The Emergency Department Setting

  • Seth Powsner

Consultants may be called to an emergency department for a variety of reasons. Most requests are like those from a general hospital ward. However, two issues are notable: a broader definition of psychiatric emergencies and greater concern about patient rights. These issues stem from an emergency department’s lack of a buffer from its surrounding community: patients come as they are, whether pushed, or just so inclined. There is little or no time for patients and emergency department staff to come to any understanding. In this absence of a traditional physician–patient relationship, consultants may be forced to change their usual approach.


Emergency Department Medical Illness Conversion Disorder Normal Pressure Hydrocephalus Psychiatric Emergency 
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  1. Alexander J, Tharyan P, Adams C, John T, Mol C, Philip J. Rapid tranquillisation of violent or agitated patients in a psychiatric emergency setting. Pragmatic randomised trial of intramuscular lorazepam v. haloperidol plus promethazine. Br J Psychiatry 2004;185:63–69.PubMedCrossRefGoogle Scholar
  2. Allen MH, Currier GW, Carpenter D, Ross R, Docherty JP. Treatment of behavioral emergencies. J Psychiatr Pract 2005;11(suppl 1):5–108.PubMedCrossRefGoogle Scholar
  3. Andrezina R, Josiassen RC, Marcus RN, et al. Intramuscular aripiprazole for the treatment of acute agitation in patients with schizophrenia or schizoaffective disorder: a double-blind, placebo-controlled comparison with intramuscular haloperidol. Psychopharmacology (Berl) 2006;188:281–292.CrossRefGoogle Scholar
  4. American Academy of Emergency Medicine., 2006.
  5. American Psychiatric Association. Practice guideline for the assessment and treatment of patients with suicidal behaviors. Am J Psychiatry 2003;160(11 suppl):1–60.Google Scholar
  6. Battaglia J, Moss S, Rush J, et al. Haloperidol, lorazepam, or both for psychotic agitation? A multicenter, prospective, double-blind, emergency department study. Am J Emerg Med 1997;15:335–340.PubMedCrossRefGoogle Scholar
  7. Breier A, Meehan K, Birkett M, et al. A double-blind, placebo-controlled dose-response comparison of intramuscular olanzapine and haloperidol in the treatment of acute agitation in schizophrenia. Arch Gen Psychiatry 2002;59:441–448.PubMedCrossRefGoogle Scholar
  8. Breitbart W, Marotta R, Platt MM, et al. A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. Am J Psychiatry 1996;153:231–237.PubMedGoogle Scholar
  9. Broderick KB, Lerner EB, McCourt JD, Fraser E, Salerno K. Emergency physician practices and requirements regarding the medical screening examination of psychiatric patients. Acad Emerg Med 2002;9:88–92.PubMedCrossRefGoogle Scholar
  10. Brook S, Lucey JV, Gunn KP, Ziprasidone IM Study Group. Intramuscular ziprasidone compared with intramuscular haloperidol in the treatment of acute psychosis. J Clin Psychiatry 2000;61:933–941.PubMedGoogle Scholar
  11. Centers for Medicare and Medicaid Services. WebGuide/25_EMDOC.asp, 2006.
  12. Drugdex® System. Greenwood Village, CO: Thomson Micromedex, 2006.
  13. Food and Drug Administration. Rockville, MD: ANSWERS/2001/ANS01123.html, 2001.
  14. Food and Drug Administration. Rockville, MD:, 2005.
  15. Food and Drug Administration. Rockville, MD:, 2006.
  16. Herbert PB, Young KA. Tarasoff at twenty-five. J Am Acad Psychiatry Law 2002;30:275–281.PubMedGoogle Scholar
  17. Lukens TW, Wolf SJ, Edlow JA, et al. Clinical policy: critical issues in the diagnosis and management of the adult psychiatric patient in the emergency department. Ann Emerg Med 2006;47:79–99.PubMedCrossRefGoogle Scholar
  18. Martel M, Sterzinger A, Miner J, Clinton J, Biros M. Management of acute undifferentiated agitation in the emergency department: a randomized double-blind trial of droperidol, ziprasidone, and midazolam. Acad Emerg Med 2005;12:1167–1172.PubMedCrossRefGoogle Scholar
  19. Mayo-Smith MF, Beecher LH, Fischer TL, et al. Working Group on the Management of Alcohol Withdrawal Delirium, Practice Guidelines Committee, American Society of Addiction Medicine. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch Intern Med 2004;12(164):1405–1412.CrossRefGoogle Scholar
  20. Paris J. Predicting and Preventing Suicide: Do We Know Enough to Do Ether? Harv Rev Psychiatry 2006;14:233–240.PubMedCrossRefGoogle Scholar
  21. Preval H, Klotz SG, Southard R, Francis A. Rapid-acting IM ziprasidone in a psychiatric emergency service: a naturalistic study. Gen Hosp Psychiatry 2005;27:140–144.PubMedCrossRefGoogle Scholar
  22. Rund DA, Hutzler JC. Behavioral disorders: emergency assessment. In: Tintinalli JE, Kelen GD, Stapczynski JS, eds. Emergency Medicine: A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill, 2004.Google Scholar
  23. Scahill L, Blair J, Leckman JF, Martin A. Sudden death in a patient with Tourette syndrome during a clinical trial of ziprasidone. J Psychopharmacol 2005;19:205–206.PubMedCrossRefGoogle Scholar
  24. Tesar GE. The emergency department. In: Rundell JR, Wise MG, eds. Textbook of Consultation-Liaison Psychiatry. Washington, DC: American Psychiatric Press, 1996:914–945.Google Scholar
  25. TREC Collaborative Group. Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine. Br Med J 2003;327:708–713.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Seth Powsner
    • 1
  1. 1.Yale UniversityNew HavenUSA

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