Emergency medicine clinics of North America
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Depressive disorders encompass a spectrum of diagnoses and are more common in women and transgender individuals. Diagnosis involves thorough history-taking and exclusion of underlying medical disorders. The emergency physician should assess the risk of self-harm and consider environmental and social factors prior to disposition.
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Emerg. Med. Clin. North Am. · Feb 2024
ReviewRecognizing and Responding to Patients with Personality Disorders.
Caring for patients with personality disorders and traits presents unique challenges for physicians and other providers. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, recognizes 10 personality disorders, which are organized into 3 clusters (A, B, and C) based on shared diagnostic features. Personality disorders or traits create difficulty in clinical and interpersonal interactions, promoting missed diagnosis or underdiagnosis, nonadherence to medical recommendations, or other dangerous outcomes. It is important to recognize patients with potential personality disorders and understand strategies to achieve optimal patient interactions and best possible medical outcomes.
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Emerg. Med. Clin. North Am. · Feb 2024
ReviewLegal and Ethical Considerations in Psychiatric Emergencies.
Individual rights can be limited in the context of psychiatric emergencies. The emergency physician should be familiar with state laws pertaining to involuntary holds. Physicians are equipped to perform a medical screening examination, address mental health concerns, and lead efforts to de-escalate agitation. The physician should conduct a thorough assessment and distinguish between malingering and mental health decompensation, when appropriate.
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Pediatric psychiatric emergencies account for 15% of emergency department visits and are on the rise. Psychiatric diagnoses in the pediatric population are difficult to make, due to their variable presentation, but early diagnosis and treatment improve clinical outcome. ⋯ Both physical and emotional safety must be ensured. A multidisciplinary approach, utilizing local primary care and psychiatric resources, is recommended.
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Substance use disorders (SUDs) present a challenge in the emergency department (ED) setting. This article provides an overview of SUDs, their clinical assessment, legal considerations in drug testing, diagnosis, and treatment approaches. SUDs are prevalent and coexist with mental health disorders, necessitating comprehensive evaluation and management. ⋯ Diagnosis relies on a thorough evaluation of substance abuse patterns and associated medical conditions. Treatment approaches encompass a multidisciplinary approach, incorporating counseling, medications, and social support. Effective management of SUDs in the ED requires a comprehensive understanding of these complex disorders.