“We Become a Madman to Be Calmed”—Patients’ Voices: Crossing the Threshold of Psychiatric Emergency Departments

Crossing the threshold of a psychiatric emergency room is a real ordeal. It is a passage that upsets, worries and sometimes paralyzes. However, it can also become an opportunity if psychological suffering is welcomed, accepted and understood. The welcome is the starting point for care. Our objective is to understand the meaning given to the phenomenon of “being welcomed” by patients experiencing psychiatric emergencies. The research is based on Grounded Theory Methodology (Glaser and Strauss, 1967) to explore and understand the complexity of the phenomenon. The results reveal that being welcomed can be considered as a rite of passage taking place in four successive phases, which are themselves organized into four interactive dimensions. The welcome as a rite of passage constitutes a powerful psychic support which arranges the transitional space in which the individual finds themself, and accompanies the identity transformations, the anguish, and the various sufferings which are not lacking in these moments of crisis.

Medication use and physical assaults in the psychiatric emergency room

Objective: To evaluate the relationship between medications used to treat acute agitation (antipsychotics, mood stabilizers and benzodiazepines) and subsequent assault incidence in the psychiatric emergency room. Methods: Medication orders and assault incident reports were obtained from electronic health records for 17,052 visits to an urban psychiatric emergency room from 2014-2019. Assault risk was modeled longitudinally using Poisson mixed-effect regression. Results: Assaults were reported during 0.5% of visits. Intramuscular medications (IMs) were administered in 23.3% of visits overall, and predominately administered within the first 4-hours of a visit. IM administration was correlated with assault (IRR=24.2 [5.33, 110.0]), often because IM medication was administered immediately subsequent to reported assaults. Interacted with time, IMs were not significantly associated with reduction in future assaults (IRR=0.700 [0.467, 1.04]). Neither benzodiazepines nor mood stabilizers were associated with subsequent changes to the risk of reported assault. By contrast, antipsychotic medications were associated with decreased assault risk across time (IRR=0.583 [0.360, 0.942]). Conclusions: IM order rates are high relative to overall assault incident risk. Of the three major categories of medications administered commonly in the psychiatric emergency setting, only antipsychotic medications were associated with measurable decreases in subsequent assault risk. Careful weighing of the risks and benefits of medications is encouraged; antipsychotic medication can have a significant side effect burden, and other medications (IMs, benzodiazepines, mood stabilizers) were not associated with subsequent reduction in assault risk in this analysis.

Length of Stay in a Community Psychiatric Emergency Room: An Analysis of Contributing Factors

Background: The length of patients’ stay in the emergency room is a key measure of service delivery and a marker to measure the quality of care. Studies have shown that patients with psychiatric and substance use disorders have a prolonged length of stay in the emergency room compared to medical and surgical patients. Various factors have been found to contribute to this disparity. Method: This is a retrospective case by case review of four hundred and ninety-three consecutive patients who presented to a community psychiatric emergency. Results: Our results show a length of stay ranging between 1.21 – 33.48 hours. The mean length of stay of 8.72 hours and the median was 7.41 hours. Furthermore, the utilization of emergency medication and age above 44 have a significant influence on patients’ length of stay in the psychiatric emergency room (p<0.05). Conclusion: The length of stay in the psychiatric emergency room deserves more study in literature as it remains a metric for service delivery. Although, factors contributing to a prolonged length of stay may vary, in different settings and situations, understanding these factors will improve outcomes for patients in psychiatric emergency rooms.