General psychiatric approach

(Redirected from General psychiatric workup)

Background

  • Be wary of diagnostic overshadowing (e.g. erroneously attributing symptoms of medical illness to psychiatric disease)
    • Compared to overall population, patients with mental illness have significantly higher rates of stroke[1], CAD[2], DM[3], cancer[4], HIV, HCV[5]

Clinical Features

Mental Status Exam

  • General Appearance
  • Orientation and Attention
  • Speech
  • Mood and affect
  • Thought Patterns (process, content)
  • Psychomotor behavior
  • Insight and Judgement

Differential Diagnosis

General Psychiatric

Evaluation

  • Rule out medical pathology as cause or exacerbating factor for presentation

General ED Psychiatric Workup

Evaluation

ACEP Guidelines 2005

  • Class B recommendations
  • Routine laboratory testing is of low yield and unnecessary
  • Routine urine toxicology need not be performed
  • Pending results should not delay transfer or evaluation
  • Patient’s cognitive abilities, rather than specific blood alcohol level, should dictate initiation of psychiatry evaluation

Management

General ED Psychiatric Management

Disposition

See Also

External Links

References

  1. Leucht S, Burkand T, Henderson J, Maj M, Sartorius N (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 116: 317– 333
  2. Leucht S, Burkand T, Henderson J, Maj M, Sartorius N (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 116: 317– 333.
  3. Mai Q, D’Arcy C, Holman J, Sanfilippo FM, Emery JD, et al. (2011) Mental illness related disparities in diabetes prevalence, quality of care and outcomes: a population-based longitudinal study. BMC Med 9: 118.
  4. https://www.cdc.gov/mentalhealth/data_stats/mental-illness.htm
  5. Disability Rights Commission (2006) Equal Treatment: Closing the Gap. A Formal Investigation into Physical Health Inequalities Experienced by People with Learning Disabilities and/or Mental Health Problems. Disability Rights Commission. London.

Authors:

Ross Donaldson