Abstract
This chapter will address cross-cutting issues relevant to the work of psychologists in medical settings. One The focus will be on diagnostic assessment and differentials for psychiatric emergencies and on using a biopsychosocial formulation as well as cultural and developmental perspectives as the foundation for the management of acute safety concerns (e.g., agitation, homicidal/violent behaviors) and other psychiatric emergencies (e.g., suicidality, self-harm, substance abuse, and addictions). The chapter also addresses intervention strategies that psychologists can employ in managing psychiatric emergencies in medical settings (both inpatient units and outpatient specialty and primary care clinics), tips for engaging youth in crisis and their families, strategies for behavioral and environmental interventions, as well as tools to further assess and inform care. The final focus of the chapter is on multidisciplinary collaboration within the medical setting and on the available resources in the medical setting and in the community that psychologists can access when creating treatment recommendations.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Adi, A., & Mathbout, M. (2018). The duty to protect: Four decades after tarasoff. The American Journal of Psychiatry Residents’ Journal, 13, 6. https://doi.org/10.1176/appi.ajp-rj.2018.130402
Ambrose, A. J. H., & Prager, L. M. (2018). Suicide evaluation in the pediatric emergency setting. Child and Adolescent Psychiatric Clinics of North America, 27(3), 387–397. https://doi.org/10.1016/j.chc.2018.03.003
Carroll, D., Hallett, V., McDougle, C. J., Aman, M. G., McCracken, J. T., Tierney, E., … Scahill, L. (2014). Examination of aggression and self-injury in children with autism spectrum disorders and serious behavioral problems. Child and Adolescent Psychiatric Clinics of North America, 23(1), 57–72. https://doi.org/10.1016/j.chc.2013.08.002
Cha, C. B., Augenstein, T. M., Frost, K. H., Gallagher, K., D’Angelo, E. J., & Nock, M. K. (2016). Using implicit and explicit measures to predict nonsuicidal self-injury among adolescent inpatients. Journal of the American Academy of Child and Adolescent Psychiatry, 55(1), 62–68. https://doi.org/10.1016/j.jaac.2015.10.008
Chun, T. H., Mace, S. E., Katz, E. R., & American Academy of Pediatrics; Committee on Pediatric Emergency Medicine; American College of Emergency Physicians; Pediatric Emergency Medicine Committee. (2016). Executive summary: Evaluation and management of children and adolescents with acute mental health or behavioral problems. Part I: Common clinical challenges of patients with mental health and/or behavioral emergencies. Pediatrics, 138(3), e20161571. https://doi.org/10.1542/peds.2016-1571
Copelan, R. (2006). Assessing the potential for violent behavior in children and adolescents. Pediatrics in Review, 27(5), e36–e41.
D’Amico, E. J., Parast, L., Shadel, W. G., Meredith, L. S., Seelam, R., & Stein, B. D. (2018). Brief motivational interviewing intervention to reduce alcohol and marijuana use for at-risk adolescents in primary care. Journal of Consulting and Clinical Psychology, 86(9), 775–786. https://doi.org/10.1037/ccp0000332
DeMaso, D. R., Martini, D. R., Cahen, L. A., Bukstein, O., Walter, H. J., Benson, S., … Medicus, J. (2009). Practice parameter for the psychiatric assessment and management of physically ill children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 48(2), 213–233. https://doi.org/10.1097/CHI.0b013e3181908bf4
First, M. B. (2017). The DSM-TM handbook of differential diagnosis. Washington, DC: American Psychiatric Association Publishing.
Gerson, R., Malas, N., & Mroczkowski, M. M. (2018). Crisis in the Emergency Department: The evaluation and management of acute agitation in children and adolescents. Child and Adolescent Psychiatric Clinics of North America, 27(3), 367–386. https://doi.org/10.1016/j.chc.2018.02.002
Hawton, K., Saunders, K. E., & O’Connor, R. C. (2012). Self-harm and suicide in adolescents. Lancet, 379(9834), 2373–2382. https://doi.org/10.1016/S0140-6736(12)60322-5
Hersh, J., Curry, J. F., & Kaminer, Y. (2014). What is the impact of comorbid depression on adolescent substance abuse treatment? Substance Abuse, 35(4), 364–375. https://doi.org/10.1080/08897077.2014.956164
Hicks, B. M., Johnson, W., Durbin, C. E., Blonigen, D. M., Iacono, W. G., & McGue, M. (2014). Delineating selection and mediation effects among childhood personality and environmental risk factors in the development of adolescent substance abuse. Journal of Abnormal Child Psychology, 42(5), 845–859. https://doi.org/10.1007/s10802-013-9831-z
Jellinek, M. S., & McDermott, J. F. (2004). Formulation: Putting the diagnosis into a therapeutic context and treatment plan. Journal of the American Academy of Child and Adolescent Psychiatry, 43(7), 913–916. https://doi.org/10.1097/01.chi.0000125090.35109.57
Kendall, P., & Beidas, R. S. (2007). Smoothing the trail for dissemination of evidence-based practices for youth: Flexibility within fidelity. Professional Psychology: Research and Practice, 38(1), 13–20.
Knight, J., Sherritt, L., Shrier, L., Harris, S. H., & Chang, G. (2002). Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. The Archives of Pediatrics & Adolescent Medicine, 156, 607–614.
