Zwangseinweisung und Zwangsbehandlung bei psychiatrischen Patienten als notärztliche Aufgabe

Tonn, Peter; Reuter, Sven; Weilert, A. Katarina; Rupp, S.; Friedrich, Benjamin; Dahmen, Norbert; Gerlach, Nicole

doi:10.1007/s00101-005-0960-9

Cited by 4 publications

(1 citation statement)

References 17 publications

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“…Although emergencies with psychiatric indications are about as common as neurological or traumatological emergencies in Germany, many emergency physicians (EM) do not feel adequately qualified to treat them [9][10][11]14]. Indeed, psychiatric emergencies differ significantly from other emergencies in terms of the predominantly syndromal classification of disease symptoms, lack of algorithms, and ultimately the individual experience of the emergency physician [9,[15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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

Schick

Mayer²,

Jäger³

et al. 2022

BMC Emerg Med

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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.

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Section: Introductionmentioning

confidence: 99%

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

Schick

Mayer²,

Jäger³

et al. 2022

BMC Emerg Med

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Einführung

Pajonk¹,

Messer²,

Berzewski³

2020

S2k-Leitlinie Notfallpsychiatrie

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Zur Situation der Notfall- und Akutpsychiatrie in Deutschland

Pajonk

2015

Nervenarzt

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The impact of psychiatric emergencies for the care of patients in preclinical emergency medicine, in emergency departments and in psychiatric hospitals has been underestimated for a long time. There is still insufficient knowledge and a need for further research. There are, however, sufficient reasons to assume that annually approximately 500,000 patients with a psychiatric emergency receive treatment from a preclinical emergency physician and another 1.5 million in emergency departments in Germany. Further, approximately 500,000 patients are admitted to psychiatric hospitals as an emergency. The most frequent reasons are intoxication, agitation, aggressiveness and suicidal ideation, posing a threat of self-harm to the patient or to other persons and evoking other life-threatening conditions. Emergency psychiatry also plays a role in collective injuries, such as mass disasters, catastrophes and rampage situations. There is some evidence that the number of psychiatric emergencies is increasing. Reasons are, among others, changes in the services provided for inpatient and outpatient treatment, a reduction in stabilizing psychosocial factors and a general increase in the utilization of emergency healthcare services.

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Zwangseinweisung und Zwangsbehandlung bei psychiatrischen Patienten als notärztliche Aufgabe

Cited by 4 publications

References 17 publications

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

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

Einführung

Zur Situation der Notfall- und Akutpsychiatrie in Deutschland

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