The emergency amobarbital interview.

Patients infrequently present to the general emergency department with what appears to be a severe psychiatric condition needing rapid differentiation from urgent and emergency medical problems for proper initial disposition and treatment. These include patients with both acute conversion reactions and those in acute catatonic or pseudocatatonic states. Fifteen consecutive patients (11 women and four men ranging in age from 17 to 62) with these symptoms underwent interviews under intravenous amobarbital in the emergency department. Five of these patients presented with acute paralysis of extremities. Ten presented in a state of vigilant awareness similar to, or identical with, catatonia. Using this technique, all 15 patients had the presumptive psychiatric nature of their underlying condition quickly confirmed. The five patients with conversion reactions have no recurrence to date. Four of the 10 catatonia-type patients had resolution of their symptoms without recurrence. All 15 patients responded to 500 mg or less of amobarbital. There were no complications. Two cases are discussed.