Dr Hartley is a psychiatrist in a private practice in Oakland, Calif.
Drs Kunen and Mandry respond:
We would like to thank Dr Hartley for her thoughtful comments on our article, since one purpose of the article was to stimulate discussion about the importance of screening for psychiatric disorders among ED patients.
Dr Hartley notes that we did not emphasize the importance of screening for delirium, which she considers to be the most critical psychiatric condition. We certainly do not dispute the importance of screening for delirium and agree that it should be a high priority, although we do not necessarily agree that it is the most critical of all psychiatric conditions. It seems to us that there are several psychiatric conditions, some of which are potentially lethal, that should be of higher priority. These include patients with major depression who have attempted suicide, patients with schizophrenia who have expressed homicidal intent, patients with bipolar disorder who are manic and floridly psychotic, patients with substance dependence who have overdosed and compromised their cardiopulmonary and/or renal function, and children with pica who have self-poisoned.
Dr Hartley's comment about the importance of routinely conducting MSEs stimulated us to examine the frequency of reported MSEs in the CDC's national survey of EDs (which was the basis of part of our article1), and sure enough, 91% of the sampled ED physicians had not conducted an MSE. It is our hope that emergency medicine physicians will soon recognize that it is good medicine to screen patients for psychiatric disorders and that, if they are not willing to do so, they will advocate for including mental health professionals on staff who will conduct such screenings.
Seth Kunen, PhD, PsyD
Cris V. Mandry, MD
Baton Rouge, La
Dr Kunen is clinical assistant professor of medicine and director of research at the Louisiana State University Emergency Medicine Residency Program at Earl K. Long Medical Center in Baton Rouge. Dr Mandry is clinical associate professor of medicine and program director of the Louisiana State University Emergency Medicine Residency Program at the Earl K. Long Medical Center.
Reference
1. McCaig LF, Burt CW.National hospital ambulatory care survey: 2002 emergency department summary. Adv Data. 2004;340:1-34.
