Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
  1. Home
  2. Search

Refine search

Refine search

Access:
Content type:
Publication date:
Apply   From and To filters
Subject: Show more
Journals Show more
Publishers: Show more
Societies Show more
Series: Show more
Collections: Show more

Actions for selected content:

Select all | Deselect all
  • View selected items
  • Export citations
  • Download PDF (zip)
  • Save to Kindle
  • Save to Dropbox
  • Save to Google Drive

Save Search

You can save your searches here and later view and run them again in "My saved searches".

Please provide a title, maximum of 40 characters.
Cancel
×

12 results

An Improbable Psychiatrist
  • Rebecca Lawrence
  • Published online:
    07 November 2024
    Print publication:
    21 November 2024
  • An Improbable Psychiatrist is a powerful and insightful story of mental illness, told through the dual lens of a doctor, who later became a patient. Rebecca Lawrence shares her story of being a doctor and a psychiatrist while living with bipolar disorder. She details her experience of being an inpatient on a psychiatric ward, receiving electroconvulsive therapy, training as a doctor, and navigating the challenges of grief, loss, and family. Through her inspiring story, Rebecca aims to reduce the stigma surrounding mental illness and provide comfort to those who suffer from severe mood disorders and those who care for them. Told through engaging and captivating prose, this book will pull you into Rebecca's world and leave you with the powerful reminder that with the right support and treatment, it is possible to live with severe mental illness. Ultimately, this is a story of hope.

  • Clinical spectrum of psychiatric patients with rhabdomyolysis

  • Yoshifumi Suzuki, Futoshi Shibuya, Kazuhiko Toyooka, Yoshiaki Kawashima, Yasuho Suzuki, Masahiro Gotoh
  • Journal:
    Journal of Psychiatric Intensive Care / Volume 11 / Issue 1 / April 2015
    Published online by Cambridge University Press:
    13 June 2014, pp. 36-42
    Print publication:
    April 2015
    • Article
      • You have access
      • Open access
    • PDF
    • HTML
    • Export citation
  • Objective

    Rhabdomyolysis is a potentially life-threatening syndrome that can develop from various causes. This study was undertaken to analyse the clinical spectrum and to evaluate the prevalence of various aetiologies in psychiatric patients with rhabdomyolysis.

    Methods

    We retrospectively analysed the medical charts of 87 patients. For them, serum creatine kinase (SCK) activity higher than 1500 IU/l was defined as rhabdomyolysis. The causes of increased SCK activity were assessed.

    Results

    The annual incidence of rhabdomyolysis during 2007–2012 was 0.8–1.45%. In 59 men and 28 women (17–87 years old; median 50.9 years), no relation was found between age and the highest value of SCK activity. Their SCK activities were 1544–186 500 IU/l (median 3566 IU/l), but 45% had SCK activity higher than 5000 IU/l. Men were at greater risk than women. Major aetiologic factors were medical drugs, excessive physical activity, and psychogenic polydipsia. Patients with psychogenic polydipsia and alcoholism had higher SCK activity. Acute kidney injury (AKI) occurred in 8 men (9.1%). Five patients died, but only one died of rhabdomyolysis.

    Conclusions

    Most psychiatric patients with rhabdomyolysis were asymptomatic. The increase in SCK activity subsided spontaneously without specific treatment.

  • Chapter 24 - Restraint and seclusion techniques in the emergency department

  • from Section 4. - Treatment of the psychiatric patient
  • Edited by Leslie S. Zun
  • Edited in association with Lara G. Chepenik, Mary Nan S. Mallory
  • Book:
    Behavioral Emergencies for the Emergency Physician
    Published online:
    05 April 2013
    Print publication:
    21 March 2013, pp 177-181

  • Summary

    It is given that medical illness is common in psychiatric patients and that psychiatric pathology is common in medical conditions. Within the emergency department, psychiatric patients make-up one of the major diagnostic categories. Evaluation of pre-existing and comorbid psychiatric conditions and their treatments, which can have a profound impact on the patient's medical evaluation, differential diagnosis, and treatment plan, should quickly follow stabilization of the emergency condition. According to the NIMH Epidemiologic Catchment Area Program, more than half of those that abuse drugs have a psychiatric comorbidity with an odds ratio of 4.5. Polypharmacy is a growing national problem, not just in the comorbid medical-psychiatric patient, and is noted especially in select patient populations like nursing homes, a growing referral source for many emergency departments. Psychiatric patients are often taking adjunctive medications such as tricyclic antidepressants, anticonvulsants, and benzodiazepines that can be adjusted to serve dual therapeutic purpose.

