CME 20/04/17 – ED Psychiatry

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.

Other Resources:

Dr James Wheeler
Dr James Wheeler

Emergency Physician, SCGH, WA, Australia

Articles: 498

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