Chapter 39. Psychiatric Emergencies

D. Richard Martini, M.D.
DOI: 10.1176/appi.books.9781585623921.465976



Children and adolescents with psychiatric disorders are presenting in the emergency department (ED) at ever increasing rates. Some of this is due to the limited availability of inpatient psychiatric beds and the subsequent growth of emergent care facilities (Christodulu et al. 2002). These young patients stress the system by placing unique demands on pediatric and mental health clinicians. Frequently, the emergency contact is their first visit with psychiatric services. Despite a lack of familiarity and information, the mental health team must safely, carefully, and in a culturally and developmentally appropriate manner, manage these cases. Patients may present with adults who are not the child's primary caregivers and who are unfamiliar with the psychiatric history. In addition, these children are more likely to be aggressive and dangerous, requiring more time and resources (see Table 39–1 for an assessment summary). Psychiatric symptoms may be the result of an intercurrent medical illness, which is more likely in patients who present with new-onset, acute psychiatric complaints (Olshaker et al. 1997). Each patient presenting for emergent care should, therefore, receive a medical history and a full medical evaluation. Identification and treatment of psychiatric emergencies in children and adolescents are essential parts of the "safety net" that must be available for children in crisis and for those who have not been able to appropriately access mental health services.

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Table Reference Number
TABLE 39–1. Causes of aggression and agitation in the emergency department
Table Reference Number
TABLE 39–2. Risk factors for a suicide attempt
Table Reference Number
TABLE 39–3. The Joint Commission guidelines for the use of seclusion and restraint


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All of the following statements regarding assessing suicidal youth in an emergency room are correct except
Which of the following statements regarding youth evaluated in emergency settings for suicidal behavior is false?
An intervention is defined as seclusion if the patient is placed alone in a room under which of the following circumstances?
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