Talk:Emergency psychiatry

photo of bed

does not look like a picture of emergency psychiatric bed. Maybe an inpatient medicine bed. In the US typically patients in the psych ER are in either regular beds, or no beds at all. The stay is typically short. Many patient do not even have a bed, they may wait for 4-5 hours and be dischrged. I vote for removing the photo.

I second that. This is a medical bed as evidenced by wall-mounted suction, BP cuffs attached to wall, cords visible, etc. No psychiatric room would have these, too dangerous if a psych patient had a medical emergency they would be transferred out. I will remove it. 71.110.173.61 (talk) 06:32, 28 November 2007 (UTC)

Treatment

the treatment section is quite odd, part is irrelevant, such as the use of 'psych' medication is the general ER. Some is factually incorrect. Intrathecal (via spinal fluid) would never be used in the psych ER, for many reasons. Also the citations are 24 years old. I'll try to buff things up. —Preceding unsigned comment added by Expo512 (talk • contribs) 08:01, 23 November 2007 (UTC)

Pharmacokinetics, while related to medications, probably should be discussed in depth elsewhere

Improvements?

any suggestions for improvement? Expo512 22:52, 18 October 2005 (UTC)

VFD

User:V. Molotov put a VfD on this article, then deleted it. You can't unilaterally delete a VfD, even if you added it. --Rogerd 05:49, 20 October 2005 (UTC)

Rewrite

I rewrote the article today. Please feel free to include comments here, or make any changes. Thanks for the contributions thus far! Chupper 00:06, 16 July 2007 (UTC)

The content looks good. However is it really necessary for every single sentence to have an in-line citation? References 2 and 3 are repeated a lot. If three sentences in a row refer to number 2, it is better to put a single in-line citation at the end of the third sentence. Axl 08:42, 16 July 2007 (UTC)

I understand your concern regarding citations for every sentence. I used to, like you said, just put the citation after a few sentences. However I have run across reviewers, admins, and other editors who subscribe to the "Not every statement in an article needs a citation, but if in doubt, provide one" mentality, especially with medicine articles. Because I run into people from both camps, I figure it is better to include more than to include less. However, if you feel like this is a strong point hindering the quality of the article, I can remove some... Just let me know. Chupper 12:26, 16 July 2007 (UTC)

The reason reference notes 2 and 3 appear so much (Emergency Psychiatry by Hillard & Zitek as well as Emergency Psychiatry: Concepts, Methods, and Practices by Bassuk and Birk) is probably because every sentence is referenced. But from a reference standpoint, they are pretty exhaustive and authoritative references when it comes to the clinical application of emergency psychiatry. This is probably why they are so prevalent, especially in the "Patient Care" section. Chupper 12:26, 16 July 2007 (UTC)

I'm going to remove some of the excess citations. Axl 18:29, 16 July 2007 (UTC)

Okay, that's much better. :-) Axl 18:50, 16 July 2007 (UTC)

Images

I note that the "Psi & Caduceus" image appears in the main Psychiatry article as well. However is it really a valid symbol for psychiatry? The caduceus is a symbol of commerce. Axl 08:50, 16 July 2007 (UTC)

Well, it's included on the psychiatry template, see {{Template:psychiatry}}. If you feel as if the template is hurting the article, I can remove it. Otherwise this issue deals more with that template than the article. I do agree with you, however I was trying to gain some consensus at the talk page over there to use an image of a brain. If you would like to leave a comment on the talk page over there, I know it would be appreciated! Chupper 12:26, 16 July 2007 (UTC)

The "Greek letter Psi" and the "Star of Life" are included on the page. Although I know the relevance of those symbols, there doesn't seem to be any explanation of them. Axl 09:16, 16 July 2007 (UTC)

Corrected, I've added an explanation in the caption. Chupper 12:26, 16 July 2007 (UTC)

Thanks, the context is clear now. Axl 18:29, 16 July 2007 (UTC)

Good article

1. Well-written? Yes.
2. Factually accurate and verifiable? Yes, with reliable references.
3. Broad in coverage? Yes, comprehensive.
4. Neutral? Yes.
5. Stable? Yes.
6. Appropriate images? Yes.

