CME 20/04/17 - ED Psychiatry

ED Psychiatry from SCGH ED CME

Here is Anne’s excellent presentation on emergency psychiatry.

To summarise a part of Anne’s talk, the essential processes of assessment and management in the ED are covered by ‘SACCIT’:

Safety:
- Ensuring risks of self harm & harm to others are minimised.
Assessment:
- Clear and reliable history
- Mental state examination
  - general appearance
  - form of thought
  - content of thought
  - mood and affect
  - attitude
- Vital signs and physical examination.
- Risk assessment: Risk of absconding, harm to self/others, suicide, missed physical illness
Confirmation of provisional diagnosis:
- NB: Definitive mental health diagnoses rarely made in the ED
- Obtaining corroborative history:
  - From family, friends, Police, Ambulance, GP or case manager.
  - The lack off corroboration reduces the confidence in an assessment.
  - Consider the patient’s right to confidentiality.
- Performing investigations to confirm or exclude organic factors
Consultation:
- ED consultant, local Mental Health Services and/or Drug and Alcohol, Aged Care or Child and Adolescent Mental Health Services.
Immediate treatment:
- Providing the right short-term intervention, using the biopsychosocial paradigm:
  - Biological: e.g. treat any underlying cause, drug Rx for presenting psychiatric symptoms, medication for sedation.
  - Psychological: e.g. therapeutic engagement, supportive counselling, using de- escalation.
  - Social: e.g. mobilising social supports, family and others to provide care post- discharge, finding emergency accommodation.
Transfer of care:
- Safe, appropriate & timely transfer of care to inpatient or community settings.