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Psychiatric and Behavioral Emergencies, An Issue of Emergency Medicine Clinics of North America, E-Book

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Guest editors Dr. David Kuo and Dr. Veronic Tucci have assembled an expert team of authors on the topic of Psychiatric and Behavioral Emergencies. Articles include: The Emergency Physician's role in the Medical Clearance of the Psychiatric Patient, Stabilization and Management of the Acutely Agitated or Psychotic Patient, Stabilizing and Managing Patients with Altered Mental Status and Delirium, Depression and Suicidal Patients, The New Drugs of Abuse and Withdrawal Syndromes, Strategies for Managing Patients with Personality and Somatoform Disorders, Special Considerations in the Trauma Patient, and more!

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Published 07 January 2016
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EAN13 9780323416856
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Psychiatric and
Behavioral Emergencies
Emergency Medicine Clinics of North
America
EDITORS
Dick C. Kuo, MD
Section of Emergency Medicine, Department of Medicine, Baylor College of Medicine,
Houston, TX, USA
Veronica Tucci, MD, JD
Section of Emergency Medicine, Department of Medicine, Baylor College of Medicine,
Houston, TX, USA
CONSULTING EDITOR
Amal Mattu

Clinics Review Articles

www.emed.theclinics.com

November 2015 • Volume 33 • Number 4Table of Contents
Cover image
Title page
Copyright
Contributors
Consulting Editor
Editors
Authors
Forthcoming Issues
Forthcoming Issues
Recent Issues
CME Accreditation Page
Foreword. Behavioral and Psychiatric Emergencies
Preface. The Hidden Costs of Behavioral and Psychiatric Emergencies
References
Down the Rabbit Hole: Emergency Department Medical Clearance of Patients with
Psychiatric or Behavioral Emergencies
Key points
Introduction
Clinical evaluation
Medical problems presenting as psychiatric complaints
Laboratory and ancillary testingSummary
References
Stabilization and Management of the Acutely Agitated or Psychotic Patient
Key points
Introduction
Pathophysiology
Assessment
Management goals
Nonpharmacologic strategies
Pharmacologic strategies
Summary
References
Stabilizing and Managing Patients with Altered Mental Status and Delirium
Key points
Introduction
Recognizing delirium
Differentiating psychiatric presentation from delirium
History
Physical examination
Work up for altered mental status
Stabilization and management
Summary
References
Depression and the Suicidal Patient
Key points
Background and epidemiology
Definition of depression
Differential diagnosis
Role of emergency department physician in evaluating patients with depressionThe emergency department interview of depressed patients
The role of collateral and family support
Screening tools for depression
Assessment of suicide
Disposition in the emergency department
Summary
References
New Drugs of Abuse and Withdrawal Syndromes
Key points
NBOMe
Stimulants
Synthetic cannabinoids
Evaluation and management in the emergency department setting
Evaluation and management in the outpatient setting
References
Shift, Interrupted: Strategies for Managing Difficult Patients Including Those with
Personality Disorders and Somatic Symptoms in the Emergency Department
Key points
Introduction
Somatoform disorders: diagnostic difficulty and poor response to routine treatments
Patients with difficult personalities
Difficulty caused by provider feelings—bias and countertransference
Summary
References
Special Considerations in Pediatric Psychiatric Populations
Key points
Introduction
Triage of the pediatric emergency patient
Depression and suicidal ideationPatient evaluation overview
Pharmacologic treatment
Disposition
The aggressive or violent pediatric patient
