Evidence-based evaluation of psychiatric patients

Zun, Leslie S.

doi:10.1016/j.jemermed.2004.10.002

Cited by 37 publications

(10 citation statements)

References 32 publications

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“…This practice also ensures that no concurrent medical illnesses preclude safe and appropriate transfer to a psychiatric facility 1. Several studies have demonstrated that routine laboratory or radiographic studies are of little benefit, costly and unlikely to provide further diagnostic clarity or alter the course of treatment 2–5.…”

Section: Discussionmentioning

confidence: 99%

Missing the point: self-inflicted traumatic brain injury in psychosis

Maruca-Sullivan¹,

Goldenberg

Cone

et al. 2016

BMJ Case Reports

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A 36-year-old man was brought to the emergency department by emergency medical services after being found acting unusually at a gas station with blood on his head and clothing. He presented acutely psychotic and reported that he had a pen in his head. Medical evaluation was notable for a superficial puncture wound to the right temple, and he was medically cleared for psychiatric evaluation. After he developed nausea and headache later that evening, the CT scan revealed a temporal bone fracture, pneumocephalus, intraparenchymal haemorrhage and the presence of a metal pen tip lodged in the brain parenchyma. The full nature of the injury went undiscovered in the emergency department for 16 hours due to the superficial appearance of the injury and his acute psychosis with prominent delusional thought content and disorganisation. He underwent craniotomy with removal of the pen and subsequent hospitalisation for intravenous antibiotics, followed by a prolonged psychiatric hospitalisation for psychosis.

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Section: Discussionmentioning

confidence: 99%

Missing the point: self-inflicted traumatic brain injury in psychosis

Maruca-Sullivan¹,

Goldenberg

Cone

et al. 2016

BMJ Case Reports

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“…60 Although the concept of "medical stability, " which can be defined as the lack of medical conditions requiring acute evaluation and/or treatment, is gaining traction, for the purposes of this discussion, the term "medical clearance" will be used. A growing body of adult and pediatric studies suggest that an ED patient's history, physical examination, and vital signs provide important data for determining the appropriate medical evaluation for a psychiatric patient.…”

Section: Medical Diseases In Ed Psychiatric Patientsmentioning

confidence: 99%

“…58 Key elements for detecting underlying medical condition(s) include careful assessment of abnormal vital signs, a complete history and physical examination, with particular attention to the neurologic, cardiac, and respiratory systems. 64 Various screening tools have been developed to assist in the medical clearance of psychiatric patients in the ED, 60, 65 although these authors also stress the importance of an adequate history and physical examination and do not mandate laboratory or other investigations. 65 After medical clearance has been performed, the AAP and ACEP support the development of transport protocols to definitive psychiatric treatment facilities for EDs that transfer patients with mental health care needs.…”

Section: The Goals Of Medical Clearancementioning

confidence: 99%

Evaluation and Management of Children and Adolescents With Acute Mental Health or Behavioral Problems. Part I: Common Clinical Challenges of Patients With Mental Health and/or Behavioral Emergencies

Chun¹,

Mace²,

Katz³

2016

Pediatrics

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“…In a 2010 study, the authors found that the clinical exam most often omitted was the cognitive exam [10]. There are several possible reasons: discomfort with psychiatric patients, prioritizing patient's perceived as sicker, and combative or uncooperative patients among other factors [11].…”

Section: History and Physicalmentioning

confidence: 99%

An Evidence-Based Approach to Medical Clearance of Psychiatric Patients in the Emergency Department

Turner

Zun

2015

Curr Emerg Hosp Med Rep

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Medical clearance of psychiatric patients is the process whereby emergency physicians (EP) screen for medical causes of psychiatric symptoms as well as incidental comorbid illnesses in order to appropriately dispose the patient to either a medical or psychiatric unit. There is much disagreement between EPs and psychiatrists regarding the extent of workup required. It is universally accepted that an adequate history and physical exam, including complete vital signs, mental status exam, and neurological exams are crucial to this process. However, several components of the H&P, particularly the mental status and neurological exam, are often omitted by the EP. Routine labs, imaging, and toxicological screening on all psychiatric patients are low yield, and these studies should instead be guided by the history and exam. Psychiatrists and EPs need to work together to streamline the medical screening process to be safe, efficient, and evidence based.

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Evidence-based evaluation of psychiatric patients

Cited by 37 publications

References 32 publications

Missing the point: self-inflicted traumatic brain injury in psychosis

Missing the point: self-inflicted traumatic brain injury in psychosis

Evaluation and Management of Children and Adolescents With Acute Mental Health or Behavioral Problems. Part I: Common Clinical Challenges of Patients With Mental Health and/or Behavioral Emergencies

An Evidence-Based Approach to Medical Clearance of Psychiatric Patients in the Emergency Department

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