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List of contributors=viii

Preface=xiii

Section 1. General considerations for psychiatric care in the emergency department

1. The magnitude of the problem of psychiatric illness presenting in the emergency department / Gregory Luke Larkin ; Annette L. Beautrais=1

2. Delivery models of emergency psychiatric care / Scott L. Zeller=11

Section 2. Evaluation of the psychiatric patient

3. The medical clearance process for psychiatric patients presenting acutely to the emergency department / Vaishal Tolia ; Michael P. Wilson=19

4. Advanced interviewing techniques for psychiatric patients in the emergency department / Jon S. Berlin=25

5. Use of routine alcohol and drug testing for psychiatric patients in the emergency department / Ross A. Heller ; Erin Rapp=33

6. Drug intoxication in the emergency department / Jagoda Pasic ; Margaret Cashman=36

7. Drug withdrawal syndromes in psychiatric patients in the emergency department / Paul Porter ; Richard D. Shih=46

Section 3. Psychiatric illnesses

8. The patient with depression in the emergency department / James L. Young ; Douglas A. Rund=53

9. Assessment of the suicidal patient in the emergency department / Clare Gray=60

10. The patient with somatoform disorders in the emergency department / Reginald I. Gaylord=69

11. The patient with anxiety disorders in the emergency department / Mila L. Felder ; Marcia A. Perry=76

12. The patient with post-traumatic stress disorder in the emergency department / Michael S. Pulia ; Janet S. Richmond=83

13. The patient with psychosis in the emergency department / J. D. McCourt ; Travis Grace=88

14. Personality disorders in the acute setting / Dennis Beedle=103

15. The patient with factitious disorders or malingering in the emergency department / Rachel Lipson Glick=113

16. The patient with delirium and dementia in the emergency department / Lorin M. Scher ; David C. Hsu=117

17. The patient with excited delirium in the emergency department / Michael P. Wilson ; Gary M. Vilke=125

18. Medical illness in psychiatric patients in the emergency department / Victor G. Stiebel ; Barbara Nightengale=132

19. Acute care of eating disorders / Suzanne Dooley-Hash=140

20. Management of the emergency department patient with co-occurring substance abuse disorder / David S. Howes ; Alicia N. Sanders=150

Section 4. Treatment of the psychiatric patient

21. Use of verbal de-escalation techniques in the emergency department / Janet S. Richmond=155

22. Use of agitation treatment in the emergency department / Marc L. Martel ; Amanda E. Horn ; William R. Dubin=164

23. Management of aggressive and violent behavior in the emergency department / Amanda E. Horn ; William R. Dubin=170

24. Restraint and seclusion techniques in the emergency department / John Kahler ; Anita Hart=177

25. Use of psychiatric medications in the emergency department / Alvin Wang ; Gerald Carroll=182

26. The patient with neuroleptic malignant syndrome in the emergency department / Omeed Saghafi ; Jeffrey Sankoff=190

27. Treatment of psychiatric illness in the emergency department / Kimberly Nordstrom=197

28. Rapidly acting treatment in the emergency department / Ross A. Heller ; Laurie Byrne=206

Section 5. Special populations

29. Pediatric psychiatric disorders in the emergency department / Margaret Cashman ; Jagoda Pasic=211

30. Geriatric psychiatric emergencies / Michael A. Ward ; James Ahn=219

31. Disaster and terrorism emergency psychiatry / Michael S. Pulia=230

32. Trauma and loss in the emergency setting / Janet S. Richmond=235

33. Management of homeless and disadvantaged persons in the emergency department / Louis Scrattish ; Valerie Carroll=244

34. Management of neurobehavioral sequelae of traumatic brain injury in the emergency department / Andy Jagoda ; Silvana Riggio=251

35. Management of psychiatric illness in pregnancy in the emergency department / Eric L. Anderson=260

36. Cultural concerns and issues in emergency psychiatry / Suzie Bruch=270

37. Rural emergency psychiatry / Anthony T. Ng ; Jonathan Busko=282

Section 6. Administration of psychiatric care

38. Coordination of emergency department psychiatric care with psychiatry / Benjamin L. Bregman ; Seth Powsner=291

39. Integration with community resources / Jennifer Peltzer-Jones=297

40. The role of telepsychiatry / Avrim B. Fishkind ; Robert N. Cuyler=303

41. Emergency medical services psychiatric issues / Joseph Weber ; Eddie Markul=308

42. Triage of psychiatric patients in the emergency department / Mark Newman ; Margaret Judd ; Divy Ravindranath=313

43. The Emergency Medical Treatment and Active Labor Act (EMTALA) and psychiatric patients in the emergency department / Derek J. Robinson=320

44. Assessing capacity, involuntary assessment, and leaving against medical advice / Susan Stefan=324

45. Best practices for the evaluation and treatment of patients with mental and substance use illness in the emergency department / Maureen Slade ; Deborah Taber ; Jerrold B. Leikin ; MaryLynn McGuire Clarke=335

46. Improving emergency department process and flow / Peter Brown ; Stuart Buttlaire ; Larry Phillips=347

47. Physical plant for emergency psychiatric care / Patricia Lee ; Joseph R. Check=355

48. Legal issues in the care of psychiatric patients / Susan Stefan=362

49. Law enforcement and emergency psychiatry / Daryl Knox=373

50. Research in emergency psychiatry / Ross A. Heller ; Preeti Dalawari=378

51. Administration / Harvey L. Ruben ; Lara G. Chepenik=382

Index=391

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Emergency physicians, in all practice settings, care for patients with both undifferentiated psycho-behavioral presentations and established psychiatric illness. This reference-based text goes beyond diagnostics, providing practical input from physicians experienced with adult emergency psychiatric patients. Physicians will increase their understanding and gain confidence working with these patients, even when specialized psychiatric back-up is lacking. Behavioral Emergencies for the Emergency Physician is comprehensive, covering the pre-hospital setting and advising on evidence-based practice; from collaborating with psychiatric colleagues to establishing a psychiatric service in your ED. Sedation, restraint and seclusion are outlined. Potential dilemmas when treating pregnant, geriatric or homeless patients with mental illness are discussed in detail, along with the more challenging behavioral diagnoses such as malingering, factitious and personality disorders. This go-to, comprehensive volume is invaluable for trainee and experienced emergency physicians, as well as psychiatrists, psychologists, psychiatric and emergency department nurses and other mental health workers.

This comprehensive, go-to volume features cutting edge discussion of the emergency department management of mental health patients.

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