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This study examined national patterns in emergency department (ED) treatment of patients aged 7 to 22 years who were seen after episodes of deliberate self-harm. Data were from the 1997-2002 National Hospital Ambulatory Medical Care Survey. Population data from the 2000 US Census Bureau were used to estimate population visit rates for the age group studied.

Medical school graduation usually involves the Hippocratic Oath, in which physicians vow not to intentionally harm their patients. Keeping patients safe is another basic principle of patient care. Physicians are charged with ensuring that their patients are in a safe environment and minimizing risks to their patients by carefully selecting treatment options. In emergency psychiatric settings, patient safety is critical, especially when the patient is a danger to himself or herself or to others.

Assessing a patient's capacity to make a decision about accepting or refusing a medical intervention should be performed quickly but systematically. Physicians from the department of psychiatry at the Mayo Clinic in Rochester, Minn, present a 3-dimensional model for evaluating capacity. This model includes the risk of the proposed treatment (high vs low), the benefit level of the treatment (high vs low), and the patient's decision about the treatment (accept vs refuse).

Psychiatric advance directives (PADs) allow persons to authorize proxy decision makers and document advance instructions or preferences about future mental health treatment in the event of a crisis. The intent of PAD legislation is to enhance treatment autonomy for persons with severe mental illnesses (such as schizophrenia, bipolar disorder, and major depression) who anticipate periods of decisional incapacity associated with illness relapse.

Dance Lesson

Dance Lesson - Poetry of the Times

Psychiatric Times

The online contents of the April 2006 issue of Psychiatric Times.

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