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Psychiatric Emergency: Services (PES) and Comprehensive Programs (CPEP)

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By Edwin Kim Addiction Psychiatrist
Suzette Glasner-Edwards, Larissa J Mooney
Psychotic symptoms and syndromes are frequently experienced among individuals who use methamphetamine, with recent estimates of up to approximately 40 % of users affected. Although transient in a large proportion of users, acute symptoms can include agitation, violence, and delusions, and may require management in an inpatient psychiatric or other crisis intervention setting. In a subset of individuals, psychosis can recur and persist and may be difficult to distinguish from a primary psychotic disorder such as schizophrenia...
December 2014: CNS Drugs
Ziva D Cooper
Although several chemical structural classes of synthetic cannabinoids (SCs) were recently classified as Schedule I substances, rates of use and cases of serious toxic effects remain high. While case reports and media bring attention to severe SC toxicity, daily SC use resulting in dependence and withdrawal is a significant concern that is often overlooked when discussing the risks of these drugs. There is a rich literature on evidence-based approaches to treating substance use disorders associated with most abused drugs, yet little has been published regarding how to best treat symptoms related to SC dependence given its recency as an emerging clinically significant issue...
May 2016: Current Psychiatry Reports
Antony Loebel, Leslie Citrome, Christoph U Correll, Jane Xu, Josephine Cucchiaro, John M Kane
BACKGROUND: Early non-response to antipsychotic treatment in patients with schizophrenia has been shown in multiple studies to predict poor response at short-term trial endpoint. Therefore, strategies to address the challenge of non-improvement early in the course of treatment are needed. A novel trial design was developed to assess the potential utility of antipsychotic dose escalation in patients with an inadequate initial treatment response. This design was embedded in a study intended to assess the efficacy of low dose lurasidone in patients with schizophrenia...
October 31, 2015: BMC Psychiatry
Kirsten Wiese Simonsen, Dorte J Christoffersen, Jytte Banner, Kristian Linnet, Ljubica V Andersen
INTRODUCTION: Fatal poisonings among drug addicts in Denmark in 2012 were examined. Cause of death, abuse pattern and geographic differences are discussed and data are compared with previous studies. METHODS: All fatal poisonings examined at the three institutes of forensic medicine in Denmark in 2012 were included in the study. RESULTS: A total of 188 fatal intoxications were recorded. The median age increased from 37.5 in 2007 to 41.5 in 2012...
October 2015: Danish Medical Journal
Glenda Wrenn
No abstract text is available yet for this article.
May 2015: Annals of Emergency Medicine
Merete Nordentoft, Mette S√łgaard
Persons who are treated at hospital after attempted suicide comprise a high-risk group for suicide. The proposal for a National Programme for Prevention of Suicide and Suicide Attempt in Denmark recommends that all persons who attempt suicide should be offered treatment and that treatment should be implemented, using a supportive and guiding principle. The aim of the present study is to investigate whether patients receive psychiatric evaluation after a suicide attempt, and whether they receive the psychiatric treatment to which they are referred...
2005: Nordic Journal of Psychiatry
Ingrid Berling, Geoffrey K Isbister
STUDY OBJECTIVE: Antipsychotic drugs are frequently reported to cause QT prolongation and torsade de pointes. We aim to investigate the potential risk of torsade de pointes in antipsychotic overdose by assessing the QT interval with the QT nomogram. METHODS: All presentations to a toxicology service between January 1987 and May 2013 were reviewed. Admissions with single ingestions of an antipsychotic greater than maximum daily dose were extracted. Demographics, dose, ECG, and outcomes (arrhythmias and death) were obtained...
August 2015: Annals of Emergency Medicine
Michelle Richardson, Geoffrey Brennan, Karen James, Mary Lavelle, Laoise Renwick, Duncan Stewart, Len Bowers
OBJECTIVE: This study aims to (a) describe what conflict (aggression, absconding etc.) and containment (de-escalation, restraining etc.) events occur before and after events of medication nonadherence on acute psychiatric wards and (b) identify which patient characteristics are associated with medication nonadherence. METHOD: Conflict and containment events for each shift over the first 2 weeks of admission were coded retrospectively from nursing records for a sample of 522 adult psychiatric inpatients...
November 2015: General Hospital Psychiatry
Megan L Petrik, Peter M Gutierrez, Jon S Berlin, Stephen M Saunders
OBJECTIVE: To understand emergency department (ED) providers' perspectives regarding the barriers and facilitators of suicide risk assessment and to use these perspectives to inform recommendations for best practices in ED suicide risk assessment. METHODS: Ninety-two ED providers from two hospital systems in a Midwestern state responded to open-ended questions via an online survey that assessed their perspectives on the barriers and facilitators to assess suicide risk as well as their preferred assessment methods...
November 2015: General Hospital Psychiatry
Federico Dazzi, Angelo Picardi, Luigi Orso, Massimo Biondi
OBJECTIVE: To identify which patient factors predict psychiatric hospitalization in patients presenting to the emergency department and to examine the role of the dimensional approach to psychopathology in predicting hospitalization. METHODS: We consecutively recruited 312 patients undergoing psychiatric evaluation in the emergency room of a hospital in Rome over a 6-month period. Patients were rated on the SVARAD (Scala per la Valutazione Rapida Dimensionale), a scale designed for the rapid assessment of the main psychopathological dimensions...
