A substantial number of patients with mental illness present to emergency departments (EDs) for treatment, and their numbers are continuing to rise. Patients with substance use disorders are the most common, but there are also patients with suicidal ideation or those who have already attempted suicide, as well as patients with psychosis, altered mental status, and acute anxiety disorders. Among patients with substance use disorders, “traditional” drugs of abuse (ie, alcohol, marijuana, cocaine) continue to predominate, but there is an increasing number of patients who present with intoxication caused by “designer” drugs, which are much harder to detect. Suicide attempts remain a leading cause of ED presentation and require ED personnel to not just do triage and in-depth assessment, but also to make recommendations for adequate follow-up. This article focuses on the epidemiology of mental health visits to the ED and reviews the most common mental health conditions that ED medical staff are likely to encounter. [ Psychiatr Ann. 2018;48(1):21–27.]

The management of borderline personality disorder (BPD) can be difficult, and specialized psychotherapy remains the core component of treatment with the most robust evidence. Dialectical-behavioral therapy and mentalization-based therapy are the most studied and commonly used among the specialized psychotherapy treatment options. Pharmacotherapy has more limited evidence and should be used primarily to address specific symptom alleviation. Inpatient hospitalization should be used cautiously to minimize unintended, unproductive consequences. Day hospital or intensive outpatient programs are good alternatives between hospitalization and routine outpatient visits for many patients. Because the rate of nonsuicidal self-injury is high among people with BPD, safety assessments by clinicians are an ongoing part of treatment and often involve family and loved ones. [ Psychiatr Ann . 2020;50(1):24–28.]

Historically, the term serious mental illness (SMI) has referred to bipolar, schizophrenia, and severe depression, which are conditions that are well studied and discussed. Although there have been inconsistent definitions of SMI in the United States, the one with the broadest consensus is that of the National Institutes of Mental Health (NIMH), which includes personality disorders. Borderline personality disorder (BPD), one of the most common problems encountered in psychiatry practice, has distinctive characteristics and associated severe functional impairment that fits the NIMH definition of SMI. BPD can also lead to poor general health and lower life expectancy from causes such as suicide, substance abuse, and poor physical health. In this article, we explore the background of various definitions of SMI and why BPD should be classified as an SMI based on the definition set out by the National Institute of Mental Health. We also explore how BPD can develop into an SMI that makes early diagnosis and treatment imperative. Furthermore, we identify the issues of stigma and counter-transference that are routinely encountered by mental health providers and that can be barriers to appropriate treatment and optimal outcome. [ Psychiatr Ann . 2020;50(1):8–13.]

No abstract

Attention-deficit/hyperactivity disorder (ADHD) usually is considered a childhood disease, and the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, clearly mentions that symptoms should begin before age 12 years and cause functional impairment in two or more settings. Contrary to this known diagnostic criterion, clinicians routinely make a diagnosis of adult ADHD, at times without any documented childhood history. This article describes a few cases of adult ADHD to illustrate some key challenges in diagnosing adult presentations of ADHD.