This is a comprehensive article about the emergency psychiatry services. I have assigned "Good article" status. Axl 18:56, 16 July 2007 (UTC)

Annual suicides

The article says 786,000 worldwide (based on a shaky source); this Medscape article references a book which indicates a million worldwide. [1] This article says the WHO estimates a million annual worldwide. [2] WHO data should be tracked down. SandyGeorgia (Talk) 23:28, 11 August 2007 (UTC)

Source for WHO million, as of 2000 (that is, now old data). [3] SandyGeorgia (Talk) 23:34, 11 August 2007 (UTC)

Thanks a lot for finding a better source and including it as a reference! For some reason I was having a problem finding a better source for that data, but I knew it was high. Chupper 00:53, 26 August 2007 (UTC)

Quotation request

User:Outriggr requested a citation from the book Emergency Psychiatry edited by Randy Hillard and Brook Zitek. I'm providing a quotation from the book for the information he requested.

Initially he requested a citation for the sentence "In addition, having a high intelligence quotient, high aspirations, or insight into illnesses can also be risk factors for violence." I restored the APA reference for that sentence removed by User:Axl and rewrote the sentence. It now reads "Other risk factors for violence include a high intelligence quotient and having a vast knowledge of mental disorders." The following comes from Hillard, R. & Zitek, B. (2004). Emergency Psychiatry. New York: McGraw-Hill.

"General risk factors for violence in such patients include:

• Prior arrests
• Substance abuse
• Presence of hallucinations, delusions, or bizzare behaviors
• Presence of neurological impairment
• Being male, poor, unskilled, uneducated, or unmarried

In addition, more specific risk factors include:

• Young age
• High IQ
• High level of premorbid scholastic achievement
• High aspirations
• Insight, awareness, into illnesses and losses
• Chronic intermittent course characterized by relapses and exacerbations of illness"

(Hillard & Zitek, 2004, p.77) —Preceding unsigned comment added by Chupper (talk • contribs) 22:08, August 25, 2007 (UTC)

Emergency psychiatry verse Psychiatric Emergency Services

I initially started an article on Psychiatric Emergency Services (PES). I think that this is distinct subset of Emergency Psychiatry. PES is often a physical place where patients with mental health complaints are seen. Emergency psychiatry can be practiced in either a clinic specific to psychiatry or in a general medical emergency room. Maybe this article needs a subsection on PES? —Preceding unsigned comment added by Expo512 (talk • contribs) 08:58, 23 November 2007 (UTC)

Hi Expo and thanks for your contributions. A subsection of this article already discusses PES. It is called "Delivery of emergency service". It, of course, could be updated. Chupper (talk) 16:21, 23 November 2007 (UTC)

psychosurgery

I think that the reference to psychosurgery and ECT should stay removed from the article. The citation is from 1983 (currently 24 years old) and being a text book, it is probally based inteh information from the 1970s. I would be interested in seeing what it says actually.Expo512 (talk) 05:32, 24 November 2007 (UTC)

One could make an argument that ECT could be done urgently/ emergently, for example in the case of catatonia, but this in not really emergency psychiatry. ECT will involve an anesthesiologist, and likely admission to a hospital if it so very urgent. That would come more under the topic of inpatient psychiatry or general psychiatry.I think that the 1st four paragraphs of the article make it clear that the subject relates to treating people in crisis that immediately come in from the community, rather than all urgent psychiatric matters. Expo512 (talk) 05:43, 24 November 2007 (UTC)

Not to belabor the point but here is a quote from on of the references listed (#17):

"Psychosurgery and other intrusive and irreversible treatments for mental illness shall never be carried out on a patient who is an involuntary patient in a mental health facility and, to the extent that domestic law permits them to be carried out, they may be carried out on any other patient only where the patient has given informed consent and an independent external body has satisfied itself that there is genuine informed consent and that the treatment best serves the health needs of the patient. "

This is from Ireland. If treatment in em. psych services is short term 24-48 hours, no one is getting an independent external body to review the case. I'll leave in the ECT mention, but mentioning psychosurgery in relationship to PES is fairly off. Psychiatrist work in PES, they don't do surgery.Expo512 (talk) 07:59, 24 November 2007 (UTC)

The wikipedia article on psychosurgery implies that is rarely done anymore and this referance: http://neurosurgery.mgh.harvard.edu/Functional/psysurg.htm implies that one must carefully consider and review each case before a neurosurgeon will operate. Not psych emergency materialExpo512 (talk) 08:35, 24 November 2007 (UTC)