Kuypers, L. (2018). Retrieved September 19, 2018, from http://www.zonesofregulation.com/index.html
Lelonek, G., Crook, D., Tully, M., Trufelli, K., Blitz, L., & Rogers, S. C. (2018). Multidisciplinary approach to enhancing safety and care for pediatric behavioral health patients in acute medical settings. Child Adolesc Psychiatric Clin N Am, 27, 491–500.
Marzullo, L. R. (2014). Pharmacologic management of the agitated child. Pediatric Emergency Care, 30(4), 269–275;.; quiz 276–268. https://doi.org/10.1097/PEC.0000000000000112
O’Reilly, M., Kiyimba, N., & Karim, K. (2016). “This is a question we have to ask everyone”: Asking young people about self-harm and suicide. Journal of Psychiatric and Mental Health Nursing, 23(8), 479–488. https://doi.org/10.1111/jpm.12323
Richmond, J. S., Berlin, J. S., Fishkind, A. B., Holloman, G. H., Jr., Zeller, S. L., Wilson, M. P., … Ng, A. T. (2012). Verbal de-escalation of the agitated patient: Consensus statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. The Western Journal of Emergency Medicine, 13(1), 17–25. https://doi.org/10.5811/westjem.2011.9.6864
Rocker, J. A., & Oestreicher, J. (2018). Focused medical assessment of pediatric behavioral emergencies. Child and Adolescent Psychiatric Clinics of North America, 27(3), 399–411. https://doi.org/10.1016/j.chc.2018.02.003
Saxton, A., Resnick, P., & Noffsinger, S. (2018). Chief complaint: Homicidal. Assessing violence risk. Current Psychiatry, 17(5):26–35.
Shaw, R. J., & DeMaso, D. R. (2010). Textbook of pediatric psychosomatic medicine. Arlington, VA: American Psychiatric Publishing.
Snyder, L. L., Truong, Y. K., & Law, J. R. (2016). Evaluating substance use and insulin misuse in adolescents with type 1 diabetes. The Diabetes Educator, 42(5), 529–537. https://doi.org/10.1177/0145721716659149
Sterling, S., Kline-Simon, A. H., Satre, D. D., Jones, A., Mertens, J., Wong, A., & Weisner, C. (2015). Implementation of screening, brief intervention, and referral to treatment for adolescents in pediatric primary care: A cluster randomized trial. JAMA Pediatrics, 169(11), e153145. https://doi.org/10.1001/jamapediatrics.2015.3145
Substance Abuse and Mental Health Services Administration. (2018). Motivational interviewing. Retrieved from https://www.integration.samhsa.gov/clinical-practice/motivational-interviewing
Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (2010). The National Survey on Drug Use and Health report: Violent behaviors and family income among adolescents. Rockville, MD.
Suicide Prevention Resource Center. (2018). Suicide prevention resource center. Retrieved September 19, 2018, from http://www.sprc.org/
Testa, M., & West, S. G. (2010). Civil commitment in the United States. Psychiatry (Edgmont), 7(10), 30–40.
Wharff, E. A., Ginnis, K. B., Ross, A. M., White, E. M., White, M. T., & Forbes, P. W. (2017). Family-based crisis intervention with suicidal. Adolescents: A randomized clinical trial. Pediatric Emergency Care, 35, 170. https://doi.org/10.1097/PEC.0000000000001076
Winters, N. C., Hanson, G., & Stoyanova, V. (2007). The case formulation in child and adolescent psychiatry. Child and Adolescent Psychiatric Clinics of North America, 16(1), 111–132., ix. https://doi.org/10.1016/j.chc.2006.07.010
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Appendix: Attachments: Resources
Appendix: Attachments: Resources
“The Substance Abuse and Mental Health Services Administration is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation.”
https://www.integration.samhsa.gov/about-us/about-cihs
“The SAMHSA Center for Integrated Health Solutions (CIHS) promotes the development of integrated primary and behavioral health services to better address the needs of individuals with mental health and substance use conditions, whether seen in specialty behavioral health or primary care provider settings.”
Alcohol and substance abuse screening tools
https://www.integration.samhsa.gov/clinical-practice/sbirt/CRAFFT_Screening_interview.pdf
Motivational interviewing tools
https://www.integration.samhsa.gov/clinical-practice/motivational-interviewing
Depression screening tools
http://www.cqaimh.org/pdf/tool_phq9.pdf
https://www.nimh.nih.gov/labs-at-nimh/asq-toolkit-materials/index.shtml
Safety planning tools
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Bujoreanu, S., Pell, S.G., Ribeiro, M. (2020). Psychiatric Emergencies: Self-Harm, Suicidal, Homicidal Behavior, Addiction, and Substance use. In: Carter, B.D., Kullgren, K.A. (eds) Clinical Handbook of Psychological Consultation in Pediatric Medical Settings. Issues in Clinical Child Psychology. Springer, Cham. https://doi.org/10.1007/978-3-030-35598-2_31
Download citation
DOI: https://doi.org/10.1007/978-3-030-35598-2_31
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-35597-5
Online ISBN: 978-3-030-35598-2
eBook Packages: Behavioral Science and PsychologyBehavioral Science and Psychology (R0)