  • Chapter 48 - Legal issues in the care of psychiatric patients

  • from Section 6. - Administration of psychiatric care
  • Edited by Leslie S. Zun
  • Edited in association with Lara G. Chepenik, Mary Nan S. Mallory
  • Book:
    Behavioral Emergencies for the Emergency Physician
    Published online:
    05 April 2013
    Print publication:
    21 March 2013, pp 362-372

  • Summary

    Emergency telepsychiatry can improve patient care and satisfaction, reduce boarding of emergency department (ED) psychiatric patients, improve the accuracy of psychiatric diagnoses made in the ED, and decrease the baseline admission rate to psychiatric hospitals. It is important that a telepsychiatrist perform a remote site assessment before initiating services. An onsite assessment should be used to help the telepsychiatrist become aware of local collaborators and service agencies. The guidelines indicate that there should be attention to certain clinical issues. Identification and selection of qualified consulting telepsychiatrists and associated support systems are the keys to a successful collaboration in the ED. Early in the process for implementing telepsychiatry consultation to emergency departments, information technology (IT) staff should be involved. The final phase of implementation involves staff training. ED staff should know what the criteria are for getting a telepsychiatry consultation.

  • Chapter 8 - The patient withdepression in the emergency department

  • from Section 3. - Psychiatric illnesses
  • Edited by Leslie S. Zun
  • Edited in association with Lara G. Chepenik, Mary Nan S. Mallory
  • Book:
    Behavioral Emergencies for the Emergency Physician
    Published online:
    05 April 2013
    Print publication:
    21 March 2013, pp 53-59

  • Summary

    This chapter introduces and describes the process of medical evaluation, also termed medical screening, of the psychiatric patient in the emergency department (ED). It discusses the diagnosis of medical mimics, along with the utility of both the patient history and physical exam and laboratory evaluations. The evaluation that an emergency physician conducts is an extremely important and, albeit, limited chance for the patient to be treated for a medical condition that may be causing their symptoms. The chapter also discusses the use of standard screening algorithms, which have been shown in several studies to decrease testing costs for ED patients undergoing medical screening. Local processes, such as coordination of care, trust between providers, wait times for subsequent psychiatric admission, facility overcrowding, and subgroup demographics may play a strong role in acceptance and accuracy of the emergency medicine evaluation process.

  • Chapter 49 - Law enforcement and emergency psychiatry

  • from Section 6. - Administration of psychiatric care
  • Edited by Leslie S. Zun
  • Edited in association with Lara G. Chepenik, Mary Nan S. Mallory
  • Book:
    Behavioral Emergencies for the Emergency Physician
    Published online:
    05 April 2013
    Print publication:
    21 March 2013, pp 373-377

  • Summary

    As the prevalence of mental illness increases in the United States, emergency medical services' (EMS) role in the care of the psychiatric patient continues to grow. The goal of EMS systems is safe transport of the psychiatric patient to the hospital for further evaluation and care. The cooperative patient can usually be transported without physical or chemical restraint, or law enforcement assistance. In cases of the extremely violent or agitated patient in whom de-escalation techniques have proved futile, law enforcement may elect to use an electronic control device (ECD) to subdue the patient. Refusal of care in the psychiatric patient poses a challenging dilemma. The violent and agitated patient clearly lacks decision-making capacity. Thus EMS personnel need to determine decision making capacity in the difficult prehospital environment. Organic causes of abnormal behavior, such as hypoglycemia, should always be considered.

  • Chapter 34 - Management of neurobehavioral sequelae oftraumatic brain injury in the emergency department

  • from Section 5. - Special populations
  • Edited by Leslie S. Zun
  • Edited in association with Lara G. Chepenik, Mary Nan S. Mallory
  • Book:
    Behavioral Emergencies for the Emergency Physician
    Published online:
    05 April 2013
    Print publication:
    21 March 2013, pp 251-259

  • Summary

    This chapter reviews the acute treatment process from evaluation and determination of the disease, which may or may not have a psychiatric origin, to stabilization. Psychosis is disruption in perception, organization of speech and/or organization of behavior. There are several disorders related to psychosis: brief psychotic disorder, schizophreniform, schizophrenia, severe mood disorders (depression or mania) with psychosis, schizoaffective disorder, delusional disorder, and shared psychotic disorder. Stabilization of the psychiatric patient in the emergency department (ED) depends largely on the presenting symptoms but can be thought of as having three main components: de-escalation, treatment, and evaluation of safety. De-escalation is needed for the agitated patient, to ensure safety. There are various treatment strategies for psychosis; the decision is based on several factors, such as patient preference, cost, and access to care. Disposition is largely determined on severity of illness.

