> Psych

Psychiatric Patient

Official guideline from the American College of Emergency Physicians.

summary by Eric Steinberg, DO

Recommendations

Risk Stratification

In patients presenting to the emergency department with suicidal ideation, physicians should not use currently available risk-assessment tools in isolation to identify low-risk patients who are safe for discharge. The best approach to determine risk is an appropriate psychiatric assessment and good clinical judgment, taking patient, family, and community factors into account.

Level C

Laboratory Testing

Do not routinely order laboratory testing on patients with acute psychiatric symptoms. Use medical history, previous psychiatric diagnoses, and physician examination to guide testing.

Level C

Brain Imaging

Use individual assessment of risk factors to guide brain imaging in the emergency department for patients with new-onset psychosis without focal neurologic deficit. [Consensus recommendation]

Level C

Ketamine for Agitation

Ketamine is one option for immediate sedation of the severely agitated patient who may be violent or aggressive. [Consensus recommendation]

Level C

What do the icons mean?

Level A

Generally accepted principles for patient care that reflect a high degree of clinical certainty (eg, based on evidence from one or more Class of Evidence I or multiple Class of Evidence II studies).

Level B

Recommendations for patient care that may identify a particular strategy or range of strategies that reflect moderate clinical certainty (eg, based on evidence from one or more Class of Evidence II studies or strong consensus of Class of Evidence III studies).

Level C

Recommendations for patient care that are based on evidence from Class of Evidence III studies or, in the absence of any adequate published literature, based on expert consensus. In instances where consensus recommendations are made, “consensus” is placed in parentheses at the end of the recommendation.

Literature

Original/Primary Reference

Nazarian DJ, Broder JS, Thiessen MEW, et al. American College of Emergency Physicians. Clinical Policy: Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department. Ann Emerg Med. 2017;69(4):480-498.

Calc Function

Recommendations