Training and research in emergency psychiatry.

In this chapter we have attempted to describe some of the issues that must be addressed in funding, designing, and running a research and training program for emergency psychiatry. Such a program serves the in-house needs of staff training, skill and morale renewal, and program evaluation. In addition it can serve as a resource for the community to train a future cadre of individuals and to seek answers that will provide a solid base of knowledge for emergency psychiatry in the future.

Crisis treatment in a day hospital. Impact on medical care-seeking.

The cost-effectiveness of a day hospital program is documented by examining the utilization of medical and psychiatric services before and after a time-limited following crisis-presentations. Patients in crisis have been shown to have increased need for services following a crisis. In contrast, medical-care events decreased for the population treated in the day hospital. The results, with respect to reduction of medical care were greatest for those patients judged to have benefited from the psychiatric interventions.

Organic versus functional etiology in catatonia: case report.

The case of an illegal alien brought to the emergency room in a catatonic stupor is described. The patient's condition worsened following the administration of a high-potency neuroleptic, and it was later learned that he had a history of epileptic seizures. This case emphasizes the importance of ruling out organic causes in patients presenting with catatonic symptoms.

Assessment of the efficacy of activated charcoal following gastric lavage in acute drug emergencies.

The efficacy of administering a slurry of 100 g of activated charcoal (AC) via the gastric tube following lavage was assessed in 25 treated and 37 control patients presenting to the emergency room with chemical evidence of sedative-hypnotics or aspirin in the blood. Efficacy was evaluated as the ability of AC to prevent further absorption as determined by subsequent blood drug concentration changes. Although fewer patients in the AC group showed increased blood drug concentrations, the differences were not statistically significant. Comparison of the mean percent change in blood drug concentrations at various times following treatment produced similar results. Comparisons using subgroups of patients based on the individual drugs, the treatment delay time, and entering functional decompensation showed significant benefit from AC only in the less symptomatic patients. Comparing these results with other studies demonstrating the unequivocal efficacy of early (e.g., 30 min) treatment, it is concluded that the use of AC following lavage may often be too late to benefit most patients. The authors suggest that AC be given in the home, emergency vehicle, or immediately upon admission.

Studies on the efficacy of gastric lavage as practiced in a large metropolitan hospital.

The efficacy of gastric lavage as it is practiced in a major metropolitan hospital was evaluated. From a population of 76 patients with chemical evidence of sedative-hypnotic drugs in the blood, two or more therapeutic doses were recovered from 15.8% of the lavage samples, and 10 or more therapeutic doses were recovered from 6.6%. In a population consisting of patients with detectable quantities of drugs in the lavage sample, diazepam and amitriptyline are more adequately recovered than the sedative-hypnotic drugs. Very poor recoveries were obtained in patients lavaged more than 2 h after ingestion except in cases of amitriptyline overdose or massive sedative-hypnotic ingestion. The study indicates that inadequate criteria are employed in selecting patients most likely to benefit from lavage. Dose, time since ingestion, and symptomatology are discussed as criteria for selection of patients for lavage.

Suicide in the 1970s: a second look.

The decade of the 70's has been reviewed with the document Suicide Prevention in the 70's serving as a guide. Twenty-one goals put forward in the report were reviewed in light of subsequent progress in the field. Although progress was noted on many fronts, four areas were outstanding in the sense that envisioned goals were met or exceeded. These involved the areas of promulgation of information about suicide, establishment of standards and certification procedures, development of regional organizations to forward training and program development, and education of the public to improve awareness of suicide as a public problem. This analysis also identified areas where little or no progress has been made. From this there developed four recommendations: 1. The funding and establishment of a national case file using a standard nomenclature and a standard data base to improve epidemiologic knowledge, and to provide pooled data appropriate for more sophisticated research analyses. 2. The establishment of a task force to study the application of program evaluation methods to suicide prevention efforts. 3. The development of new programs at local levels to try to reach known high-risk groups and to provide relevant programs of suicide prevention for them. 4. Making creative efforts toward elaboration of a comprehensive theory of life-threatening behavior and exploration of developmental corrolates of such behavior.

MMPI changes in briefly hospitalized non-narcotic drug users.

The Minnesota Multiphasic Personality Inventory (MMPI) was administered to 66 non-narcotic drug abusers as part of an intensive study of polydrug abuse. Patients were classified into four primary drug-of-abuse groups using either stimulants, barbiturates, other sedative-hypnotics, or a combination of these drugs. It was readministered to 42 of these patients after 2 weeks' hospitalization. At admission, the group's MMPI profile was consistent with psychosis. At discharge, most of the MMPI T-scores were sharply reduced, and the groups' profile was consistent with sociopathy. The admission MMPI profiles of the four primary drug-of-abuse groups did not differ. At discharge, the stimulant group's profile remained psychotic, while the profiles of the other three groups were not psychotic. Such results raise the possibility of a toxic psychotic effect of chronic non-narcotic drug abuse. The group of stimulant abusers appeared schizophrenic, while the other groups of non-narcotic drug abusers appeared sociopathic.

Group therapy as a treatment technique for severely disturbed outpatients.

The outpatient psychia-ric department of a general hospital utilizes an economical four-day-a-week group program for severely disturbed patients who need intensive therapy but not hospitalization. The main treatment modality is group therapy four days a week; patients also have access to occupational therapy, vocational rehabilitation counseling, and community activities. Follow-up of 48 patients showed that 82 per cent felt they had improved. The author believes such a program can be offered as an economical alternative to a day hospital that is not feasible because of lack of space and staff.