Treatment of Psychiatric Emergencies

Treatment of Psychiatric Emergencies in Children Versus Adults

              We are presented with an adult woman with a history of chronic pain and thyroid disease, presenting with severe depression and suicidal ideation.  The patient had periods of severe anger towards her husband because of his alleged lack of emotional support and love.  When she engaged in self harm to gain his attention, the husband’s response was not to offer the emotional attention and love, but rather to arrange for commitment of his wife to the inpatient psychiatric unit.

              Treatment of this patient starts with ruling out of any life threatening organic causes of the patient’s behavior, such as; hypoglycemia, hypoxia, thyroid, liver or kidney dysfunction.  After medical clearance, this patient requires emergency psychiatric evaluation to determine the true level of suicide risk (Monnens, 2005, p. 878-880).

              If this were a child or adolescent, the treatment also getting the patient medically cleared prior to psychiatric evaluation.  These patients who have psychiatric disorders that impair emotional, cognitive, physical, and/or behavioral functioning are evaluated in the context of the family, school, community, and culture (Garson & Havens, 2015; Wharff, Ginnis, & Ross, 2012).  Most of their identified signs and symptoms with their associated impairments in developmental functioning responds to established treatments (Chun, Katz, Duffy, & Gerson, 2015).  The psychiatric evaluator must prioritize symptoms and diagnosis so that a reasonable treatment plan will address multiple problems.

              Ethically, similar rules apply to all children up to age 18 years.  Parents must consent to treatment but children may agree or disagree (Sondheimer & Jensen, 2009).  When guardian and child agree, care can proceed smoothly, and when they disagree, fundamental ethical considerations is required.  Because safety of the child is important (beneficence and nonmaleficence), guardian and/or child opposition to psychiatric intervention is disregarded in the event of imminent danger.  When, parent’s consent and children disagrees, the same principles are used as a basis for reasoning, but because of developmental dissimilarities they will be applied differently (justice) (American Academy of Child and Adolescent Psychiatry (2009).

References

American Academy of Child and Adolescent Psychiatry. (2009). Code of Ethics. Retrieved April 4, 2018 from http://www.aacap.org/galleries/AboutUs/AACAP_Code_of_Ethics.pdf.pdf.

Chun, T.H., Katz, E.R., Duffy, S.J., & Gerson, R.S. (2015). Challenges of managing pediatric mental health crises in the emergency department. Child and Adolescent Psychiatric Clinics of North America, 24(1), 21-40. doi: 10.1016/j.chc.2014.09.003

Gerson, R., & Havens, J. (2015). The child and adolescent psychiatric emergency: A public health challenge. Psychiatric Times, 32(11). Retrieved April 4, 2018 from http://www.psychiatrictimes.com

Monnens, J.B. (2005). Mental health emergencies. In: L. Newberry, L.M. Criddle. (Eds.). Sheehy’s Manual of Emergency Care (6th ed.). Elsevier, Mosby.

Sondheimer, A., & Jensen, P. (2009). Ethics and child adolescent psychiatry. In: S. Bloch, S. Green. (Eds.). Psychiatric Ethics (4th ed.). Oxford, UK: Oxford University Press.

Wharff, E.A., Ginnis, K.M., & Ross, A.M. (2012). Family-based crisis intervention with suicidal adolescents in the emergency room. Social Work, 57(2), 133-143.