| Popis: |
All doctors working in the ED will regularly meet patients with acute mental health problems. Five percent of total ED attendees are attributable to mental disorder. With nationwide ED attendances averaging 400 000 per week during November to April 2013, the trend shows a growing pressure on emergency services. However, these figures represent just the tip of the true burden of acute mental illness in our communities. Stigma, the healthcare funnel, and marginalization often mean that it is the sickest who finally present to the ED. It is also important to recognize the co-morbidity of mental illness and addictions in those seeking help for what initially appear to be physical complaints, as so often the mind and body are closely intertwined. Most common psychiatric presentations to the ED include DSH, alcohol and substance misuse, delirium, acute psychosis, factitious disorders, medically unexplained symptoms (MUS), and acute stress reactions (such as to trauma). DSH is common but under-recognized. A quarter of people who die by suicide attended the ED in the preceding year. All patients in the ED presenting with self-harm should have a detailed psychosocial assessment. Alcohol is responsible for 0% of all ED attendances. It is also an independent variable, raising the risk of DSH. Substance users are also frequent attendees, with high levels of medical morbidity and mortality. Patients with a dual diagnosis of substance use plus mental illness frequently present with multiple psychosocial problems. Acute psychosis may be caused by a functional disorder, such as schizophrenia, but organic conditions must also be considered. Where a patient is extremely disturbed in the ED, restraint and sedation may be necessary to enable safe and adequate assessment. Security presence may also be required to minimize the risk of violence, where this has been identified. Implications for working in the ED are that all doctors should familiarize themselves with the management of common acute psychiatric presentations. Know how to access local Trust rapid tranquillization guidelines. Read NICE guidelines for management of self-harm. Seize opportunities to screen for mental illness and social problems. |
