[Dreaming of a psychomotrician in a medical-psychological emergency room]. / Rêver d'un psychomotricien en cellules d'urgence médico-psychologique.

The psychomotrician is a healthcare professional trained in mind-body approaches. They take into account sensoriality, motor skills, cognition, psyche and emotions in relation to the individual's environment and the expression of disorders. It  is an integral part of the treatment of post-traumatic stress disorder. For some years now, psychomotricians have been part of volunteer teams in medical-psychological emergency units, where they offer an integrative approach. Using the body and mediation as their working tools, they rely on non-verbal communication and body language to bring the patient back to the present moment within a reassuring framework.

Clinical and sociodemographic characteristics of patients with epilepsy attended at a regional reference psychiatric emergency unit.

OBJECTIVE: Epilepsy is one of the most prevalent chronic neurological diseases, presenting a high frequency of psychiatric disorders (PD). This study sought to evaluate the clinical and sociodemographic profile of patients with epilepsy (PWE) attended at a regional reference psychiatric emergency unit. METHODS: A retrospective, cross-sectional, and descriptive observational study was conducted utilizing a patient record database of individuals with epilepsy who were attended in a regional reference psychiatric emergency unit between January 2018 and August 2022. RESULTS: Out of the 31,800 psychiatric emergency visits, 260 (0.8 %) were of patients with epilepsy (ICD-10: G40). The majority were males (63.5 %) with a mean age of 42.11±15.39 years, single marital status (154; 59.25 %) and elementary education (75; 28.9 %). Most of them (203; 78.1 %) presented at least one psychiatric comorbidity at the emergency visit, but 109 (41.9 %) were not receiving any psychiatric follow-up. A total of 106 patients (40.8 %) had experienced at least one past psychiatric hospitalization. CONCLUSIONS: The occurrence of PD is highly prevalent in PWE, and probably with a high frequency of psychiatric emergencies occurring among them. Further studies are needed to assess such patient profile, particularly involving data from psychiatric emergency units.

Comparison of V-RISK-Y and V-RISK-10 for risk of violence: A one-year study from a psychiatric emergency department for adolescents.

There has been a lack of short and simple screening instruments to assess the risk of violence in youth. Many acute youth departments have used the V-RISK-10, a risk screener for adults. V-RISK-Y is a risk screener based on the V-RISK-10 and adapted to youths. Our aim was to compare the predictive validity between V-RISK-Y and VRISK-10 in an emergency psychiatric adolescent ward. Target population were all 92 patients admitted within one year, and study population consisted of 49 (53 %) patients who had completed data. V-RISK-10 and V-RISK-Y were scored at admission and compared with recorded episodes of violence during the hospitalization. V-RISK-Y showed higher AUC values for recorded violence and some of the individual items also showed better results. Most differences were not significant, but results may still be of clinical interest.

[Intended utilization of health care services in cases of mental illnesses with varying urgency]. / Intendierte Inanspruchnahme von Versorgungsangeboten bei psychischen Erkrankungen mit unterschiedlicher Dringlichkeit.

OBJECTIVE: To investigate variations in intended utilization in cases of an acute psychotic episode, an alcohol related or depressive disorder depending on different case characteristics. METHODS: A telephone survey with case vignettes was conducted (N=1,200). Vignettes varied in terms of urgency of symptoms, daytime, sex of the afflicted person and age/mental disorder. The respondents were asked to indicate whom they would contact first in the described case. RESULTS: Outpatient physicians were named most frequently as the first point of contact (61.1%) while only 6.5% of the respondents named emergency medicine including the medical on call service (8.1% in high urgency cases, i. e. emergencies that did not tolerate any delay). Intended utilization varied by urgency and age/mental illness. CONCLUSION: More Information about the need to seek medical help immediately in cases of mental illnesses with high urgency should be provided.

Protest behaviors among patients placed in seclusion in a psychiatric emergency service.

