In the field of psychiatric expertise, formal quality criteria such as organization, duration and extent of psychiatric exploration are of significant importance to ensure better transparency and reliability. Psychiatric diagnosis should be made according to DSM-IV or ICD-10 criteria. Following an extensive literature review (medline 1980-2007) we will discuss the importance of the use of The Mini International Neuropsychiatric Interview (M.I.N.I.), and other validated clinical diagnosis tools in psychiatric expert practice.Beside the clinical validated scales, patients with neurotic or personality disorder require particular clinical experience for a good diagnostic assessment, especially because little evidence based medicine in psychiatric expert practice is available. Thus, we emphasize the interest of a good educational program about expert practice for residents.Large epidemiological studies are required in order to clarify the evolution of patients after the expertise process. Furthermore, randomized studies should optimize the efficacy of a specific combined therapeutic program concerning patients with somatoform disorders.The creation of an international network of clinicians with experience in psychiatric expert practice could be an important tool, in order to develop and promote evidence based guidelines for diagnosis and therapeutic issues around psychiatric expert practice.
Alcohol related visits account for 10 to 46 % of all emergency department visits each year (D'Onofrio et al. 2006; Nassisi et al. 2006; Baleydier et al. 2003). This presentation focused on psychiatric guidelines and the clinicians’ position about the management of agitation due to substance intoxication. American Psychiatric Experts' recommendations (Allen, 2005) for managing agitation are discussed.The use of psychiatric validated scales to assess agitation seems to ameliorate the quality of care in emergency psychiatry. Several standardized tools could be useful for assess a diagnosis of alcohol abuse or dependence in emergency for adults and adolescents (AUDIT, CAGE, CRAFFT, et RAPS-QF), even if the clinicians are often sceptical about this issue.The use of medication to protect the patient, staff and to prevent an escalation of violence remains a personal choice for each practitioner, depending on individual patient needs and context. In the treatment of agitation due to substance intoxication in emergency, a balance needs to be found between the subjective dimension and data issue from evidence based medicine.
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