Emergency Psychiatry

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He wasn’t the first person I met days before I was to start my psychiatric residency, but as I walked about in my new city, he caught my attention much more than most. As psychiatrists, we typically assume that we will hear the inside stories, even if in bits and pieces, that will help us better understand and help patients. But perhaps we are too expectant . . .

Violence by patients towards staff members is an inherently complex matter for the physically and/or psychologically injured person. An expert in the field of forensic psychiatry answers a reader's question about what clinicians can do in the aftermath of an assault.

Which treatment was found to be detrimental to patients with PTSD? What is the Brøset Violence Checklist used for? These questions and more in this week's quiz.

What routine screening for alcohol abuse is recommended to avoid alcohol-related psychiatric emergencies in older adults? How will the presence of additional staff members affect an agitated patient in a psychiatric emergency? These and more in this week's quiz.

Since the time of Homer, warriors have returned from battle with wounds both physical and psychological, and healers from priests to physicians have tried to relieve the pain of injured bodies and tormented minds.1 The soldier’s heartache of the American Civil War and the shell shock of World War I both describe the human toll of combat that since Vietnam has been clinically recognized as posttraumatic stress disorder (PTSD).2 The veterans of Operation Iraqi Freedom (OIF) and of Operation Enduring Freedom (OEF) share with their brothers and sisters in arms the high cost of war. As of August 2009, there have been 4333 confirmed deaths of US service men and women and 31,156 wounded in Iraq. As of this writing, 796 US soldiers have died in the fighting in Afghanistan.3

The foreword to the Textbook of Vio­lence Assessment and Management promptly reminds readers that the mental health system has been invested in the prediction and prevention of violence since its inception. In a field dedicated to promoting wellness via the management of cognition, emotion, and behavior, violent thoughts, feelings, and actions are of primary concern. When psychiatric illness or psychological distress manifests as violence, the costs in terms of human suffering are extreme, wreaking havoc in the lives of patients, clinicians, and society at large-often with irrevers­ible consequences.

The term “domestic violence” emerged in the United States with the rise of the women’s movement in the 1970s. Before that, violence between partners was considered a private matter. A specific type of domestic violence, intimate partner violence, refers to violence between intimate partners. Public awareness campaigns help us identify one type of intimate partner violence in which one partner, typically the male partner, is the aggressor, and the other partner, typically the female, is the victim.