Table Of ContentEmergency Psychiatry
Emergency Psychiatry
Arjun Chanmugam, MD, MBA
AssociateProfessor,DepartmentofEmergencyMedicine,
TheJohnsHopkinsUniversitySchoolofMedicine,
Baltimore,MD,USA
Patrick Triplett, MD
AssistantProfessorandClinicalDirector,DepartmentofPsychiatry,
TheJohnsHopkinsUniversitySchoolofMedicine,
Baltimore,MD,USA
Gabor Kelen, MD
ProfessorandChair,DepartmentofEmergencyMedicine,
TheJohnsHopkinsUniversitySchoolofMedicine,
Baltimore,MD,USA
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Emergencypsychiatry/[editedby]ArjunChanmugam,PatrickTriplett,
GaborKelen.
p. ; cm.
Includesbibliographicalreferencesandindex.
ISBN978-0-521-87926-2(Hardback)
I. Chanmugam,ArjunS. II. Triplett,Patrick. III. Kelen,GaborD.
[DNLM: 1. EmergencyServices,Psychiatric–methods. 2. Mental
Disorders–diagnosis. 3. MentalDisorders–therapy. WM401]
616.890025–dc23
2012029376
ISBN978-0-521-87926-2Hardback
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fromactualcases,everyefforthasbeenmadetodisguisetheidentitiesofthe
individualsinvolved.Nevertheless,theauthors,editorsandpublisherscan
makenowarrantiesthattheinformationcontainedhereinistotallyfreefrom
error,notleastbecauseclinicalstandardsareconstantlychangingthrough
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Idedicatethis book to Karen,my wonderful
inspiration; to Sydney, William,and Nathan, who
all remind me ofwhatis important;andto Teruni
and Tamara and my parents,whose support helped
make this work possible. May this book serve well
those who seek to reduce suffering.
ArjunChanmugam
For Audrey, Hallie, andAlex, andwith thanks to
James and Florence for their support andkindness.
Thanks too to my colleagues at Johns Hopkins for
theirwisdom,guidanceandunwaveringcommitment
to our shared missions.
Patrick Triplett
To my late parents,Andrewand Susan Kelen, who
instilledin me alove for discovery.
Gabor Kelen
Contents
List of contributors viii
Preface xi
Acknowledgement xii
1 Assessment and general 12 Issues inpediatric psychiatric
approach 1 emergency care 185
Patrick Triplettand J. Raymond
EmilyFrosch and Patrick Kelly
DePaulo
13 The evaluation ofintellectual and
2 Management of agitation and developmental disabilities 200
violence 25
Lisa S. Hovermale,Theodosia
Mustapha Saheed
Paclawskyj, DyanneSimpson,
3 Suicideassessments 41 and Eric Samstad
Holly C. Wilcox, Annette L. Beautrais, 14 Emergency management of eating
and Gregory Luke Larkin disorders 219
4 Managing substanceabuse in the GrahamW.Redgrave,JamesHarrison,
acute setting 57 and Angela S.Guarda
Arjun Chanmugam, Dave Milzman, 15 The acutemanagement ofpatients
Curtis Bone, and Hahn Soe-Lin with psychiatric complicationsof
5 Psychosis 78 chronic illness or chronic pain 235
Paul P. Rega MichaelClark and Glenn Treisman
6 The delirious patient 94 16 Deathand dying 257
Sharon Bord CatherineA.MarcoandValerieR.Lint
7 The anxious patient 112 17 The emergencymanagement of
womenwith psychiatric illness 268
Ashley D.Bone and O.Joseph
Bienvenu KarenSchwartz
8 Mood disorders 130 18 The impact of culture on the acute
management of psychiatric
Eric L.Anderson
illness 280
9 Personality disorders 148
Geetha Jayaram
FrederickHouts and GlennTreisman
19 Understandingthe psychology of
10 Legal issues in the careof difficultpatients 290
psychiatric patients in the
RoshniI. Thakore
emergency department 156
Cynthia Major-Lewis, Dennis Barton,
Patrick Triplett, and Darren Mareiniss
11 Geriatricpsychiatry 165 Appendix 294
CrystalWatkinsand Patrick Triplett Index 298 vii
Contributors
Eric L.Anderson, MD Arjun Chanmugam, MD, MBA
AssistantProfessor Associate Professor,Departmentof
Department of Psychiatry Emergency Medicine
The Johns Hopkins University School The Johns Hopkins University School of
of Medicine Medicine
Baltimore,MD, USA Baltimore,MD, USA
Dennis Barton,MD MichaelClark,MD
PhysicianExecutive, Dearborn Associate Professorand Vice Chairfor
Advisors, LLC ClinicalAffairs
The Johns Hopkins University School Department of Psychiatry
of Medicine The Johns Hopkins University School of
Baltimore,MD, USA Medicine
Baltimore,MD, USA
AnnetteL. Beautrais,PhD
Department of Emergency Medicine J. RaymondDePaulo, MD
Yale University School of Medicine
HenryPhipps Professorand Director
New Haven, CT, USA
Department of Psychiatryand Behavioral
Sciences
O. Joseph Bienvenu, MD,PhD
The Johns Hopkins University School of
Associate Professor
Medicine
Department of Psychiatryand Behavioral
Baltimore,MD, USA
Sciences
The Johns Hopkins University School
Emily Frosch, MD
of Medicine
AssistantProfessor
Baltimore,MD, USA
Divisionof Child & AdolescentPsychiatry
Ashley D.Bone, MD Department of Psychiatry& Behavioral
Sciences
Department of Psychiatryand Behavioral
The Johns Hopkins University School of
Sciences
Medicine
TheJohnsHopkinsBayviewMedicalCenter
Baltimore,MD, USA
Baltimore,MD,USA
CurtisBone, MD AngelaS. Guarda,MD
Department of Psychiatryand Behavioral Associate Professorof Psychiatryand
Sciences Behavioral Sciences
The Johns Hopkins Bayview Medical The Johns Hopkins University School of
Center Medicine
Baltimore,MD, USA Baltimore,MD, USA
Sharon Bord, MD James Harrison, BA
Emergency Department University of Pennsylvania Schoolof
TheJohnsHopkinsBayviewMedicalCenter Medicine
Baltimore,MD,USA Philadelphia, PA,USA
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