RESUMEN

STUDY OBJECTIVE: The goal of this study was to evaluate demographic factors associated with increased emergency department use among people with psychiatric conditions. METHODS: This was a retrospective cohort study of all patients presenting to an urban, academic emergency department with a history of at least one mental health-related final diagnosis. RESULTS: A total of 569 people with psychiatric conditions were included in the study. Of this group, 22.1% had four or more visits within 2009. People with more than four annual visits were more likely to be over age 40, to have at least one chronic condition, to have Medicaid, and to be Black compared with those with fewer than four annual visits. DISCUSSION: The frequent-user group had fewer visits with a final psychiatric diagnosis, lower rate of psychiatric admissions, and higher rate of visits resulting in a medical admission than the infrequent-user group.

Asunto(s)

Servicio de Urgencia en Hospital/estadística & datos numéricos , Trastornos Mentales/epidemiología , Adulto , Negro o Afroamericano/psicología , Negro o Afroamericano/estadística & datos numéricos , Distribución por Edad , Anciano , Enfermedad Crónica , Femenino , Humanos , Masculino , Medicaid/estadística & datos numéricos , Trastornos Mentales/etnología , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos/epidemiología

RESUMEN

INTRODUCTION: Patients with abdominal pain often return multiple times despite no definitive diagnosis. Our objective was to determine if repeat emergency department (ED) use among patients with non-specific abdominal pain might be associated with a diagnosis of moderate to severe depressive disorder. METHODS: We screened 987 ED patients for major depression during weekday daytime hours from June 2011 through November 2011 using a validated depression screening tool, the PHQ-9. Each subject was classified as either no depression, mild depression or moderate/severe depression based on the screening tool. Within this group, we identified 83 patients with non-specific abdominal pain by either primary or secondary diagnosis. Comparing depressed patients versus non-depressed patients, we analyzed demographic characteristics and number of prior ED visits in the past year. RESULTS: In patients with non-specific abdominal pain, 61.9% of patients with moderate or severe depression (PHQ9≥10) had at least one visit to our ED for the same complaint within a 365-day period, as compared to 29.2% of patients with no depression (PHQ9<5), (p=0.013). CONCLUSION: Repeat ED use among patients with non-specific abdominal pain is associated with moderate to severe depressive disorder. Patients with multiple visits for abdominal pain may benefit from targeted ED screening for depression. [West J Emerg Med. 2014;15(3):325-328.].

Asunto(s)

Dolor Abdominal/psicología , Depresión/complicaciones , Depresión/diagnóstico , Servicio de Urgencia en Hospital/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Dolor Abdominal/epidemiología , Adulto , Distribución por Edad , Estudios Transversales , Depresión/epidemiología , Femenino , Humanos , Masculino , Tamizaje Masivo , Medicaid , Aceptación de la Atención de Salud/estadística & datos numéricos , Escalas de Valoración Psiquiátrica , Índice de Severidad de la Enfermedad , Distribución por Sexo , Factores de Tiempo , Estados Unidos/epidemiología

RESUMEN

Numerous medical and psychiatric conditions can cause agitation; some of these causes are life threatening. It is important to be able to differentiate between medical and nonmedical causes of agitation so that patients can receive appropriate and timely treatment. This article aims to educate all clinicians in nonmedical settings, such as mental health clinics, and medical settings on the differing levels of severity in agitation, basic triage, use of de-escalation, and factors, symptoms, and signs in determining whether a medical etiology is likely. Lastly, this article focuses on the medical workup of agitation when a medical etiology is suspected or when etiology is unclear.