Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Feb 2024
ReviewDifficult Patients: Malingerers, Feigners, Chronic Complainers, and Real Imposters.
Malingering is the intentional production of false or grossly exaggerated symptoms motivated by internal and external incentives. The true incidence of malingering in the emergency department is unknown because of the difficulty of identifying whether patients are fabricating their symptoms. ⋯ Several case studies are presented and analyzed from a medical ethics perspective. Practical recommendations include use of the NEAL (neutral, empathetic, and avoid labeling) strategy when caring for patients suspected of malingering.
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Emerg. Med. Clin. North Am. · Feb 2024
ReviewRecognizing and Responding to Patients with Personality Disorders.
Caring for patients with personality disorders and traits presents unique challenges for physicians and other providers. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, recognizes 10 personality disorders, which are organized into 3 clusters (A, B, and C) based on shared diagnostic features. Personality disorders or traits create difficulty in clinical and interpersonal interactions, promoting missed diagnosis or underdiagnosis, nonadherence to medical recommendations, or other dangerous outcomes. It is important to recognize patients with potential personality disorders and understand strategies to achieve optimal patient interactions and best possible medical outcomes.
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Affective disorders affect the way that people think and feel and are classified into unipolar disorders and bipolar disorders. Bipolar disorders represent a spectrum of these chronic mental health illnesses. Patients with bipolar disorder have high recurrence of acute symptoms, and on average spend 20% of their life in exacerbations characterized by mania, depression, or psychosis. Given the increased morbidity and mortality associated with bipolar disorders, it is imperative that the emergency physician remain vigilant when these patients seek emergency care.
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Emerg. Med. Clin. North Am. · Feb 2024
ReviewEmergency Department Care of the Patient with Suicidal or Homicidal Symptoms.
Patients frequently present to the emergency department (ED) with acute suicidal and homicidal thoughts. These patients require timely evaluation, with determination of disposition by either voluntary or involuntary hospitalization or discharge with appropriate outpatient follow-up. Safety concerns should be prioritized for patients as well as ED staff. Patient dignity and autonomy should be respected throughout the process.
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Geriatric patients, those 65 years of age and older, often experience psychiatric symptoms or changes in mentation as a manifestation of an organic illness. It is crucial to recognize and treat delirium in these patients as it is often under-recognized and associated with significant morbidity. ⋯ Treatment of the underlying cause, creating an environment conducive to orientation, and minimizing agitation and discomfort are first-line interventions. Antipsychotics are first-line pharmacologic interventions if needed to preserve patient safety.