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FOCUS

Volume 21, Issue 1

Emergency Psychiatry: Updates, Future Directions, and Core Concepts

January 2023

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From the Guest Editor

January 2023

Emergency Psychiatry: Core Concepts for All Psychiatric Physicians

Tony Thrasher, D.O., M.B.A.

Pages:1–2
Published Online:16 January 2023

https://doi.org/10.1176/appi.focus.20220084

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Reviews

January 2023

Legal Considerations in Emergency Psychiatry

John S. Rozel, M.D., M.S.L.,
Tara Toohey, M.D.,
Priyanka Amin, M.D.

Pages:3–7
Published Online:16 January 2023

https://doi.org/10.1176/appi.focus.20220071

Abstract
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Emergency psychiatry stands at the fulcrum between the general principles of autonomy and liberty balanced against illnesses that both subvert autonomy and amplify risks for violence and suicide. Although all ...

January 2023

Suicide Risk Assessment, Management, and Mitigation in the Emergency Setting

Seth Powsner, M.D.,
Deborah Goebert, Dr.P.H.,
Janet S. Richmond, M.S.W.,
Junji Takeshita, M.D.

Pages:8–17
Published Online:16 January 2023

https://doi.org/10.1176/appi.focus.20220072

Abstract
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Suicide is a serious public health issue and is a leading cause of death worldwide. Suicidal ideation is a common presentation in emergency department (ED) settings, with many nuanced complications. Therefore, understanding screening, assessment, and ...

January 2023

Community-Based Crisis Services, Specialized Crisis Facilities, and Partnerships With Law Enforcement

Margaret E. Balfour, M.D., