Introduction: Reconsidering Psychiatry in the Emergency Department

Wilson, Michael P.; Zeller, Scott L.

doi:10.1016/j.jemermed.2012.01.035

Cited by 18 publications

(10 citation statements)

References 7 publications

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“…Few reports in small samples of patients undergoing intramuscular olanzapine – intramuscular BDZ combination treatment for agitation seem to indicate lower oxygen saturations especially in patients with alcohol abuse (Wilson et al, 2012a,b). Furthermore, we have found limitations in the use of such a combination in the guidelines examined.…”

Section: Discussionmentioning

confidence: 99%

Issues in the Management of Acute Agitation: How Much Current Guidelines Consider Safety?

et al. 2013

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Agitated behavior constitutes up to 10% of emergency psychiatric interventions. Pharmacological tranquilization is often used as a valid treatment for agitation but a strong evidence base does not underpin it. Available literature shows different recommendations, supported by research data, theoretical considerations, or clinical experience. Rapid tranquilization (RT) is mainly based on parenteral drug treatment and the few existing guidelines on this topic, when suggesting the use of first generation antipsychotics and benzodiazepines, include drugs with questionable tolerability profile such as chlorpromazine, haloperidol, midazolam, and lorazepam. In order to systematically evaluate safety concerns related to the adoption of such guidelines, we reviewed them independently from principal diagnosis while examining tolerability data for suggested treatments. There is a growing evidence about safety profile of second generation antipsychotics for RT but further controlled studies providing definitive data in this area are urgently needed.

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Section: Discussionmentioning

confidence: 99%

Issues in the Management of Acute Agitation: How Much Current Guidelines Consider Safety?

et al. 2013

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“…When medications are used for agitated delirium in older patients, the goal should not be sedation, but rather sufficient treatment for safe symptom management. 55,56 If medication is required, the recommendations are similar to those for nongeriatric patients, although lower doses should be used (Table 4). Although the few existing high-quality studies have not noted a difference between low-dose haloperidol, olanzapine, or risperidone for the pharmacologic treatment of delirium in hospitalized patients, 57 the best current consensus evidence is for the use of low-dose olanzapine or risperidone.…”

Section: Treatmentioning

confidence: 99%

Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool

Shenvi

Kennedy

Austin

et al. 2020

Annals of Emergency Medicine

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Twitter: @clshenvi.Agitation and delirium are common reasons for older adults to seek care in the emergency department (ED). Providing care for this population in the ED setting can be challenging for emergency physicians. There are several knowledge translation gaps in how to best screen older adults for these conditions and how to manage them. A working group of subject-matter experts convened to develop an easy-to-use, point-of-care tool to assist emergency physicians in the care of these patients. The tool is designed to serve as a resource to address the knowledge translation and implementation gaps that exist in the field. The purpose of this article is present and explain the Assess, Diagnose, Evaluate, Prevent, and Treat tool. Participants were identified with expertise in emergency medicine, geriatric emergency medicine, geriatrics, and psychiatry. Background literature reviews were performed before the inperson meeting in key areas: delirium, dementia, and agitation in older adults. Participants worked electronically before and after an in-person meeting to finalize development of the tool in 2017. Subsequent work was performed electronically in the following months and additional expert review sought. EDs are an important point of care for older adults. Behavioral changes in older adults can be a manifestation of underlying medical problems, mental health concerns, medication adverse effects, substance abuse, or dementia. Five core principles were identified by the group that can help ensure adequate and thorough care for older adults with agitation or delirium: assess, diagnose, evaluate, prevent, and treat. This article provides background for and explains the importance of these principles related to the care of older adults with agitation. It is important for emergency physicians to recognize the spectrum of underlying causes of behavioral changes and have the tools to screen older adults for those causes, and methods to treat the underlying causes and ameliorate their symptoms.

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“…Given the open access and availability of EDs nationwide, they are also frequently the only source of care for mental health patients who may have poor healthcare literacy, inadequate access to care, or insufficient insurance 13–14. Thus, contemporary EDs are uniquely positioned to address acute behavioral emergencies 3. Unfortunately, despite the importance of EDs in caring for mental health patients, there are currently many gaps in our understanding of optimal ED care for behavioral emergencies.…”

Section: Introductionmentioning

confidence: 99%

“…To address this need, the CPE convened a research consensus conference with experts from both psychiatry and EM. Unlike previous consensus conferences in this area, which included only clinicians and/or research scientists,1, 17 the current conference instead convened a diverse set of organizations representing clinician stakeholders, clinical researchers, psychology, governmental agencies and patients’ advocacy organizations so as to ensure that resulting priorities reflected both patient priorities and scientific need 2, 3, 12, 18–23…”

Section: Introductionmentioning

confidence: 99%

Opportunities for Research in Mental Health Emergencies: Executive Summary and Methodology

Wilson¹,

Shenvi²,

Rives³

et al. 2019

WestJEM

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Introduction Despite the ever-increasing numbers of mental health patients presenting to United States emergency departments, there are large gaps in knowledge about acute care of the behavioral health patient. To address this important problem, the Coalition on Psychiatric Emergencies convened a research consensus conference in December 2016 consisting of clinical researchers, clinicians from emergency medicine, psychiatry and psychology, and representatives from governmental agencies and patient advocacy groups. Methods Participants used a standardized methodology to select and rank research questions in the order of importance to both researchers and patients. Results Three working groups (geriatrics, substance use disorders, and psychosis) reached consensus on 26 questions within their respective domains. These questions are summarized in this document. Conclusion The research consensus conference is the first of its kind to include non-clinicians in helping identify knowledge gaps in behavioral emergencies. It is hoped that these questions will prove useful to prioritize future research within the specialty.

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Introduction: Reconsidering Psychiatry in the Emergency Department

Cited by 18 publications

References 7 publications

Issues in the Management of Acute Agitation: How Much Current Guidelines Consider Safety?

Issues in the Management of Acute Agitation: How Much Current Guidelines Consider Safety?

Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool

Opportunities for Research in Mental Health Emergencies: Executive Summary and Methodology

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