Emergency Psychiatry > Psychiatry

From Book News, Inc.
Hillard (psychiatry, University of Cincinnati College of Medicine) and Zitek (psychiatry, Temple University School of Medicine) present essentials of emergency management of acutely ill psychiatric patients, for psychiatrists, emergency room personnel, neurologists, and residents on rotation or in training. Early chapters provide an introduction to basic principles of emergency psychiatry, while the rest of the book addresses the unique features of various psychiatric disorders and situations encountered in emergency psychiatry.
Book Info
Univ. of Cincinnati, OH. Reference is focused on the emergency management of the acutely ill psychiatric patient. Offers coverage of clinical strategies for diagnosing and treating patients who may be dangerous. Emphasizes an evidence-based approach and refers to the latest DSM-IV diagnostic criteria and terminology. Softcover. DNLM: Emergency Services, Psychiatric-methods.
From the Back Cover
Featuring useful new psychotherapeutic interventions and pharmacologic agents, this unique reference is the only resource focused on the emergency management of the acutely ill psychiatric patient. Conveying the experience and authority of one of the world's leading departments in psychiatry and emergency medicine, Emergency Psychiatry offers comprehensive coverage of clinical strategies for diagnosing and treating patients who may be dangerous to themselves or others.
Ideal for psychiatrists, emergency room personnel, neurologists, and residents on rotation or in training, this much-needed resource offers:
*On-the-spot help for management of acutely depressed, anxious, angry, and potentially dangerous patients
*Diagnostic and treatment algorithms for each disorder
*Clear access to prescribing information on psychotropic agents, including dosages and methods of administration
*Tables of salient diagnostic features and differential diagnoses throughout
*An evidence-based approach, featuring emphasis on a biopsychosocial philosophy toward patient management
*The latest DSM-IV diagnostic criteria and terminology
More than an emergency treatment reference, this an excellent source of information for any clinician who wants up-to-date information on the evaluation, diagnosis, and treatment of acute psychiatric illnesses or behavioral disorders.
Book Description
The only book to provide concise, authoritative coverage of the management of the acutely ill psychiatric patient. Covers all of the clinical management strategies employed to successfully diagnose and treat patients with psychiatric disorders. Features treatment algorithms for each disorder, tables of salient diagnostic features, and differential diagnoses

