Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry

Abstract

Background and Objectives: Psychiatric disorders constitute frequent causes of emergency department (ED) admissions and these rates are increasing. However, referring to ED a whole range of conditions that could or should be dealt with elsewhere is imposing itself as a problematic situation. We aimed: (1) to provide a descriptive picture of the socio-demographic and diagnostic characteristics of the visits among adults at the psychiatric ED; (2) to estimate the clinical pertinence of these visits. Materials and Methods: Retrospective analysis of diagnostic/socio-demographic characteristics and clinical trajectories of patients admitted for a psychiatric condition at the adult psychiatric ED of the University Hospital of Geneva (HUG), Switzerland, during a 6-week timespan. Results: In our sample (n = 763 total admissions for psychiatric conditions; n = 702 for inclusion of patients having received a medical evaluation), depression/anxiety, suicidal behavior (SB), psychotic episode, and substance use disorder (SUD), in descending order, were the most common diagnoses for referral. Patients belonged to younger age groups (≤65 years), had a familial status other than married/in couple, and did not present an unfavorable socio-demographic profile. Concerning the pertinence for a psychiatric ED, primary diagnosis of depression/anxiety is the only variable significantly associated with different grade of degree. By the examination of the patients’ trajectory from admission to discharge, the clinical pertinence for a psychiatric ED admission existed for cases assigned to the Echelle Suisse du Tri (EST®) scale degree 1 (corresponding to most urgent and severe conditions), particularly for diagnoses of depression/anxiety associated with SB, SB as primary or comorbid diagnosis, and psychotic and manic/hypomanic episode. However, diagnoses of depression/anxiety without urgent and severe features (degrees 2, 3, 4) constituted the most frequent mode of presentation. Conclusions: Ambulatory and community-integrated settings could be more appropriate for the majority of patients admitted to adult psychiatric EDs. Moreover, the implementation of telepsychiatry strategies represents a very promising opportunity to offer these patients care continuity, reduce costs and filter the demand for psychiatric ED.

Severe Suicidality in Athletes with Chronic Traumatic Encephalopathy: A Case Series and Overview on Putative Ethiopathogenetic Mechanisms

“…Similar to the scarcity of data on SI and SB in patients with comorbid illness [32][33][34], fairly little is known about the association between CTE and suicidality to date. Thus, the primary objective of this report is to describe the occurrence of severe suicidality in two retired contact sports professionals who exhibited CTE.…”

Time Trends of the Public’s Attention Toward Suicide During the COVID-19 Pandemic: Retrospective, Longitudinal Time-Series Study

“…Although these measures are needed to protect physical health, the psychological impact of the pandemic is still emerging. To alleviate the concerns surrounding mental health, there has been a growing interest in telepsychiatry, which is defined as "the delivery of mental health care in the form of live and interactive videoconferencing'' [3]. Telepsychiatry has proven to be an effective approach for helping people access mental health services in remote and underserved areas [4,5].…”

“…Ongoing measures, such as isolation and social distancing, have separated people from their loved ones, leading to loneliness, boredom, and stress. Recent mental health studies on COVID -19 have revealed that these feelings are associated with common mental health disorders, such as depression and anxiety [6][7][8], and that the most vulnerable are those with preexisting mental health disorders [3][4][5]. Moreover, emerging evidence has suggested that the environmental nature of public health measures (eg, locations where quarantine is carried out) can lead to different effects on mental health.…”

Suicidality in Patients with Brain Tumors: A Brief Literature Review with Clinical Exemplar

“…Suicidality covers a host of phenomena, ranging from suicidal ideation (SI) to suicidal behaviors (SB), which include suicide attempts (SA), as well as completed suicide [ 1 ]. In spite of its seriousness, data on the prevalence of suicidality in individuals with a pre-existing illness [ 2 , 3 , 4 ], especially conditions with a neurological origin such as brain tumors, have not been frequently reported [ 5 , 6 ]. In this study, we provide a concise synthesis of the literature on this topic in order to summarize the reported frequency of SI and SB in patients with brain tumors.…”