  • Chapter 23 - Management of aggressive and violent behavior in the emergency department

  • from Section 4. - Treatment of the psychiatric patient
  • Edited by Leslie S. Zun
  • Edited in association with Lara G. Chepenik, Mary Nan S. Mallory
  • Book:
    Behavioral Emergencies for the Emergency Physician
    Published online:
    05 April 2013
    Print publication:
    21 March 2013, pp 170-176

  • Summary

    Excited delirium syndrome (ExDS) is a specific type of extreme agitation. As patients with ExDS are often transported to an emergency department (ED), they are also cared for by emergency medicine clinicians. Currently, the majority of reported cases of ExDS are associated with stimulant drug use, such as cocaine or methamphetamine, although cases of ExDS still occur in psychiatric patients who are untreated or have abruptly discontinued their medication. This chapter reviews the existing literature on evaluation and treatment considerations for ExDS. Expert consensus guidelines recognize three classes of medications for initial calming of agitated patients: benzodiazepines, first-generation antipsychotics (FGA), and second-generation antipsychotics (SGA). Attention to airway maintenance, breathing adequacy, and volume resuscitation, along with rapid treatment of hypoglycemia, hyperthermia, and metabolic acidosis may be life saving. ExDS is a medical emergency, and cooperative protocols are needed between law enforcement, EMS, and local emergency departments to best manage these patients.

  • Chapter 35 - Management of psychiatric illness inpregnancy in the emergency department

  • from Section 5. - Special populations
  • Edited by Leslie S. Zun
  • Edited in association with Lara G. Chepenik, Mary Nan S. Mallory
  • Book:
    Behavioral Emergencies for the Emergency Physician
    Published online:
    05 April 2013
    Print publication:
    21 March 2013, pp 260-269

  • Summary

    Psychiatric patients in the emergency department (ED) present unique and difficult challenges for the emergency medicine physician. This chapter reviews current therapies, as well as newer and investigational treatment options useful to diminish acute psychiatric symptoms. All ED staff involved in the use of restraints must be well versed in criteria for use of restraints and their proper and appropriate application. The most used typical antipsychotics in the ED for rapid lysis of acute psychosis have been haloperidol (Haldol) and droperidol (Inapsine). The atypical antipsychotics such as risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), and ziprasidone (Geodon) have a pharmacologic profile that is favorable. An agent that would provide the acute lysis of suicide thoughts and provide for a cooling off period for patients while they achieve therapeutic benefit from antidepressant therapy and receive outpatient therapy would be quite useful in the ED setting.

  • Chapter 50 - Research in emergency psychiatry

  • from Section 6. - Administration of psychiatric care
  • Edited by Leslie S. Zun
  • Edited in association with Lara G. Chepenik, Mary Nan S. Mallory
  • Book:
    Behavioral Emergencies for the Emergency Physician
    Published online:
    05 April 2013
    Print publication:
    21 March 2013, pp 378-381

  • Summary

    Facilitating efficiency and safety, triage is the process by which multiple patients are rapidly assessed for risk and queued for care by the emergency department (ED) providers. Before conducting an assessment and formulating a treatment plan with psychiatric patients in the ED, clinicians are encouraged to obtain pre-arrival patient information whenever possible. Ambulatory patients with psychiatric complaints may present to triage alone or arrive with family or friends. It is advisable to have a protocol for determining the location of initial triage based on the circumstances of arrival. Continual reassessment of patient status is critical for clinical care. At various points in this chapter, the movement of patients from one clinical environment to another is discussed. Each transition includes an attendant hand-off between clinical providers. At times, a patient is sent to the emergency department en route to an inpatient psychiatric unit, for example, from a psychiatric clinic.

  • Suicide in recently discharged psychiatric patients: a case-control study

  • I. M. Hunt, N. Kapur, R. Webb, J. Robinson, J. Burns, J. Shaw, L. Appleby
  • Journal:
    Psychological Medicine / Volume 39 / Issue 3 / March 2009
    Published online by Cambridge University Press:
    28 May 2008, pp. 443-449
  • Background

    Few controlled studies have specifically investigated aspects of mental health care in relation to suicide risk among recently discharged psychiatric patients. We aimed to identify risk factors, including variation in healthcare received, for suicide within 3 months of discharge.

    Method

    We conducted a national population-based case-control study of 238 psychiatric patients dying by suicide within 3 months of hospital discharge, matched on date of discharge to 238 living controls.

    Results

    Forty-three per cent of suicides occurred within a month of discharge, 47% of whom died before their first follow-up appointment. The first week and the first day after discharge were particular high-risk periods. Risk factors for suicide included a history of self-harm, a primary diagnosis of affective disorder, recent last contact with services and expressing clinical symptoms at last contact with staff. Suicide cases were more likely to have initiated their own discharge and to have missed their last appointment with services. Patients who were detained for compulsory treatment at last admission, or who were subject to enhanced levels of aftercare, were less likely to die by suicide.

    Conclusions

    The weeks after discharge from psychiatric care represent a critical period for suicide risk. Measures that could reduce risk include intensive and early community follow-up. Assessment of risk should include established risk factors as well as current mental state and there should be clear follow-up procedures for those who have self-discharged. Recent detention under the Mental Health Act and current use of enhanced levels of aftercare may be protective.