BACKGROUND: Patients placed in seclusion for behavioral dyscontrol often perceive that the health care team is treating them inappropriately. These patients may express their indignation in many ways. To better characterize these behaviors, we conducted a study of protest behaviors in a psychiatric emergency service. METHODS: Video surveillance of seclusion room occupants is routinely reviewed as part of our safety protocol. For 1 month in 2022, we noted the frequency and timing of potential protest behaviors such as disrobing and evacuation. Descriptive statistics were applied. RESULTS: A total of 41 seclusion events (8.1%) occurred over the surveillance period, which included 504 initial emergency psychiatric evaluations. Six patients (14.6%) engaged in protest behaviors (all within 5 minutes of being placed in seclusion), including 3 (7.3%) who urinated and 3 (7.3%) who disrobed. One patient urinated almost immediately (2.4%), and another urinated 25 minutes after entering seclusion; the latter was not interpreted as a protest behavior. CONCLUSIONS: Immediate behaviors in seclusion that are different from behaviors that led to seclusion can be interpreted as protest behaviors. The 2 most often observed protest behaviors were urination and disrobing.

Avaliação do conhecimento em emergências psiquiátricas entre discentes de medicina / Evaluation of knowledge in psychiatric emergencies among medicine students / Evaluación del conocimientoen urgencias psiquiátricas en estudiantes de medicina

As emergências psiquiátricas são distúrbios agudos do pensamento, comportamento, humor ou relações sociais, necessitando de uma intervenção imediata. Além disso, ressalta-se que o diagnóstico psiquiátrico de maneira geral difere dos demais por exigir além de habilidades técnico-científicas ou de anamnese uma prática interpessoal e conhecimento do contexto pessoal do paciente.Objetivo:O presente estudotem como objetivo avaliar o nível de conhecimento dosacadêmicos de medicina de uma universidade públicaacerca das emergênciaspsiquiátricas. Metodologia:Trata-se de um estudo observacional, descritivo, do tipo transversal, realizado com 293estudantes de medicina.Foi aplicado um questionário validado, via Google Forms. Foi utilizado o teste qui-quadrado para avaliar as correlações.Resultados:observou-se que há uma associação entre período do curso e conhecimento acerca de emergências psiquiátricas, viu-se que quanto maior o período maior o nível de conhecimento. Ademais, notou-se escassez de cenários de prática para os acadêmicos.Conclusões:Conclui-se que existem lacunas na abordagem da educação médica sobre o tema em questãoe faz-se necessário uma discussão aprofundada para melhoria nesse quesito (AU).

Psychiatric emergenciesare acute disorders of thinking, behavior, mood or social relationships, requiring immediate intervention. In addition, there is an emphasys thatpsychiatric diagnosis in general differs from the others because it requires, in addition to technical-scientific skills or anamnesis, interpersonal practice and knowledge of the patient's personal context.Objective:This study aims to assess the level of knowledge of medical students at a public university regarding psychiatric emergencies. Methodology:This isan observational, descriptive, cross-sectional study, carried out with 293 medical students. A validated questionnaire applied via Google Forms. The chi-square test was used to assess correlations. Results:The study observed that there is an association between the period of the course and knowledge about psychiatric emergencies, that higher the period, greater the level of knowledge. Furthermore, there was a shortage of practice scenarios for academics. Conclusions:It is concluded that there are gaps inthe approach of medical education on the subject in question and an in-depth discussion is necessary to improve this aspect (AU).

Las urgencias psiquiátricasson trastornos agudos del pensamiento, la conducta, el estado de ánimo o las relaciones sociales, que requieren una intervención inmediata. Además, se destaca que el diagnóstico psiquiátrico en general se diferencia de los demás porque requiere, además de habilidades técnico-científicas o anamnesis, práctica interpersonal y conocimiento delcontexto personal del paciente. Objetivo: Este estudio tiene como objetivo evaluar el nivel de conocimiento de los estudiantes de medicina de una universidad pública sobre emergencias psiquiátricas. Metodología: Se trata de un estudio observacional, descriptivo, transversal, realizado con 293 estudiantes de medicina. Se aplicó un cuestionario validado através de Google Forms. Se utilizó la prueba de chi-cuadradopara evaluar las correlaciones. Resultados: Se observó que existe asociación entre el período de la carrera y el conocimiento sobre urgencias psiquiátricas, cuanto mayor era el período, mayor era el nivel de conocimiento. Además, había escasez de escenarios de prácticapara los académicos.Conclusiones: Se concluye que existen lagunas en el abordaje de la educación médica sobre el tema en cuestión y es necesaria una discusión profunda para mejorar en este sentido (AU).

