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Chapter 62. Treatment of Psychiatric Emergencies

Margaret B. Weigel, M.D.; David C. Purselle, M.D., M.S.; Barbara D'Orio, M.D., M.P.A; Steven J. Garlow, M.D., Ph.D.
DOI: 10.1176/appi.books.9781585623860.425634

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Excerpt

Psychiatric emergencies occur in many different situations in both clinical and nonclinical settings. While often managed in specialized psychiatric emergency and crisis stabilization units, psychiatric emergencies may also surface in other settings, such as general medical/surgical units and outpatient clinics, general emergency departments, and other nonclinical settings. The resources and personnel available in a facility will significantly affect the thoroughness of the evaluation, options for short-term stabilization, and ultimate disposition of the patient. A fully staffed, freestanding psychiatric emergency room will provide more options for patient care than will an ambulatory clinic or a general emergency medicine department.

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Table Reference Number
TABLE 62–1. Psychiatric emergencies that do not require pharmacological intervention
Table Reference Number
TABLE 62–2. Acute and chronic risk factors for suicide
Table Reference Number
TABLE 62–3. Psychiatric emergencies requiring minimal or adjunctive pharmacological intervention
Table Reference Number
TABLE 62–4. Psychiatric emergencies that *usually* require pharmacological intervention

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Sample questions:
1.
You evaluate a 17-year-old adolescent for depression and recommend to the mother that because the daughter’s symptoms of depression are of moderate severity, her daughter would benefit from pharmacotherapy and, in particular, a selective serotonin reuptake inhibitor (SSRI). The mother is quite concerned about the new U.S. Food and Drug Administration (FDA) black box warning in the prescribing information for SSRIs about an increased risk of suicidal ideation in children, adolescents, and young people who are placed on these medications. You respond by referring to research that has been published concerning this issue. Which of the following statements is correct?
2.
Which of the following statistical statements concerning suicide is true?
3.
You are called to evaluate a patient in the emergency room following a multiple-vehicle accident in which several people were killed. The patient was a passenger in one of the cars and is experiencing symptoms that place him at high risk for developing posttraumatic stress disorder (PTSD). You decide to start him on medication in the emergency room with the hope of decreasing the likelihood of his subsequently developing PTSD. Which of the following medications should you avoid?
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