A Case Based Approach To Emergency Psychiatry

Working in an emergency department as a psychiatrist or mental health clinician requires an ability to gain a patient's rapport, establish a differential diagnosis, assess risk and make disposition decisions in a fast-paced and potentially chaotic setting. Patients may be medically ill, agitated, intoxicated, or suicidal, and resources for treatment may be difficult to access. A Case-Based Approach to Emergency Psychiatry provides the emergency department clinician with vivid and complex cases, discussed by psychiatrists who work daily in the emergency setting, that illustrate basic principles of assessment, diagnosis and treatment. These challenging and complex cases are based on the years of experience of the authors combined with current evidence-based practices and discussion. Risk assessment, psychosis, mood disorder, substance abuse, ethics, forensic issues, and personality disorders are discussed, along with child and adolescent, geriatric, and developmental disabilities. Special attention is also paid to alternatives to inpatient care, short-term crisis intervention, and the interface between medical and psychiatric illnesses. The case-based format allows the authors to link aspects of the clinical presentation to discussion and literature review in a memorable and compelling format.

Expert public psychiatrists use case studies to share best-practice strategies in this clinically-oriented introduction to community mental health. Today, the majority of psychiatrists work with people who suffer not only from mental illness, but also from poverty, trauma, social isolation and discrimination. They cannot do this work alone, but instead are part of teams of behavioral health workers navigating larger healthcare and social service systems. In an increasingly complex healthcare environment, mental health clinicians need to master systems-based practice in order to provide optimal care to their patients. The rapid development of public psychiatry training programs is a response to the learning needs of psychiatrists in an evolving system. The book begins with seven foundational principles of public psychiatry: recovery, trauma-informed care, integrated care, cultural humility, harm reduction, systems of care, and financing care, using cases to bring these concepts to life. Then, using a population health framework, cases are used to explore the typical needs of different age groups or vulnerable populations and to illustrate evidence-based/ best practices that have been employed to meet these needs. Common to all of the chapters is a focus on the potential of each person, regardless of illness, to achieve personal goals, supported by a clinician who is also an advocate, activist and leader.

In this issue of Emergency Medicine Clinics, guest editors Drs. Eileen F. Baker and Catherine A. Marco bring their considerable expertise to the topic of Psychiatric and Behavioral Emergencies. Top experts cover key topics such as the emergency psychiatric interview; the agitated patient; the suicidal or homicidal patient; excited delirium; substance use disorders; schizophrenia; depression; and more. Contains 15 relevant, practice-oriented topics including bipolar affective disorder; geriatric and pediatric psychiatric emergencies; personality disorders; malingering; legal and ethical considerations; and more. Provides in-depth clinical reviews on psychiatric and behavioral emergencies, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

Written and edited by leading emergency psychiatrists, this is the first comprehensive text devoted to emergency psychiatry. The book blends the authors' clinical experience with evidence-based information, expert opinions, and American Psychiatric Association guidelines for emergency psychiatry. Case studies are used throughout to reinforce key clinical points. This text brings together relevant principles from many psychiatric subspecialties—community, consultation/liaison, psychotherapy, substance abuse, psychopharmacology, disaster, child, geriatric, administrative, forensic—as well as from emergency medicine, psychology, law, medical ethics, and public health policy. The emerging field of disaster psychiatry is also addressed. A companion Website offers instant access to the fully searchable text. (www.glickemergencypsychiatry.com)

This book documents the ways that clinical practitioners and trainees have used the “structural competency” framework to reduce inequalities in health. The essays describe on-the-ground ways that clinicians, educators, and activists craft structural interventions to enhance health outcomes, student learning, and community organizing around issues of social justice in health and healthcare. Each chapter of the book begins with a case study that illuminates a competency in reorienting clinical and public health practice toward community, institutional and policy level intervention based on alliances with social agencies, community organizations and policy makers. Written by authors who are trained in both clinical and social sciences, the chapters cover pedagogy in classrooms and clinics, community collaboration, innovative health promotion approaches in non-health sectors and in public policies, offering a view of effective care as structural intervention and a road map toward its implementation. Structural Competency in Mental Health and Medicine is a cutting-edge resource for psychiatrists, primary care physicians, addiction medicine specialists, emergency medicine specialists, nurses, social workers, public health practitioners, and other clinicians working toward equality in health.

"A 38-year-old married woman is brought to the emergency department by EMS. The EMTs report that she had been talking about having suicidal ideation and wanting to kill herself. She also complains of nausea and vomiting. You have been called to examine her. As you approach her stretcher, you notice that she has long, dark hair that looks matted and somewhat disheveled. She looks pale and is gripping a bowl. As you step to her side, she sits up, bends over the bowl and throws up liquid material, with a trace of bright red blood. You wait until she is done, and ask her: "Can I help you?" She looks at you for a split second and then puts her finger down her throat and induces vomiting. She then slides down on the stretcher, feet hanging off the edge and begins to moan. She does not answer, and does not look at you. You ask again: "You must feel very nauseous. Is there anything I can do to help you?" She barely looks at you, just groans, and once again puts her finger in her mouth to initiate the gag reflex. She hugs the bowl, throws up clear liquid, and continues to heave. She then turns away from you and stops responding to your offer to help"--

Presents almost 100 common and uncommon gynecologic problems encountered in urgent and emergency settings with an emphasis on practical management.

The only book to provide concise, authoritative coverage of the management of the acutely ill psychiatric patient.