Chapter 1: Behavioral Health and Substance Use Disorders

ACUTE PSYCHOSIS

Management

Children, Adolescents, and Adults

Recommendations from

► ACEP 2017, AAFP 2015, AAP 2022

• –Do not obtain routine laboratory testing.¹ Medical history, examination, and previous psychiatric diagnoses should guide testing.

• –Do not routinely order neuroimaging studies in the absence of focal neurologic deficits.

• –Refer to specialty management as indicated.

• –Refer to emergency care if the patient appears manic or expresses suicidal/homicidal ideation or intent.

Sources

• –Ann Emerg Med. 2017;69(4):480–498.

• –Am Fam Physician. 2015;91(12):856–863.

• –AAP. Quick Reference Guide to Pediatric Care, 2nd ed. 2022. ISBN 978-1-61002-111-1

• –AAP. Screening Tools: Mental Health MiniSeries. https://www.aap.org/en/patient-care/mental-health-minute/screening-tools/

ALCOHOL USE DISORDERS

Screening

Adolescents

Recommendations from

► USPSTF 2018, AAP 2019

• –Consider screening children and adolescents.

Sources

• –AAP. Pediatrics. 2019;144(1):2018.

• –USPSTF. JAMA. 2018;320(18):1899–1909.

Screening

Adults

Recommendations from

► CDC 2024, USPSTF 2018

• –Screen all adults in primary care settings for alcohol misuse, including pregnant persons.

• –If positive, administer a brief behavioral counseling intervention and offer or refer for diagnostic assessment.

Sources

• –CDC. Alcohol Screening and Brief Intervention. 2024.

• –USPSTF. JAMA. 2018;320(18):1899–1909.

• –ASAM. Public Policy Statement on Screening for Addiction in Primary Care Settings. 1997.

Management

Adults

Recommendations from

► USPSTF 2018, APA 2018, WHO 2023

• –For adults identified with an alcohol use disorder, provide a brief intervention and schedule follow-up via SBIRT (Screening, Brief Intervention, and Referral to Treatment) model.

• –Assess all patients with frequent or heavy alcohol use regularly for risk of developing withdrawals. Treat alcohol withdrawal with benzodiazepines, gabapentin, or phenobarbital.

• –Refer all patients with life-threatening withdrawal such as seizure ...