941.

    CAS  PubMed  CrossRef  Google Scholar 

  • Centers for Medicare and Medicaid Services. (2006). http://www.cms.hhs.gov/MLNEd WebGuide/25_EMDOC.asp.

  • Drugdex® System. (2006). http://www.thomsonhc.com. Greenwood Village, CO: Thomson Micromedex.

  • Eli Lilly. (2006). http://www.fda.gov/medwatch/safety/2006/Aug_PIs/Zyprexa_PI.pdf.

  • FDA. (2001). Food and drug administration. Rockville, MD http://www.fda.gov/bbs/topics/ANSWERS/2001/ANS01123.html.

  • FDA. (2005). Food and drug administration. Rockville, MD. http://www.fda.gov/cder/drug/antidepressants/default.htm.

  • FDA. (2006). Food and drug administration. Rockville, MD: http://www.fda.gov/cder/drug/InfoSheets/HCP/aripiprazoleHCP.htm.

  • FDA. (2012). Food and drug administration. Rockville, MD. http://www.accessdata.fda.gov/drugsatfda_docs/appletter/2012/022549Orig1s000ltr.pdf.

  • Follman, M., Aronsen, G., Pan, D., & Caldwell, M. US Mass Shootings, 1982–2012: Data From Mother Jones’ Investigation (plus additional cases from 2013). Mother Jones Fri Dec. 28, 2012 http://www.motherjones.com/politics/2012/12/mass-shootings-mother-jones-full-data. Accessed 2013.09.22 20:42 UTC.

  • Herbert, P. B., & Young, K. A. (2002). Tarasoff at twenty-five. The Journal of the American Academy of Psychiatry and the Law, 30, 275–281.

    PubMed  Google Scholar 

  • HHS: U.S. Dept of Health & Human Services. About the Law [ACA]. http://www.hhs.gov/healthcare/rights/index.html. Accessed 9 22, 2013, 21:00 UTC.

  • Holloman, G. H., Jr., & Zeller, S. L. (2012). Overview of project BETA: Best practices in evaluation and treatment of agitation. Western Journal of Emergency Medicine, 13(1), 1–2.

    PubMed Central  PubMed  CrossRef  Google Scholar 

  • Last Samurai, The Screenplay by John Logan. Dir. Edward Zwick. Prod. Bob Johnson. Perf. Tom Cruise and Ken Watanabe. Warner Brothers, 2003. Film.

    Google Scholar 

  • Lesem, M. D., Tran-Johnson, T. K., et al. (2011). Rapid acute treatment of agitation in individuals with schizophrenia: Multicentre, randomised, placebo-controlled study of inhaled loxapine. British Journal of Psychiatry, 198(1), 51–58.

    PubMed  CrossRef  Google Scholar 

  • Lukens, T. W., Wolf, S. J., Edlow, J. A., et al. (2006). Clinical policy: Critical issues in the diagnosis and management of the adult psychiatric patient in the emergency department. Annals of Emergency Medicine, 47, 79–99.

    PubMed  CrossRef  Google Scholar 

  • Martel, M., Sterzinger, A., Miner, J., Clinton, J., & Biros, M. (2005). Management of acute undifferentiated agitation in the emergency department: A randomized double-blind trial of droperidol, ziprasidone, and midazolam. Academic Emergency Medicine, 12, 1167–1172.

    PubMed  CrossRef  Google Scholar 

  • Mayo-Smith, M. F., Beecher, L. H., Fischer, T. L., et al. (2004). Working group on the management of alcohol withdrawal delirium, practice guidelines committee. American society of addiction medicine. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Archives of Internal Medicine, 12(164), 1405–1412.

    CrossRef  Google Scholar 

  • NIDA. (2012). DrugFacts: Spice (Synthetic Marijuana). http://www.drugabuse.gov/publications/drugfacts/spice-synthetic-marijuana. Accessed 9 22, 201, 20:55 UTC.

  • Paris, J. (2006). Predicting and preventing suicide: Do we know enough to do either? Harvard Review of Psychiatry, 14, 233–240.

