Involuntary psychiatric hold: Difference between revisions
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==Background== | ==Background== | ||
* | *Involuntary hospitalization of patient threatening/attempting to leave the ED for purposes of evaluating patient's risk of harm to self/others and/or ability to safely care for self. | ||
*Exact criteria and process vary by jurisdiction | *'''Exact criteria and process vary by jurisdiction''' | ||
==Evaluation== | ==Evaluation== | ||
'''"Clinical factors related to admission and release decisions in psychiatric emergency services"''' <ref>Way BB, Banks S: Clinical factors related to admission and release decisions in psychiatric emergency services. Psychiatr Serv 52: 214, 2001.</ref><ref>Tintinalli's Emergency Medicine A Comprehensive Study Guide, 9th edition Tintinalli, Ma, Yealy, Meckler, Stapczynski, Cline, and Thomas</ref> | |||
*''in declining order of importance:'' | |||
#level of danger to self | |||
#severity of psychosis | |||
#ability for self care | |||
#impulse control | |||
#severity of depression ( [[Depression | SIGECAPS]] , [[SAD PERSONS score | SAD PERSONS]] ) | |||
<br> | |||
= | '''Crisis Triage Rating Scale''' <ref>Bengelsdorf H, Levy L, Emerson R, et al: A crisis triage rating scale: brief dispositional assessment of patients at risk for hospitalization. J Nerve Mental Dis 172: 424, 1984. </ref> | ||
*''3 is worst, 15 is best'' | |||
*''has not been validated for ED use''<ref>Tintinalli's Emergency Medicine A Comprehensive Study Guide, 9th edition Tintinalli, Ma, Yealy, Meckler, Stapczynski, Cline, and Thomas</ref> | |||
{| class="wikitable" | |||
|- | |||
! Element !! Components | |||
|- | |||
| '''Dangerousness''' (''from most severe to least severe'') || 1. Acute SI/HI, current serious SI/HI attempt, unpredictable | |||
|- | |||
| || 2. History of violent/impulsive behavior but no current signs | |||
|- | |||
| || 3. AmbivalentSI/HI but ineffective gestures | |||
|- | |||
| || 4. SI/HI but desire to control behavior | |||
|- | |||
| || 5. No SI/HI and no history of violent/impulsive behavior | |||
|- | |||
| '''Support System''' (''from worst to best'') || 1. None | |||
|- | |||
| || 2. Some but limited effectiveness | |||
|- | |||
| || 3. Some but not easy to mobilize | |||
|- | |||
| || 4. Yes but limited | |||
|- | |||
| || 5. Yes and good support | |||
|- | |||
| '''Cooperation''' (''from worst to best'') || 1. Not able or refuses | |||
|- | |||
| || 2. Little interest in cooperating | |||
|- | |||
| || 3. Passive acceptance of help | |||
|- | |||
| || 4. Wants help but desire limited | |||
|- | |||
| || 5. Strong desire for help and will cooperate | |||
|} | |||
==See Also== | ==See Also== | ||
*[[General psychiatric approach]] | |||
*[[SAD PERSONS score]] | |||
==External Links== | ==External Links== | ||
*[http://www.samhsa.gov/ Substance Abuse and Mental Health Services Administration (SAMHSA)] | |||
==References== | ==References== | ||
Latest revision as of 09:07, 18 October 2019
Background
- Involuntary hospitalization of patient threatening/attempting to leave the ED for purposes of evaluating patient's risk of harm to self/others and/or ability to safely care for self.
- Exact criteria and process vary by jurisdiction
Evaluation
"Clinical factors related to admission and release decisions in psychiatric emergency services" [1][2]
- in declining order of importance:
- level of danger to self
- severity of psychosis
- ability for self care
- impulse control
- severity of depression ( SIGECAPS , SAD PERSONS )
Crisis Triage Rating Scale [3]
- 3 is worst, 15 is best
- has not been validated for ED use[4]
| Element | Components |
|---|---|
| Dangerousness (from most severe to least severe) | 1. Acute SI/HI, current serious SI/HI attempt, unpredictable |
| 2. History of violent/impulsive behavior but no current signs | |
| 3. AmbivalentSI/HI but ineffective gestures | |
| 4. SI/HI but desire to control behavior | |
| 5. No SI/HI and no history of violent/impulsive behavior | |
| Support System (from worst to best) | 1. None |
| 2. Some but limited effectiveness | |
| 3. Some but not easy to mobilize | |
| 4. Yes but limited | |
| 5. Yes and good support | |
| Cooperation (from worst to best) | 1. Not able or refuses |
| 2. Little interest in cooperating | |
| 3. Passive acceptance of help | |
| 4. Wants help but desire limited | |
| 5. Strong desire for help and will cooperate |
See Also
External Links
References
- ↑ Way BB, Banks S: Clinical factors related to admission and release decisions in psychiatric emergency services. Psychiatr Serv 52: 214, 2001.
- ↑ Tintinalli's Emergency Medicine A Comprehensive Study Guide, 9th edition Tintinalli, Ma, Yealy, Meckler, Stapczynski, Cline, and Thomas
- ↑ Bengelsdorf H, Levy L, Emerson R, et al: A crisis triage rating scale: brief dispositional assessment of patients at risk for hospitalization. J Nerve Mental Dis 172: 424, 1984.
- ↑ Tintinalli's Emergency Medicine A Comprehensive Study Guide, 9th edition Tintinalli, Ma, Yealy, Meckler, Stapczynski, Cline, and Thomas