Network analysis of comorbid depression, suicidality and biomarkers on HPA axis among mood disorder patients to psychiatric emergency services.

Rapid assessment and intervention of suicide risk are common and challenging in psychiatric emergency departments (PED). It is unclear whether distinct pathophysiological processes exist among depressive patients with suicidality. This study examined the network structures of biomarkers on Hypothalamic-Pituitary-Adrenal (HPA) axis, such as Adrenocorticotropic hormone (ACTH) and Corticosterone (Cort), as well as suicidality and depressive symptoms in mood disorder patients in PED. Mood disorder patients in PED were assessed with the measurements of suicidality and depressive symptoms, respectively. A network analysis was performed to identify central symptoms and bridge symptoms of this network and their links to ACTH and Cort. Network stability was examined using the case-dropping procedure. The Network Comparison Test (NCT) was conducted to evaluate whether network characteristics differed by gender. A total of 1815 mood disorder patients were recruited. The prevalence of SI was 31.2% (95% CI: 28.15-34.21%), SP was 30.4% (95% CI: 27.39-33.41%), SA was 30.62% (95% CI: 27.61-33.64%) among psychiatric outpatients. The mean score of HAMD-24 was 13.87 ± 8.02. Network analysis revealed that 'Somatic anxiety' had the highest expected centrality, followed by 'Hopelessness' and 'Suicide attempt'. 'Corticosterone' and 'Retardation' may be the main bridge symptoms between depressive symptoms and the suicidality community. The network model showed a high degree of stability. Gender did not significantly influence the network structure. The central symptoms and key bridge symptoms identified could be potential targets for interventions of the HPA axis, which is designed for regular screening of a range of suicidal activity. In the light of this, timely treatment should be provided for psychiatric emergency care.

Risk factors of involuntary referral by police to ER psychiatric services for patients with a severe mental illness: A GEE analysis.

This study aimed to identify risk factors for involuntary referral by police to emergency room (ER) psychiatric services for community-based patients with a mental illness via a generalized estimating equation (GEE) analysis. The analysis was based on data from the Management Information System of Psychiatric Care (MISPC) system for patients with a severe mental illness in Taipei, Taiwan and registered referral records of the police. Data on 6378 patients aged ≥20 years were used in this study, including 164 patients who were involuntarily referred to the ER by the police and 6214 patients who were not during the period of January 1, 2018 to December 31, 2020. GEEs were utilized to explore possible risk factors of repeated involuntary referral to ER psychiatric services for patients with a severe mental illness. The logistic regressions indicated that patients defined as "severe" according to the Mental Health Act of Taiwan (crude odds ratio (OR): 3.840, 95 % confidence interval (CI): 2.407-6.126), with a disability (crude OR: 3.567, 95 % CI: 1.339-9.501), with two or more family members with a psychiatric disorder (crude OR: 1.598, 95 % CI: 1.002-2.548), with a history of a suicide attempt (crude OR: 25.582, 95 % CI: 17.608-37.167), and with a history of domestic violence (crude OR: 16.141, 95 % CI: 11.539-22.579) were positively associated with involuntary referral to ER psychiatric services. However, age (crude OR: 0.971, 95 % CI: 0.960-0.983) and the MISPC score (crude OR: 0.834, 95 % CI: 0.800-0.869) were inversely associated with involuntary referral to ER psychiatric services. After adjusting for demographics and potential confounders, we found that patients defined as "severe" (Exp (ß): 3.236), with a disability (Exp (ß): 3.715), with a history of a suicide attempt (Exp (ß): 8.706), and with a history of domestic violence (Exp (ß): 8.826), as well as age (Exp (ß): 0.986) and the MISPC score (Exp (ß): 0.902) remained significantly associated with repeated involuntary referral to ER psychiatric services. In conclusion, community-based mentally ill patients with a history of a suicide attempt, with a history of domestic violence, with a severe illness, and with a profound level of disability were highly associated with involuntary referral to ER psychiatric services. We suggest that community mental health case managers identify significant factors associated with involuntary referral to ER psychiatric services to accordingly arrange case management plans.

Examining readmission factors in psychiatric emergency care for individuals with personality disorders: A 6-year retrospective study.

