Medical Stabilization and Clearance of the Psychiatric Patient

Conclusion

Emergency physicians are trained to assess patients with undifferentiated presentations, including acute psychiatric complaints. Acute delirium should be identified and treated medically. Consideration of other medical mimics should be included through a careful review of vital signs, history, physical examination, and collateral information. As safety-net physicians, EPs should consider evaluating and treating comorbid medical conditions in psychiatric patients referred for medical clearance who may require psychiatric admission. As with any other ED presentation, the EP should maintain a low threshold for testing in high-risk patients.

Routine medical clearance as a prerequisite for psychiatric assessment of patients presenting with acute psychiatric symptoms who are at low-risk for underlying medical causes is costly and unsupported by the literature. Toxicological testing may be indicated in select instances, but rarely alters patient disposition. Through collaboration, education, and the development of assessment protocols, EPs and psychiatry specialists can minimize testing and provide safe, efficient care of patients with acute psychiatric presentations.

Dr Mallory is a professor of emergency medicine at the University of Louisville School of Medicine in Louisville, Kentucky. Mr Knight is a senior medical student at the University of Louisville School of Medicine, Kentucky.