Handbook of Emergency Psychiatry:

Article Outline

• Copyright

Many emergency physicians harbor discomfort in treating patients with psychiatric illnesses. Familiarity with this Handbook of Emergency Psychiatry should help significantly improve that comfort level and subsequent care of psychiatric patients.

The book begins with a review of guidelines for the general assessment of the psychiatric patient, as well as a reminder that a medical evaluation and stabilization is a critical first step. The nebulous concept of “medical clearance” is also covered initially, with recommendations for laboratory and neuroimaging studies.

The bulk of the text is devoted to the recognition and treatment of acute psychiatric problems. This section is alphabetically organized according to the most common presenting symptoms and is especially helpful in discerning an initial treatment plan for those patients who do not present with a pre-assigned psychiatric diagnosis or label. Examples of the topics listed include abnormal movements, anxiety, depressed mood, memory impairments, sleep disorders, and withdrawal phenomenon. Within each subsection, attention is given to the differential diagnosis, cognitive and pharmacologic management, and disposition of the affected patient.

Tables of special interest to the emergency physician include “Urine drug screen and detectability after last use,” “Drug interactions with lithium,” “Over-the-counter sleep aid ingredients,” and “Common street terms and drug names.” An Appendix listing the brand and generic name and dosage of commonly used psychiatric medications easily facilitates the recognition and management of outpatient treatments. All are well-referenced in the book's index.

In addition, special sections on the use of restraints, child and elder abuse, sexual abuse, domestic violence, and homelessness are also included. Because this text is clearly intended to be a handbook instead of an all-inclusive reference, these abbreviated sections are excusable. An entire chapter is also devoted to safety considerations, with recommendations ranging from the use of metal detectors to the pharmacologic dosing and management of violent or agitated patients.

I would highly recommend this manual. It is a handbook in the true sense of the word. Its compact 4.5” × 8” size would fit easily in the hand or into the pocket of a resident or physician on a psychiatry rotation, or on the easy-access shelf of the emergency department.