Summary Textbook of psychiatry - H25 Spoedpsychiatrie

Textbook of Psychiatry
H25 Emergency psychiatry

Introduction
Emergency psychiatry occurs when there is a disruption of cognitive, affective and conative
functions, which requires immediate treatment. The goal of the psychiatric interventions is
to restructure an emergency situation so that the start or continuation of (psychiatric) care is
possible in a regular manner, preferably during working hours.


Registration and preparation for emergency psychiatry consultation
Typical features indicating a need for emergency psychiatry:
 Irregularity
 Agitation
 Insecurity
 Involuntary situations (not all patients ask for consultation or treatment themselves)

Sometimes police assistance is needed for safe consultation. Furthermore, when there is
need for immediate action, the police must be alerted as well. They can be on the scene
much faster than a psychiatric crisis service (same applies to ambulance and fire brigade).

Preparation for consultation:
1) Assess whether the problem should be handled by a psychiatrist or a somatic
specialist or addiction care services
2) Registration
3) Enough information on the patient?
4) Agree on mutual responsibilities and place of the consultation (with the patient)
5) Is it safe?


Initial assessment
In emergency psychiatry, acquiring a comprehensive medical history is often problematic.
This type of conversation is meant to reduce the tension. The initial assessment is comprised
of:
1) Making contact
a. Start relationship
b. Try to take control of the situation
2) History
a. Personal data
b. Main symptom (according to patient, their environment and the person
requesting the consultation)
c. Information from 3rd parties
d. Onset
e. Symptoms
f. Addiction
g. Physical diseases

, h. Precipitating factors (mental trauma and familial stress)
3) General systemic information – current living situation
a. Level of functioning
b. Social situation
c. Income
d. Day care
e. Education (including being held back at school)

The assessment and intervention phases often get intertwined in emergency psychiatry. The
psychiatrist also determines whether a patient can leave if they want to, or if the patient
presents a danger to themselves, to others or to public safety.


Diagnostics/Assessment?
You usually cannot perform a complete assessment of the patient’s mental status 
conditions are too unsettling, and the patient often doesn’t cooperate sufficiently. There is a
quick screening of the most important mental functions:

 First impressions
o Ill?
o Unkempt, neglected?
o Disturbed contact?
o Hostile, suspicious, anxious attitude?

 Cognitive functions
o Consciousness, attention & orientation
 Impaired or narrowed consciousness?
 Intoxicated?
 Hypovigilance/hypervigilance of attention?
 Disorientation in time or place?
o Memory
 Anterograde or retrograde amnesia?
 Dissociative amnesia?
o Intellectual functions
 Judgement?
 Illness awareness and insight?
 Intelligence
 Language
o Imagination, perception & self-perception
 Visual or auditory hallucinations?
 Derealization, depersonalization?
 Compulsive images?
o Thinking: form
 Tachyphrenia or bradyphrenia?
 Alogia, incoherence?
 Increased associative thought?
o Thinking: content