Treatment
Autism spectrum disorders and attention deficit hyperactivity disorder introduction
Patient evaluation overview
Oppositional-defiant disorder and conduct disorder
Effect of social media and internet on pediatric psychiatric presentations
Summary
References
Psychiatric Emergencies in the Elderly
Key points
Introduction
Delirium
Dementia
Depression
Suicide
Alcohol dependence and substance abuse
Polypharmacy
Elder abuse and neglect
Altered mental status
Summary
References
Psychiatric Emergencies in Pregnant Women
Key points
Introduction
Medical screening of psychiatric illness in pregnancy
Agitation in pregnancy
Specific disorders during pregnancySummary
References
Special Considerations in Trauma Patients
Key points
Introduction
Evaluation and treatment
Chronic traumatic encephalopathy
Acute stress disorder and posttraumatic stress disorder
Summary
References
Ethical Issues in Emergency Psychiatry
Key points
Introduction
Capacity and Consent
Privacy and confidentiality
Involuntary treatment
Summary
References
Health Policy Considerations in Treating Mental and Behavioral Health Emergencies
in the United States
Key points
History of mental health services in the United States
Emergency mental health delivery in the United States today
Emergency psychiatric care: a tattered system
Treating mental and behavioral health emergencies: mental health system
considerations
Treating mental and behavioral health emergencies: emergency department policy
considerations
Treating mental health emergencies: policy considerations beyond the hospital
SummaryReferences
IndexCopyright
ELSEVIER
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EMERGENCY MEDICINE CLINICS OF NORTH AMERICA Volume 33, Number 4
November 2015 ISSN 0733-8627, ISBN-13: 978-0-323-41684-9
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Printed in the United States of America.Contributors
Consulting Editor
AMAL MATTU, MD, FAAEM, FACEP, Professor and Vice Chair, Department of
Emergency Medicine, University of Maryland School of Medicine, Baltimore,
Maryland
Editors
DICK C. KUO, MD, Associate Professor, Section of Emergency Medicine,
Department of Medicine, Baylor College of Medicine, Houston, Texas
VERONICA TUCCI, MD, JD, Assistant Professor, Section of Emergency Medicine,
Department of Medicine, Baylor College of Medicine, Houston, Texas
Authors
MICHAEL K. ABRAHAM, MD, MS, Clinical Assistant Professor, Department of
Emergency Medicine, University of Maryland School of Medicine, Baltimore,
Maryland
NATHAN GOLD ALLEN, MD, Section of Emergency Medicine, Department of
Medicine, Center for Medical Ethics and Health Policy, Baylor College of Medicine,
Houston, Texas
MOHAMMAD SHAMI ALZAHRI, MD, MSc, Section of Emergency Medicine,
Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston,
Texas; King Saud University, Riyadh, Saudi Arabia
SHARADAMANI ANANDAN, MD, Assistant Professor, Department of
Psychiatry, Baylor College of Medicine, Houston, Texas
SARA ANDRABI, MD, Department of Medicine, Section of Emergency Medicine,
Baylor College of Medicine, Houston, Texas
PATRICK R. AQUINO, MD, Assistant Professor, Department of Psychiatry and
Behavioral Medicine, Lahey Hospital and Medical Center, Tufts University School of
Medicine, Burlington, Massachusetts
BIANCA ASAN, MD, Section of Emergency Medicine, Ben Taub Hospital, Baylor
College of Medicine, Houston, Texas
ERIN AUFDERHEIDE, MD, Section of Emergency Medicine, Baylor College of
Medicine, Houston, Texas
RAKEL C. BEALL, MD, Assistant Professor, Psychiatry and Behavioral Sciences,
Baylor College of Medicine, Houston, Texas
CEDRIC DARK, MD, MPH, Assistant Professor Medicine, Emergency Medicine,Baylor College of Medicine, Houston, Texas
ELIZABETH H. DAVID, MD, Assistant Professor, Menninger Department of
Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
