Despite repeatedly normal toxicologic and medical evaluations, all data refuting an underlying toxic cause are not accepted by this series of patients, and their search for a diagnostic linkage persists. Specific toxin identification or treatment for these patients is unlikely to occur.

No abstract

Emergency departments (EDs) have seen an increase in patients presenting with psychobehavioral emergencies in the past 20 years. Some of this increase is due to the severe shortage of mental health professionals across the country, and some is due to an increase in the incidence of psychiatric disorders. Patients can present to the ED themselves or can be brought in by emergency medical services or law enforcement under an involuntary hold. The presentations range from intentional ingestions and other suicide attempts to depression, psychosis, and medication interactions. Substance abuse is also common in this population and can exacerbate underlying conditions. Patients who present for other medical complaints and have an underlying history of mental illness are usually taking psychiatric medications that can have drug interactions. It is imperative that a practicing emergency medicine physician be aware of the multitude of drug interactions and side effects.

Appropriate antidepressant dosing and trial duration are crucial for successful treatment of depression. Before prescribing an antidepressant, primary care physicians should take into account each patient's history, responses to previous antidepressants, depressive symptoms, coexisting illnesses, and current prescriptions. Physicians must be able to help patients manage side effects and know when to discontinue treatment, switch antidepressants, or refer patients to a psychiatrist.