Piechniczek-Buczek Joanna
Division of Psychiatry, Boston University School of Medicine, Robinson Building B-410, 88 East Newton Street, Boston, MA 02118, USA.
Emerg Med Clin North Am. 2006 May;24(2):467-90, viii. doi: 10.1016/j.emc.2006.01.008.
This article reviews the most common behavioral emergencies in the geriatric population. Psychiatric emergencies are seen frequently by emergency physicians who face the challenge of assessing and managing patients presenting with psychosis, severe depression, agitation, suicidal intent, and substance abuse in the emergency department. The evaluation is frequently complicated by the necessity to investigate numerous domains such as underlying medical conditions, prior psychiatric disorders and substance abuse, as well as psychosocial factors. It is crucial to rule out organic causes for what appears to be psychiatric disease in the elderly. The assessment might be further complicated by the patient's limited ability to recall pertinent aspects of the history due to either cognitive impairment or acute distress. Emergency department personnel might have inadequate expertise in assessing emergencies in elderly persons, further impeding the ability to appropriately manage behavioral complications in geriatric patients. Availability of high-quality emergency care and tight collaboration with primary care providers, psychiatric consultants, and social services is crucial to optimal outcomes from acute psychiatric decompensations in the elderly.
本文综述了老年人群中最常见的行为紧急情况。急诊科医生经常会遇到精神科紧急情况,他们面临着在急诊科评估和处理出现精神病、重度抑郁、躁动、自杀意图和药物滥用的患者的挑战。由于需要调查众多领域,如潜在的医疗状况、既往精神疾病和药物滥用以及社会心理因素,评估常常变得复杂。排除老年人看似精神疾病的器质性病因至关重要。由于认知障碍或急性痛苦,患者回忆病史相关方面的能力有限,这可能会使评估进一步复杂化。急诊科工作人员在评估老年人紧急情况方面可能缺乏足够的专业知识,这进一步阻碍了对老年患者行为并发症进行适当处理的能力。提供高质量的紧急护理以及与初级保健提供者、精神科顾问和社会服务部门紧密合作,对于老年急性精神失代偿获得最佳结果至关重要。