NATHAN DEAL, MD, Section of Emergency Medicine, Emergency Center, Ben
Taub General Hospital, Baylor College of Medicine, Houston, Texas
ARACELI FLORES, PhD, Assistant Professor, Menninger Department of Psychiatry
and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
SPENCER GREENE, MD, MS, FACEP, Assistant professor, Departments of
Medicine and Pediatrics, Sections of Emergency Medicine, Baylor College of Medicine,
Houston, Texas
THIAGO C. HALMER, MD, MBA, Emergency Medicine Resident Physician, Baylor
College of Medicine, Houston, Texas
JIN Y. HAN, MD, Assistant Professor, Menninger Department of Psychiatry and
Behavioral Sciences, Baylor College of Medicine, Houston, Texas
MICHELLE HONG, MD, PharmD, Section of Emergency Medicine, Emergency
Center, Ben Taub General Hospital, Baylor College of Medicine, Houston, Texas
S. KALRA, MD, MPH, Post-doctoral Fellow, Department of Research and
Innovation, St Luke's University Health Network, Bethlehem, Pennsylvania
JEFFREY STEVEN KHAN, MD, Menninger Department of Psychiatry and
Behavioral Sciences, Baylor College of Medicine, Houston, Texas
DICK C. KUO, MD, Associate Professor, Section of Emergency Medicine,
Department of Medicine, Baylor College of Medicine, Houston, Texas
BENJAMIN LI, MD, Medical Director, Harris Health Substance Abuse Treatment
Program; Assistant Professor, Menninger Department of Psychiatry, Baylor College of
Medicine, Houston, Texas
ANU MATORIN, MD, Associate Professor, Menninger Department of Psychiatry
and Behavioral Sciences, Neuropsychiatric Center, Ben Taub General Hospital, Baylor
College of Medicine, Houston, Texas
NIDAL MOUKADDAM, MD, PhD, Medical Director, Stabilization, Treatment and
Rehabilitation (STAR) Program for Psychosis; Assistant Professor, Menninger
Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine,
Houston, Texas
KIMBERLY NORDSTROM, MD, JD, Department of Psychiatry, Denver Health
Medical Center, University of Colorado School of Medicine, Denver, Colorado
EBELECHUKWU A. ODIARI, MD, Section of Emergency Medicine, Baylor College
of Medicine, Houston, Texas
NATALIE PON, MD, Department of Psychiatry, Baylor College of Medicine,
Houston, Texas
SAGAR GALWANKAR, DNB, MPH, FACEE, Diplomat. ABEM, Assistant
Professor of Emergency Medicine, University of Florida, Jacksonville, Florida
NAVDEEP SEKHON, MD, Assistant Professor, Section of Emergency Medicine,
Baylor College of Medicine, Houston, TexasASIM A. SHAH, MD, Associate Professor, Departments of Psychiatry and
Behavioral Sciences, Community and Family Medicine, Neuropsychiatric Center, Ben
Taub General Hospital, Baylor College of Medicine, Houston, Texas
KAYLIN SIEVER, MD, Section of Emergency Medicine, Baylor College of Medicine,
Houston, Texas
VERONICA SIKKA, MD, PhD, MHA, MPH, FAAEM, Chief, Emergency Medicine,
Orlando VA Medical; Associate Professor, Emergency Medicine, UCF School of
Medicine, Orlando, Florida
ANDREA GAIL STOLAR, MD, Associate Professor, Menninger Department of
Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
ALEXANDER TOLEDO, DO, PharmD, Clinical Assistant Professor, Department of
Child Health, Arizona Children's Center, University of Arizona College of Medicine,
Phoenix, Arizona
MINA TRAN, MD, Section of Emergency Medicine, Department of Medicine,
Baylor College of Medicine, Houston, Texas
VERONICA TUCCI, MD, JD, Assistant Professor, Section of Emergency Medicine,
Department of Medicine, Baylor College of Medicine, Houston, Texas
GARY M. VILKE, MD, Department of Emergency Medicine Behavioral
Emergencies Research (DEMBER) Lab; Department of Emergency Medicine, UCSD
Health System, San Diego, California
MICHAEL P. WILSON, MD, PhD, Department of Emergency Medicine Behavioral
Emergencies Research (DEMBER) Lab; Department of Emergency Medicine, UCSD
Health System, San Diego, California