Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ ADULT PSYCHIATRIC PATIENTS IN THE EMERGENCY DEPARTMENT +++ Populations ++ – Adult patients presenting to ED with psychiatric symptoms. – Adults with abnormal liver chemistries. +++ Recommendations ++ – No role for routine laboratory testing. Medical history, examination, and previous psychiatric diagnoses should guide testing. – No role for routine neuroimaging studies in the absence of focal neurological deficits. – Risk assessment tools should not be used in isolation to identify low-risk adults who are safe for ED discharge if they present with suicidal ideations. +++ Source ++ – Nazarian DJ, Broder JS, Thiessen ME, Wilson MP, Zun LS, Brown MD; 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. +++ ALCOHOL USE DISORDERS +++ Population ++ – Adults. +++ Recommendations +++ USPSTF 2018, APA 2018 ++ – For patients identified with an Alcohol Use Disorder, provide a brief intervention and schedule follow-up via SBIRT (Screening Brief Intervention, and Referral to Treatment) model. – Refer all patients with life-threatening withdrawal such as seizure or delirium tremens to a hospital for admission. – Refer more stable outpatients to a behavioral therapy such as the IOP (Intensive Outpatient Program), an RTC (residential treatment center), or a Sober Living facility. – Recommend prophylactic thiamine for all harmful alcohol use or alcohol dependence. – Refer suitable patients with decompensated cirrhosis for consideration of liver transplantation once they have been sober from alcohol for ≥3 mo. – Recommend pancreatic enzyme supplementation for chronic alcoholic pancreatitis with steatorrhea and malnutrition. +++ Sources ++ – JAMA. 2018;320(18):1899-1909. – Am J Psychiatr. 2018;175(1):86-90. +++ Comments ++ Assess all patients for a coexisting psychiatric disorder (dual diagnosis). Use disorder-focused psychosocial intervention for patients with alcohol dependence. Consider adjunctive pharmacotherapy under close supervision for alcohol dependence: Naltrexone and Acamprosate have the best evidence (COMBINE Trial https://www.ncbi.nlm.nih.gov/pubmed/16670409). Consider gabapentin or topiramate if patient has not responded to above (https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9781615371969) +++ ANXIETY +++ Population ++ – Adults. +++ Recommendations +++ NICE 2018 ++ – Recommends cognitive behavioral therapy for generalized anxiety disorder (GAD). – Consider sertraline first if drug treatment is needed. – If sertraline is ineffective, recommend a different selective serotonin reuptake inhibitor (SSRI) or selective noradrenergic reuptake inhibitor (SNRI). – Avoid long-term benzodiazepine use or antipsychotic therapy for GAD. +++ Source ++ – nice.org.uk/guidance/cg113 +++ ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD) +++ Population ++ – Children age 4–18 ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth