Acute Psychiatric Emergencies

Description:

Acute Psychiatric Emergencies is designed for all medical and healthcare professionals working with patients in mental health crisis. This manual is a key component of the Acute Psychiatric Emergencies (APEx) course, which uses a structured approach developed by leading psychiatry and emergency medicine specialists with years of practical experience. 

This valuable resource provides a practical approach for dealing with mental health emergencies, helping healthcare professionals from different specialties speak a common language and develop a shared understanding that expedites excellent care. The manual outlines the assessment and management of patients who have self-harmed, those that are apparently drunk, the patient behaving strangely, the patient with acute confusion, and those that are aggressive.

Presents a structured, practical approach for the emergency care of patients presenting in acute psychiatric crisis

Covers common presentations of psychiatric emergencies

Emphasises close co-operation of emergency and mental health teams

Offers content designed jointly by practicing psychiatrists and emergency physicians from the Advanced Life Support Group (ALSG)

Acute Psychiatric Emergencies will be useful for practitioners of emergency medicine, psychiatry, emergency and mental health nursing as well as other mental health and crisis care professionals.

Table of Contents:

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CHAPTER 1: Structured approach to acute psychiatric emergencies

1.1 Introduction

1.2 Preparation

1.3 Close working between emergency and psychiatry staff

1.4 Communication

1.5 Consent

1.6 A structured approach

1.7 Summary

CHAPTER 2: Primary unified assessment and immediate psychiatric management

2.1 Introduction

2.2 Preparation

2.3 Primary assessment – the unified assessment

2.4 Primary physical risk assessment

2.5 Primary psychiatric risk assessment

2.6 Unified assessment and immediate treatment

2.9 Person‐centred care

2.10 Legal framework

2.11 Secondary assessment

2.12 Summary

CHAPTER 3: Secondary physical and psychosocial assessment

3.1 Introduction

3.2 Focused physical history and examination

3.3 Focused conversational psychosocial history

3.4 Secondary psychosocial (mental state) examination

3.5 Summary

CHAPTER 4: The patient who has harmed themselves

4.1 Introduction

4.2 General principles

PUTTING IT ALL TOGETHER – THE STRUCTURED APPROACH TO ASSESSMENT

4.3 Preparation

4.4 Primary assessment – the unified assessment

4.5 Secondary assessment

4.6 Case examples

4.7 Emergency management

4.8 Refusal to accept physical treatment following self‐harm

4.9 Summary

CHAPTER 5: The apparently drunk patient

5.1 Introduction

5.2 Pathophysiology and measurement of alcohol intoxication

5.3 Screening for alcohol intoxication

5.4 If it’s not (just) alcohol intoxication, what is it?

PUTTING IT ALL TOGETHER – THE STRUCTURED APPROACH TO ASSESSMENT

5.5 Preparation

5.6 Primary assessment – the unified assessment

5.7 Unified assessment and immediate treatment

5.8 Secondary assessment

5.9 Emergency management

5.10 Determine disposal/confirm route of care (CROC)

5.11 Handover

5.12 Brief interventions in the ED

5.13 Case example

5.14 Summary

CHAPTER 6: The patient behaving strangely

6.1 Introduction

PUTTING IT ALL TOGETHER – THE STRUCTURED APPROACH TO ASSESSMENT

6.2 Preparation

6.3 Primary assessment – the unified assessment

6.4 Secondary assessment

6.5 Emergency management

6.6 Case examples

6.7 Summary

Appendix 6.1 Organic disorders with psychiatric presentations

Appendix 6.2 Strange behaviour associated with drug and alcohol misuse

Appendix 6.3 Commonly encountered psychiatric presentations

CHAPTER 7: The acutely confused patient

7.1 Introduction

7.2 Acute confusional states

PUTTING IT ALL TOGETHER – THE STRUCTURED APPROACH TO ASSESSMENT

7.3 Preparation

7.4 Primary assessment – the unified assessment

7.5 Unified assessment and immediate treatment

7.6 Secondary assessment

7.7 Emergency management

7.8 Determine disposal

7.9 Handover

7.10 Case example

7.11 Summary

CHAPTER 8: The aggressive patient

8.1 Introduction

8.2 Principles in assessing aggression and violence

8.3 Risk formulation

8.4 Managing potential aggression and violence

8.5 Assessment, prevention and management of risk

8.6 Case examples

8.7 Summary

Appendix 8.1 Rapid tranquillisation

CHAPTER 9: Legal aspects of emergency psychiatry

9.1 Introduction

9.2 Determining mental capacity

9.3 Treating a patient who does not have mental capacity

9.4 Treating a patient who has mental capacity

9.5 Consent

9.6 Confidentiality

9.7 Documentation

9.8 Summary

CHAPTER 10: Human factors

10.1 Introduction

10.2 Extent of healthcare error

10.3 Causes of healthcare error

10.4 Human error

10.5 Communication

10.6 Team working, leadership and followership

10.7 Situation awareness

10.8 Improving team and individual performance

10.9 Summary

CHAPTER 11: The patient experience

11.1 Introduction

11.2 Aspects of a patient’s experience

11.3 Summary

Index

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