Psychiatric Emergencies: Introduction | Common Clinical Presentations | Management of the Aggressive Pediatric Patient | Summary | Summary Points | References
Children and adolescents with psychiatric disorders
are presenting in the emergency department (ED) at ever increasing
rates. Some of this is due to the limited availability of inpatient
psychiatric beds and the subsequent growth of emergent care facilities (Christodulu et al. 2002). These young patients stress the system by placing
unique demands on pediatric and mental health clinicians. Frequently,
the emergency contact is their first visit with psychiatric services.
Despite a lack of familiarity and information, the mental health
team must safely, carefully, and in a culturally and developmentally
appropriate manner, manage these cases. Patients may present with
adults who are not the child's primary caregivers and who
are unfamiliar with the psychiatric history. In addition, these
children are more likely to be aggressive and dangerous, requiring
more time and resources (see Table 39–1 for an assessment
summary). Psychiatric symptoms may be the result of an intercurrent
medical illness, which is more likely in patients who present with new-onset,
acute psychiatric complaints (Olshaker et al. 1997).
Each patient presenting for emergent care should, therefore, receive
a medical history and a full medical evaluation. Identification
and treatment of psychiatric emergencies in children and adolescents
are essential parts of the "safety net" that must
be available for children in crisis and for those who have not been able
to appropriately access mental health services.