    PubMed  CrossRef  Google Scholar 

  • Pfizer, R. (2005). New York: http://www.fda.gov/medwatch/safety/2005/aug_PI/Geodon_PI.pdf.

    Google Scholar 

  • Preval, H., Klotz, S. G., Southard, R., & Francis, A. (2005). Rapid-acting IM ziprasidone in a psychiatric emergency service: a naturalistic study. General Hospital Psychiatry, 27, 140–144.

    PubMed  CrossRef  Google Scholar 

  • Richmond, J. S., Berlin, J. S., Fishkind, A. B., et al. (2012). Verbal De-escalation of the agitated patient: consensus statement of the American association for emergency psychiatry project BETA De-escalation workgroup. Western Journal of Emergency Medicine, 13(1), 17–25.

    PubMed Central  PubMed  CrossRef  Google Scholar 

  • Rund, D. A., & Hutzler, J. C. (2004). Behavioral disorders: emergency assessment. In J. E. Tintinalli, G. D. Kelen, & J. S. Stapczynski (Eds.), Emergency medicine: A comprehensive study guide (6th ed.). New York, NY: McGraw-Hill.

    Google Scholar 

  • Scahill, L., Blair, J., Leckman, J. F., & Martin, A. (2005). Sudden death in a patient with Tourette syndrome during a clinical trial of ziprasidone. Journal of Psychopharmacology, 19, 205–206.

    PubMed  CrossRef  Google Scholar 

  • Shah, S. J., Fiorito, M., & McNamara, R. M. (2012). A screening tool to medically clear psychiatric patients in the emergency department. Journal of Emergency Medicine, 43(5), 871–875.

    PubMed  CrossRef  Google Scholar 

  • Tesar, G. E. (1996). The emergency department. In J. R. Rundell & M. G. Wise (Eds.), Textbook of consultation-liaison psychiatry (pp. 914–945). Washington, DC: American Psychiatric Press.

    Google Scholar 

  • Thomas, L. E., & King, R. A. (2007). Child and adolescent psychiatric emergencies. In A. Martin & F. R. Volkmar (Eds.), Chap 6.4 in Lewis’s child and adolescent psychiatry: A comprehensive textbook. Philadelphia, PA: Lippincott Williams & Wilkins.

    Google Scholar 

  • TREC Collaborative Group. (2003). Rapid tranquillisation for agitated patients in emergency psychiatric rooms: A randomised trial of midazolam versus haloperidol plus promethazine. British Medical Journal, 327, 708–713.

    PubMed Central  CrossRef  Google Scholar 

  • Volkow ND. “Bath Salts”—Emerging and dangerous products. Feb 2011. http://www.drugabuse.gov/about-nida/directors-page/messages-director/2011/02/bath-salts-emerging-dangerous-products. Accessed 9 22, 2013, 20:55 UTC.

  • Zun, L., & Emembolu, F. N. (2010). Medical clearance in the emergency department: Is testing indicated? Primary Psychiatry, 17(6), 29–34.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Professor of Psychiatry and Emergency Medicine, Yale University, 20 York St, Rm Fitkin 615, New Haven, CT, 06220-3220, USA

    Seth Powsner MD

Authors
  1. Seth Powsner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seth Powsner MD .

Editor information

Editors and Affiliations

  1. Department of Psychiatry, University of California, San Francisco, Fresno Community Regional Medical Center, Fresno, California, USA

    Hoyle Leigh

  2. University of Hawaii at Manoa Department of Psychiatry, Honolulu, Hawaii, USA

    Jon Streltzer

Rights and permissions

Reprints and Permissions

Copyright information

© 2015 Hoyle Leigh & Jon Streltzer

About this chapter

Cite this chapter

Powsner, S. (2015). Psychiatric Consultation in the Emergency Setting. In: Leigh, H., Streltzer, J. (eds) Handbook of Consultation-Liaison Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-11005-9_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-11005-9_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-11004-2

  • Online ISBN: 978-3-319-11005-9

  • eBook Packages: MedicineMedicine (R0)