People with personality disorders (PDs) are often admitted to psychiatric emergency services due to the frequent repetition of acute crises. This study drew on the ICD diagnostic records of 2,634 individuals with PDs who were admitted to a specialized inpatient psychiatric crisis unit over a 6-year period. Multiple logistic regressions and survival regressions were performed to examine whether PD categories, gender, and other individual, interpersonal, and precipitating factors were associated with readmission and time-to-readmission. The results showed a 16.1% readmission rate. Of these, 99.5% of readmissions occurred within 4 years following the first admission. Gender was the main factor associated with both readmission and time-to-readmission: while men were readmitted faster, more women in total were readmitted for a second psychiatric emergency hospitalization. Findings also indicated that readmission rate and time-to-readmission differed following the category of PD: readmission rate in a ratio of 1-2 (from 8% to 10% for dissocial and paranoid PD up to 19%-21% for impulsive and borderline PD), and time-to-readmission in a ratio of 1-5 (from 1 month for anankastic and dependent, to 5 months for impulsive, histrionic and anxious-avoidant PD). Limitations of this naturalistic study include a lack of self-reported measures and generalizability to less specialized emergency settings. Future research should include a prospective longitudinal design using standardized scalable measurement tools to improve the completeness and accuracy of the data concerning the psychological processes involved in risk and time-to-readmission after brief hospitalizations in emergency psychiatry. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A 6-year retrospective review of psychiatric emergency service utilization by school-age children.

To explore utilization patterns and associated clinical factors of school-age children who present to a psychiatric emergency department. This was a 6-year retrospective chart review study of children 5-12 years of age who presented to a psychiatric emergency service from July 2012 to June 2018 (n = 1654 patients). Demographic variables, clinical diagnoses, lifetime adverse events (physical abuse, sexual abuse, and bullying), and history of self-harm were documented for each visit. We performed a chi square analysis to identify association between demographic and clinical features with key outcomes. Increased service utilization as defined by inpatient psychiatric admission, recurrent visits, or increased length of stay were found in patients who were adopted, presented with suicidal ideation or self-harm behaviors, had a history of abuse, and had a diagnosis of depression or autism. Trends over the course of the study indicated a significantly increased percentage of patients presenting with suicidal ideation, bullying, and self-harm behaviors. The data add to the limited literature regarding school-age children with a psychiatric emergency. Increased emergency service utilization for certain subgroups of children and trends over the course of the study underscore the need for enhanced treatment options for individuals with certain demographic or clinical features, and increased outpatient, intermediate, and inpatient treatment options, as well as preventative care.

Service use preceding and following first referral for psychiatric emergency care at a short-stay crisis unit: A cohort study across three cities and one rural area in England.

BACKGROUND: Internationally, hospital-based short-stay crisis units have been introduced to provide a safe space for stabilisation and further assessment for those in psychiatric crisis. The units typically aim to reduce inpatient admissions and psychiatric presentations to emergency departments. AIMS: To assess changes to service use following a service user's first visit to a unit, characterise the population accessing these units and examine equality of access to the units. METHODS: A prospective cohort study design (ISCTRN registered; 53431343) compared service use for the 9 months preceding and following a first visit to a short-stay crisis unit at three cities and one rural area in England. Included individuals first visited a unit in the 6 months between 01/September/2020 and 28/February/2021. RESULTS: The prospective cohort included 1189 individuals aged 36 years on average, significantly younger (by 5-13 years) than the population of local service users (<.001). Seventy percent were White British and most were without a psychiatric diagnosis (55%-82% across sites). The emergency department provided the largest single source of referrals to the unit (42%), followed by the Crisis and Home Treatment Team (20%). The use of most mental health services, including all types of admission and community mental health services was increased post discharge. Social-distancing measures due to the COVID-19 pandemic were in place for slightly over 50% of the follow-up period. Comparison to a pre-COVID cohort of 934 individuals suggested that the pandemic had no effect on the majority of service use variables. CONCLUSIONS: Short-stay crisis units are typically accessed by a young population, including those who previously were unknown to mental health services, who proceed to access a broader range of mental health services following discharge.

Locked down or locked out? Trends in psychiatric emergency services utilization during the COVID-19 pandemic.

