Emergency medicine clinics of North America
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Recent years have witnessed the rapid expansion of new psychotropic agents and psychotropic applications of primarily nonpsychiatric medications in nearly all domains of psychopathology. Increasingly, patients in emergency departments may be taking newer-generation antidepressants, antipsychotics, and mood-stabilizing drugs, and individuals with treatment-resistant psychiatric disorders are often prescribed complex, polypharmaceutical regimens. Current information on the use of psychiatric medications that have entered widespread use in the past 5 to 10 years is reviewed, with focus on indications and dosing, comparisons with older medications, management of patients with overdoses and toxicity states, and the medical and psychiatric effects of newer drugs on patients who may present to emergency departments.
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Delirium is a true medical emergency that can masquerade as chronic dementia or functional psychosis and obscure the causative underlying physical or toxic disorder. In most cases, a well-focused history and thorough physical examination can unmask the delirium and reveal the medical or toxic problem. ⋯ Control of agitated or aggressive behavior with pharmacologic or physical restraints and special support measures are required to facilitate ED care. Delirious patients whose symptoms do not totally resolve in the ED must be admitted.
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The neuroleptic malignant syndrome and the serotonin syndrome share many clinical features and may exist on a spectrum of the same disorder. The neuroleptic malignant syndrome, however, is an idiosyncratic drug reaction, whereas the serotonin syndrome is an effect of drug toxicity. ⋯ Treatment for both syndromes consists of removing the offending agent and providing intensive supportive care. Syndrome-specific therapies are controversial.
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Emerg. Med. Clin. North Am. · May 2000
ReviewThe psychiatric interview in the emergency department.
Psychiatric assessment of patients in the emergency department requires a psychological and medical approach. Acute medical problems must be investigated immediately, before a more nuanced exploration of emotional, cognitive, and behavioral aspects of these patients is undertaken. A multidimensional, nonreductive description then guides the treatment and disposition of patients in the emergency department.
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Emerg. Med. Clin. North Am. · May 2000
ReviewCritical incident stress and challenges for the emergency workplace.
A formal response to all levels of critical incidents that are potentially psychologically disturbing is needed. This response is needed for small-scale and large-scale incidents, such as natural or manmade disasters. ⋯ Critical incident stress debriefing teams have a valuable role in preventing posttraumatic stress disorder. Procedures for establishing response teams are presented, and future directions are discussed.