November 2015: General Hospital Psychiatry
Janet R McClure, Michael H Criqui, Caroline A Macera, Ming Ji, Caroline M Nievergelt, Sidney Zisook
BACKGROUND: Suicide prevention in the clinical setting is focused on evaluating risk in the coming hours to days, yet little is known about which factors increase acute risk. PURPOSE: To determine the prevalence of factors that may serve as warnings of heightened acute risk. METHODS: Veterans attending an urgent care psychiatric clinic (n=473) completed a survey on suicidal ideation and other acute risk warning signs. RESULTS: More than half the sample (52%) reported suicidal ideation during the prior week...
July 2015: Comprehensive Psychiatry
Mohsen Vazirian, Jason M Jerry, Jeffrey James, Roman M Dale
OBJECTIVES: Several novel synthetic amphetamines have been marketed worldwide as "bath salts." The use of bath salts is associated with severe medical consequences resulting in a US federal ban over the last 3 years on the more common substances found in this group. Bath salts intoxication has a relatively nonspecific presentation, and urine toxicology confirmation in emergency departments (EDs) is impractical because the turnaround time is several days. Emergency clinicians must therefore rely heavily on patients' self-reports to verify the diagnosis...
March 2015: Journal of Addiction Medicine
Florian Eyer, Rudolf Pfab, Norbert Felgenhauer, Tim Strubel, Bernd Saugel, Thomas Zilker
CONTEXT: Detailed data on severe overdoses with quetiapine are relatively sparsely reported in the literature. OBJECTIVE: To describe a cohort of 20 acute quetiapine overdoses and provide additional data on the pharmacokinetics and clinical features of intoxication with this drug. MATERIAL AND METHODS: A retrospective study was conducted on patients with quetiapine poisoning admitted to our institution. We included moderate to severe overdoses between 2005-2011 who required admission to ICU...
November 2011: Clinical Toxicology
Nastaran Eizadi-Mood, Shahla Akouchekian, Ahmad Yaraghi, Mehrnazsadat Hakamian, Rasool Soltani, Ali Mohammad Sabzghabaee
Background. Psychiatric consultation is necessary for all patients with intentional poisoning and its reliability depends on the proper function of patients' memory performance. This study aimed to determine the possible memory impairment following acute TCAs' poisoning. Materials and Methods. In this cross-sectional study, patients with acute TCAs poisoning were allocated to two groups of severe poisoning (with coma, seizures, cardiac arrhythmias, hypotension, and a wide QRS complex) and mild-to-moderate poisoning according to their clinical presentation at the time of hospital admission...
2015: Depression Research and Treatment
Lisa B Dixon, T Scott Stroup
No abstract text is available yet for this article.
March 1, 2015: American Journal of Psychiatry
Jordan E DeVylder, Ellen P Lukens, Bruce G Link, Jeffrey A Lieberman
IMPORTANCE: Suicide is a leading cause of preventable death, especially among individuals with psychotic disorders, and may also be common among nonclinical populations of adults with subthreshold psychotic experiences. Understanding this association has the potential to critically bolster suicide prevention efforts. OBJECTIVES: To examine the association between 12-month suicidality and 12-month psychotic experiences and to test the hypotheses that psychotic experiences are associated with increased prevalence of suicidal ideation and suicide attempts during the concurrent period and with greater severity of suicidal behavior...
March 2015: JAMA Psychiatry
(no author information available yet)
Many states are having success turning to telepsychiatry-based solutions to connect mental health patients with needed care while also decompressing crowded EDs. Just one year into a statewide telepsychiatry initiative in North Carolina (NC-STeP), administrators say the approach has saved as much as $7 million, and hospital demand for the service is higher than anticipated. In Texas, mental health emergency centers (MHEC) that use telepsychiatry to connect patients in rural areas with needed psychiatric care are freeing up EDs to focus on medical care...
February 2015: ED Management: the Monthly Update on Emergency Department Management
Richard W Seidel, Mark D Kilgus
We compared psychiatrists' evaluations of Emergency Department (ED) mental health patients made face-to-face or by telemedicine. In a 39-month study, 73 patients presenting in the ED were enrolled after initial screening. Patients were interviewed by a psychiatrist either face-to-face in the ED or remotely by video. A second psychiatrist, acting as an observer, was in the room with the patient and independently completed the assessment. Based on the primary diagnosis of the interviewer, 48% of patients had a depressive disorder, 18% a substance use disorder, 14% a bipolar disorder, 11% a psychotic disorder, 6% an anxiety disorder and 4% other disorders...
March 2014: Journal of Telemedicine and Telecare
Emily Saurman, Jarret Johnston, James Hindman, Sue Kirby, David Lyle
The Mental Health Emergency Care-Rural Access Programme (MHEC) aims to improve access to specialist emergency mental health care in rural and remote communities in New South Wales. It provides a range of services including emergency telephone triage and video assessment. The present report provides a detailed description of the structure and function of the MHEC model, and identifies matters concerning adaptation and transferability. Structure: the MHEC can be contacted 24 hours/day, every day of the year; no caller is refused assistance...
October 2014: Journal of Telemedicine and Telecare
A McGirr, M T Berlim, D J Bond, M P Fleck, L N Yatham, R W Lam
BACKGROUND: There is growing interest in glutamatergic agents in depression, particularly ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist. We aimed to assess the efficacy of ketamine in major depressive episodes. METHOD: We searched EMBASE, PsycINFO, CENTRAL, and Medline from 1962 to January 2014 to identify double-blind, randomized controlled trials with allocation concealment evaluating ketamine in major depressive episodes. Clinical remission, response and depressive symptoms were extracted by two independent raters...
March 2015: Psychological Medicine
2015-02-20 19:10:25
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