Clinical Factors Related to Admission and Release Decisions in Psychiatric Emergency Services

Way, Bruce B.; Banks, Steven M.

doi:10.1176/appi.ps.52.2.214

Cited by 65 publications

(53 citation statements)

References 25 publications

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“…While this study did not examine the factors that could mediate this relationship, past research has found an association between sleep problems and suicidal ideations and behaviors (13), which, in turn, are among the most common reasons for emergency department use and psychiatric hospitalization (14, 15). This and other potential mechanisms linking sleep problems with emergency service use and psychiatric hospitalization need to be assessed in future studies using a longitudinal design.…”

Section: Discussionmentioning

confidence: 94%

Sleep Problems, Psychiatric Hospitalization, and Emergency Department Use Among Psychiatric Patients With Medicaid

Kaufmann

Spira

Rae

et al. 2011

Psychiatric Services

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OBJECTIVE This study examined the prevalence of sleep problems, and their relationship with the use of inpatient and emergency department services among Medicaid psychiatric patients. METHODS Participants were 1,560 Medicaid psychiatric patients identified in a ten-state random survey of psychiatrists. Sleep problems were assessed by clinician ratings. RESULTS Over 75% of Medicaid psychiatric patients experienced a sleep problem, and in approximately 50% of patients these problems were moderate to severe. Greater sleep problem severity was associated with an increased risk of psychiatric hospitalization and emergency department visits for mental health reasons. CONCLUSIONS Sleep problems are highly prevalent among Medicaid patients, and are associated with greater inpatient and emergency mental health service use. More careful monitoring and management of sleep problems in this patient population would address a common clinical need and might also help to reduce costly service use.

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Section: Discussionmentioning

confidence: 94%

Sleep Problems, Psychiatric Hospitalization, and Emergency Department Use Among Psychiatric Patients With Medicaid

Kaufmann

Spira

Rae

et al. 2011

Psychiatric Services

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“…A admissão em enfermaria psiquiátrica deverá ser considerada fortemente em casos de agitação psicomotora intensa, impulsividade irrefreável, risco de agressividade, risco ou tentativa de suicídio, diante da exposição a situações de risco, diante da falta de insight e/ou quando não houver continência/suporte familiar para a possibilidade de internação domiciliar e manejo extra-hospitalar. Esses fatores de risco compõem uma trama que deve servir como guia, uma vez que inexistem protocolos rígidos que possam defi nir a conduta de admissão (ou não) na emergên-cia psiquiátrica 44 . A prática clínica revela nuances que devem ser detalhados por uma equipe bem treinada e experiente.…”

Section: Fase De Recuperaçãounclassified

First-Episode Psychosis: Emergency Assistance

Gouvêa¹,

Noto²,

Bonadia³

et al. 2014

RDP

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16 revista debates em psiquiatria -Nov/Dez 2014 zar, é usado para descrever um estado mental em que o indivíduo perde o contato com a realidade, manifestando caracteristicamente delírios, alucinações, pensamento e/ou comportamento desorganizado. A etapa inicial de manifestação dos sintomas psicóticos, em que a intensidade dos mesmos leva uma quebra evidente do funcionamento, define o primeiro episódio psicótico (PEP FIRST-EPISODE PSYCHOSIS: EMERGENCY ASSISTANCEResumo O termo psicose é usado para descrever um estado mental em que o indivíduo perde o contato com a realidade, e a etapa inicial de manifestação dos sintomas psicóticos define o primeiro episódio psicótico (PEP). Este artigo apresenta conceitos e dados gerais sobre PEP, apresenta fatores de risco e provê orientações sobre o diagnóstico (inclusive diagnósticos diferenciais), tratamento e acompanhamento de pacientes com PEP, com destaque para o papel das emergências psiquiátricas. As diferentes fases das psicoses também são descritas. Como conclusão, os autores salientam a importância da identificação e investigação dos casos, o início precoce do tratamento e o acompanhamento aproximado e individualizado dos pacientes.Palavras-chave: Psicoses, primeiro episódio psicótico, emergência psiquiátrica. AbstractThe term psychosis is used to describe a mental state in which the individual loses contact with reality, and the first step in the manifestation of psychotic symptoms is referred to as first-episode psychosis. This article presents general concepts and data on first-episode psychosis, describes risk factors, and provides guidance on the diagnosis (including differential diagnosis), treatment, and follow-up of these patients, with special attention to the role played by psychiatric emergency centers. The different phases of psychoses are also described. The authors conclude by underscoring the importance of identifying and investigating cases of first-episode psychosis, beginning treatment as early as possible, and maintaining a close, individualized follow-up regimen.

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“…A number of studies examine clinical and non-psychiatric predictors of diagnostic and disposition decision-making for adult PES patients [13][14][15][16][17][18][19]. However, among studies on U.S. pediatric psychiatric emergency-type settings [20][21][22][23] even fewer have specifically examined the role of sociodemographic factors (e.g., race, ethnicity) in diagnostic and disposition decision-making.…”

Section: Introductionmentioning

confidence: 99%

The role of race in diagnostic and disposition decision making in a pediatric psychiatric emergency service

Muroff

Edelsohn

Joe

et al. 2008

General Hospital Psychiatry

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Objective-We investigated the influence of race/ethnicity in diagnostic and disposition decisionmaking for children and adolescents presenting to an urban psychiatric emergency service (PES).Method-Medical records were reviewed for 2991 child and adolescent African American, Hispanic/Latino, and White patients, treated in an urban PES between October 2001 and September 2002. A series of bivariate and binomial logistic regression analyses were employed to delineate the role of race in the patterns and correlates of psychiatric diagnostic and treatment disposition decisions.Results-Binomial logistic regression analyses reveal that African American (OR=2.28, p<.001), and Hispanic/Latino (OR=2.35, p<.05) patients are more likely to receive a psychotic disorder and behavioral disorders diagnoses (African American:OR=1.66, p<.001; Hispanic/Latino:OR=1.36, p<. 05) than White children/adolescents presenting to PES. African American youth compared to White youth are also less likely to receive depressive disorder (OR=0.78, p<.05), bipolar disorder (OR=. 44, p<.001), and alcohol/substance abuse disorder (OR=.18, p<.01) diagnoses. African American pediatric PES patients are also more likely to be hospitalized (OR=1.50, p<.05), controlling for other socio-demographic and clinical factors (e.g., GAF). Conclusions-The results highlight that non-clinical factors such as race/ethnicity are associated with clinical diagnostic decisions as early as childhood suggesting the pervasiveness of such disparities.

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Clinical Factors Related to Admission and Release Decisions in Psychiatric Emergency Services

Abstract: Guidelines addressing the variables that should be considered in making disposition decisions in psychiatric emergency services should be developed. The study found five variables that should be considered for inclusion.

Cited by 65 publications

References 25 publications

Sleep Problems, Psychiatric Hospitalization, and Emergency Department Use Among Psychiatric Patients With Medicaid

Sleep Problems, Psychiatric Hospitalization, and Emergency Department Use Among Psychiatric Patients With Medicaid

First-Episode Psychosis: Emergency Assistance

The role of race in diagnostic and disposition decision making in a pediatric psychiatric emergency service

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