Emergency medical care of patients with psychiatric disorders -  challenges and opportunities: Results of a multicenter survey

Abstract

Background Pre-clinical psychiatric emergencies are generally treated by emergency medical staff. The subsequent clinical treatment is often conditioned by interaction problems between emergency medical staff and psychiatric clinical staff. Objectives To identify problems affecting interaction between emergency medical and psychiatric care of mentally ill patients and pinpoint aspects of optimized emergency care. Methods To shed light on the interaction problems an anonymous, questionnaire-based, nonrepresentative survey of 98 emergency physicians (EM) and 104 psychiatrists (PS) practicing in acute psychiatry was conducted between March 1, 2021 and October 1, 2021. Results The chi-square test for multiple response sets revealed consistently significant differences (p < 0.001) between EM and PS with respect to the questions analyzed. Approximately 36% of EM reported not to be adequately qualified to handle psychiatric emergencies (p = 0.0001), while around 50% of respondents were neutral in their assessment in how to deal with psychiatric emergencies. 80% of EM reported a negative interaction (rejection of patients) with PS when referring a psychiatric emergency patient to the acute psychiatric unit. The most common reasons for refusal were intoxication (EM: 78.8%, PS: 88.2%), emergency physician therapy (EM: 53.8%, PS: 63.5%), and not resident in the catchment area of the hospital (EM 68.8%, PS: 48.2%). In the casuistry presented, most respondents would choose “talk down” for de-escalation (EM: 92.1%, PS: 91.3%). With respect to drug therapy, benzodiazepine is the drug of choice (EM: 70.4%, PS: 78.8%). More EM would choose an intravenously (i.v.) or a Mucosal Atomization Device (MAD) administration as an alternative to oral medication (i.v.: EM: 38.8%, PS: 3.8%, p = 0.001, MAD: EM: 36.7%, PS: 10.6%, p = 0.006). Significantly more EM would seek phone contact with the acute psychiatric hospital (EM: 84.7%, PS: 52.9%, p = 0.0107). A psychiatric emergency plan was considered useful in this context by more than 90% of respondents. The need for further training for EM with regard to treating psychiatric clinical syndromes was considered important by all respondents. In particular, the topics of “psychogenic seizure,“ “intoxication,“ and “legal aspects of psychiatric emergencies” were considered important (Mann-Whitney U test, p < 0.001). Conclusion The interaction-related problems identified in the emergency medical care of pre-clinical psychiatric patients relate to non-modifiable, structural problems, such as insufficient admission capacity and non-existent or inadequate monitoring capabilities in acute psychiatric hospitals. However, factors such as the education and training of EM and communication between EM and PS can be improved. Developing personalized emergency care plans for psychiatric patients could help to optimize their care.

Emergency Physicians’ Knowledge, Attitudes, and Practices Related to Psychiatric Emergencies in Makkah’s General Hospitals in Saudi Arabia: A Cross-Sectional Study

“…Therefore, we designed a questionnaire after conducting a thorough literature review and gathering relevant questions from previous studies. [12][13][14]16,20 The questionnaire was reviewed by two emergency consultants and two psychiatric consultants for content and face validity, practicability, and interpretation of answers. Then, to ensure the quality of the questions, an emergency consultant and a psychiatric consultant reviewed the questionnaire to assess the practicability, validity, and interpretation of answers.…”

“…The study found that 36.7% of EPs do not believe that they are adequately qualified to treat PEs and, remarkably, that many of them would seek telephone contact with acute psychiatric hospitals. 13 A survey conducted in the US Midwest to assess EPs’ attitudes and practices found that 39.5% of them also feel inadequately trained to manage PEs, while 92.3% said that additional mental health resources would be beneficial for their facility. 14 In India, 83.8% of the physicians examined in one study said that there are no mental health policies in their departments.…”

Notfallrettungseinsätze mit Patient*innen mit psychiatrischer oder psychosozialer Symptomatik: eine Analyse aus Ostniedersachsen

“…Psychiatrische NFR verlangen von Rettungskräften über ihre notfallmedizinischen Kompetenzen hinaus Einfühlungsvermögen und die Fähigkeit deeskalierend zu agieren [40]. Über Fortbildungen hinaus [41]…”

“…Psychiatrische NFR verlangen von Rettungskräften über ihre notfallmedizinischen Kompetenzen hinaus Einfühlungsvermögen und die Fähigkeit deeskalierend zu agieren 40 . Über Fortbildungen hinaus 41 muss das Management psychiatrischer Notfälle daher ein integraler Bestandteil der Ausbildung von Rettungsfachpersonal und Notärzt*innen sein.…”

Phenomenology of psychiatric emergencies

“…Their essential characteristics are therefore the severity, the need for intervention and his speed ( Wheat et al, 2016 ). Faced with an urgency, it is first essential to exclude the organic causes that could have caused it, from hormonal and metabolic imbalances to acute neurological and inflammatory conditions ( Schick et al, 2022 ). Subsequently, psychiatric disorders that can give rise to situations of urgency must be considered: psychomotor agitation, acute psychoses, manic episodes, suicidal intentionality and severe behavioral alterations ( Salani et al, 2021 ).…”