Preface xi
Part I Introduction to Principles of Emergency Psychiatry
1. Emergency Medicine Approach to Psychiatric Illness 3
Introduction 3
Psychiatric Manifestations of Medical Illness 4
Medical Management of Common Toxidromes 7
General Information 7
General Approach to the Poisoned Patient 7
Treatment of Acute Poisoning 10
Bibliography 13
2. Diagnostic Principles of Emergency Psychiatry 15
Introduction 15
Assuring a Safe Environment for Emergency Evaluation 16
Interviewing in the Psychiatric Emergency Setting 16
Mental Status Examination in Emergency Psychiatry 18
Physical Assessment 19
Laboratory Tests and X-rays 19
History from Other Sources 20
Decision Process for Involuntary Hospitalization 20
Decision to Hospitalize 20
Community Referral 20
Psychiatric Diagnoses 21
3. Biological Treatment Principles 23
Introduction 23
Behavioral Emergency Defined 24
Treatment vs. Chemical Restraint 24
Use of Medication in Behavioral Emergencies 25
Strategies if Inadequate Response to Initial Interventions 29
Review of Antipsychotic Medications 30
Antipsychotic vs. Neuroleptic vs. Phenothiazine 30
Review of Anticholinergic Medications 34
Review of Antianxiety Medications 35
Review of Antidepressant Medications 38
Review of Mood Stabilizing Medications 39
Risk Management Strategies 40
Bibliography 40
4. Psychosocial Principles 41
Introduction 41
Biopsychosocial Model Definition 41
What Happens to an Individual Experiencing a Psychiatric Emergency? 42
Coping Strategies and Defense Mechanisms 43
Coping Strategies 43
Defense Mechanisms 44
Crisis Intervention 45
Psychosocial Interventions 47
Risk Management Strategies 48
Bibliography 48
5. Legal Principles 49
Introduction 49
Emergency Defined 49
Major Legal Concepts 50
Malpractice 50
Common Types of Malpractice 51
Informed Consent 51
Exceptions to Informed Consent 52
Confidentiality and Privilege 53
Seclusion/Restraint 54
Civil Commitment/Involuntary Hospitalization 55
Patient Dumping 57
Risk Management Strategies 57
For the Individual Clinician 57
For the Institution 57
Bibliography 58
6. Psychiatric Ethics 59
Introduction 59
Definitions 60
Classical Ethical Theories 60
Alternatives to Classical Theories 60
A Framework of Moral Principles 61
Paternalism 61
AMA Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry 61
Ethical Workup 62
Ethics and Suicidal Behavior 62
Ethics and Violent Behavior 62
Ethics and Informed Consent 62
Ethics and Involuntary Commitment 62
Ethics and Rationing Health Care: Ethics and Economic or Financial Factors 63
Ethics and Managed Care 63
Ethics of Confidentiality and Double Agentry 63
Risk Management 63
Bibliography 63
Part II Clinical Challenges in Emergency Psychiatry
7. The Potentially Suicidal Patient 67
Introduction 67
Definitions 67
Risk Factors 68
Interviewing the Potentially Suicidal Patient 69
Suicide Risk Assessment 69
The Difficulty of Risk Assessment 69
A Paradigm Shift 70
A Suicide Risk Checklist 70
Documentation of Suicide Risk Assessment and Risk Reduction Plan 72
A Word on "No-Suicide Contracts" 72
The Socioeconomically Deprived Patient 72
Prescribing Antidepressant Medications from the Psychiatric Emergency Department 73
Age/Gender/Cultural Considerations 73
Bibliography 74
8. The Potentially Violent Patient 75
Introduction 75
Definitions 76
Developmental Factors Associated with Adult Violence 76
Diagnoses/Symptoms Commonly Associated with Violent Behavior 77
Working with Security and Police 80
Management of the Acute Potentially Violent Patient 81
Violence Risk Assessment 83
Overt Aggression Scale 86
Legal Issues in the Prediction of Violence 87
Suicide Risk in Persons Making Homicidal Threats 88
Risk Management Strategies 88
Bibliography 89
9. Mood/Anxiety Disorders 91
Introduction 91
Definitions 92
Depressive Disorders 94
Bipolar Disorders 103
Anxiety Disorders 108
Bibliography 125
10. Substance USE Disorders 127
Introduction 127
Review of Classification of Substance Use Disorders 127
Review of DSM-IV-TR Criteria 128
Course and Remission Specifiers for Substance Dependence 128
General Management/Approach in the Emergency Phase 136
Alcohol-Related Disorders 138
Amphetamine-Related Disorders 145
Caffeine-Related Disorders 147
Emergency Assessment and Management of Caffeine Disorders 147
Cannabis-Related Disorders 148
Emergency Assessment and Management of Cannabis Disorders 148
Cocaine-Related Disorders 149
Hallucinogen-Related Disorders 153
Management of Hallucinogen Disorders 153
Inhalant-Related Disorders 156
Management of Inhalant Use Disorders 156
Opioid-Related Disorders 159
Phencyclidine-Related Disorders 165
Emergency Assessment and Management of Phencyclidine Disorders 165
Sedative-, Hypnotic-, or Anxiolytic-Related Disorders 167
Emergency Assessment and Management of Sedative-, Hypnotic-, or Anxiolytic-Related Disorders 167
Bibliography 170
11. Schizophrenia and Psychotic Disorders 171
Introduction 171
Definitions 172
DSM-IV-TR Delusional Disorder 179
DSM-IV-TR Brief Psychotic Disorder 181
DSM-IV-TR Shared Psychotic Disorder 182
DSM-IV-TR Psychotic Disorder Due to a General Medical Condition 183
DSM-IV-TR Substance-Induced Psychotic Disorder 185
DSM-IV-TR Psychotic Disorder NOS 186
Emergency Assessment and Management of Schizophrenia and Other Psychotic Disorders 186
Bibliography 189
12. Personality Disorders 191
Introduction 191
DSM-IV-TR Definitions 192
General Guidelines for Approaching Personality Disorders in the Emergency Phase 192
Cluster A 192
Cluster B 202
Cluster C 215
Disassociative Identity Disorder 224
DSM-IV-TR Personality Disorder Not Otherwise Specified 226
Collaborative Longitudinal Personality Disorders Study 226
Bibliography 226
Index 227

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