Psychopathological Dimensions in Emergency Psychiatry: Determinants of Admission, Compulsory Treatment, and Therapeutic Intervention

Abstract

Emergency psychiatry is a challenging field of application, involving specific features, aims, and criticalities. Whereas a categorical approach might show some limitations in this type of context, a dimensional approach seems to be particularly suitable, guiding psychiatrists in the determination of a therapeutic strategy. The current chapter focuses on the dimensional approach to acute psychopathology and its relationship with relevant issues for emergency psychiatry, such as hospitalisation, compulsory admission, and therapeutic intervention. More specifically, we performed a clinical study to evaluate whether a systematic dimensional evaluation, as assessed with the SVARAD, could predict the need for hospitalisation in acute psychiatric patients presenting to the emergency department and to identify which psychopathological dimensions predict the need for hospitalisation. Secondary objectives included identifying the psychopathological dimensions discriminating between voluntarily and compulsorily admitted patients presenting to the emergency department and analysing the relationship between psychopathological dimensions and medications. To this purpose, we recruited a sample of 312 acute psychiatric patients who visited the emergency department of the hospital Policlinico Umberto I (Rome, Italy) and required a psychiatric evaluation. Our results suggested that a systematic examination of the psychopathological condition is fundamental to determining the need for hospitalisation, with Reality Distortion, Apathy, and Impulsivity being the most relevant dimensions involved. Also, this approach differentiates between patients requiring compulsory vs. voluntary treatment, with the former showing higher degrees of Anger/Aggressiveness, Reality Distortion, Activation, Thought Disorganisation and Impulsivity, and lower degrees of Sadness/Demoralisation, Apathy, and Somatic Preoccupation/Somatisation. Finally, the dimensional evaluation guides clinicians through the choice of proper therapeutic intervention, involving both verbal techniques and medication.