Emergency psychiatry

Abstract

Up to 15% of people that are visited in the Emergency Department of a Hospital have a mental disorder and/or a psychiatric symptom: often this is not recognized or not properly treated. The reasons for this are more than one and involve: the emergency physicians that are not always prepared and sensible to face this kind of disorders; the psychiatrists that are not always well tuned with the language and the clinic of the emergency; and the patients, that can ignore or deny the psychiatric nature of their problems. After an initial definitions of the most important terms and concepts (Psychiatric Emergency and Urgency, Behavioral Emergency, Acute Presentations of Mental Disorders, and Crisis) the Medical and Psychiatric Assessment are discussed with different Clinical Presentations and Classifications, Psychosocial Evaluation and Risk Assessment. Finally the Clinical Management and the Pharmacological Treatment are presented with special attention to the underlying medical causes and to the use of new drugs, especially second generation antipsychotics, alone or combined with benzodiazepines.