OBJECTIVE: To estimate changes in Boston Emergency Services Team (BEST) psychiatric emergency services (PES) encounter volume (total and by care team) and inpatient disposition during the first 8 months of the COVID-19 pandemic. METHODS: Data on 30,657 PES encounters was extracted from the four-county, BEST reporting system. The study period consisted of the first 34 weeks of 2019 and 2020. This period corresponded to the first five stages of Massachusetts's COVID-19 public health restrictions: pre-lockdown, lockdown, Phase I, II and III reopenings. Descriptive and regression analyses were performed to estimate changes in encounter volume by care team and disposition. RESULTS: Compared to the same period in 2019, covariate-adjusted, weekly PES encounters decreased by 39% (ß = -0.40, 95% Confidence Interval (CI) = [-0.51, -0.28], p < 0.00) during the lockdown. PES volume remained significantly lower during Phase I reopening compared to the previous year but returned to 2019 levels during Phase II. The covariate-adjusted proportion of weekly encounters that led to inpatient admission significantly increased by 16% (CI = [0.11, 0.21], p < 0.00) for mobile crisis teams (MCTs) and significantly declined by 13% (CI = [-0.19, -0.07], p < 0.00) for BEST-designated emergency departments during the lockdown period compared to the prior year. CONCLUSIONS: The overall drop in PES utilization and the rise in inpatient admissions for MCT encounters suggests that during the early phases of the pandemic, patients delayed psychiatric care until they had a psychiatric crisis. Public health messaging about the lockdowns and absent equivalent messaging about the availability of telehealth services may have made patients more reluctant to seek psychiatric care.

Long-Term Trends in Psychiatric Emergency Services Delivered by the Boston Emergency Services Team.

Rising psychiatric emergency department (ED) presentations pose significant financial and administrative burdens to hospitals. Alternative psychiatric emergency services programs have the potential to alleviate this strain by diverting non-emergent mental health issues from EDs. This study explores one such program, the Boston Emergency Services Team (BEST), a multi-channel psychiatric emergency services provider intended for the publicly insured and uninsured population. BEST provides evaluation and treatment for psychiatric crises through specialized psychiatric EDs, a 24/7 hotline, psychiatric urgent care centers, and mobile crisis units. This retrospective review examines the sociodemographic and clinical characteristics of 225,198 BEST encounters (2005-2016). Of note, the proportion of encounters taking place in ED settings decreased significantly from 70 to 58% across the study period. Findings suggest that multi-focal, psychiatric emergency programs like BEST have the potential to reduce the burden of emergency mental health presentations and improve patient diversion to appropriate psychiatric care.

Treatment Motivation and Burden of Stress among Parents of Adolescents with Non-Suicidal Self-Injury Presenting to a Child and Adolescent Psychiatric Emergency Service.

INTRODUCTION: The successful treatment of adolescents almost always requires parents' involvement in the treatment process. Thus, parental involvement will impact further treatment, especially concerning the acute management of self-harming behavior of their children. Parental burden or low parental motivation for treatment can significantly affect the success of the intervention. Therefore, this study aimed at investigating how especially motivational factors of the adolescents and parents, as well as stressors of the parents, affect the course of non-suicidal self-injury (NSSI) after an acute psychiatric emergency presentation. METHODS: Ninety-six adolescents aged 11-18 years who have been presented to an emergency service at a child and adolescent psychiatry clinic for suicidal and/or NSSI behavior were recruited together with their accompanying parents within the framework of a specified diagnostic procedure. This included detailed questionnaire and interview procedures for psychiatric assessment. The extent of parental stress and parents' motivation for treatment and its relations to adolescents' NSSI and own treatment motivation have been investigated in a follow-up examination in the aftermath of the acute presentation. We predicted adolescents' NSSI at follow-up based on their own motivation and parental motivation and stress. RESULTS: Data analysis demonstrated that higher adolescents' treatment motivation was associated with higher parental stress. Also, higher parental treatment motivation was correlated with a higher degree of parental distress. Furthermore, parents showed lower treatment motivation when their children engaged in NSSI for a longer duration. Finally, lower adolescents' motivation and lower parental stress due to own parental concerns were predictive for higher adolescents' NSSI frequency at follow-up investigation. DISCUSSION/CONCLUSION: Patients as well as their parents who present for an emergency service are especially likely to be exposed to increased stress and strain factors. During treatment, additional focus should be placed on parental stress and parental and adolescents' treatment motivation. Identifying and addressing deficits in motivation, increases in parental stress, as well as offering support could favorably impact future NSSI behavior.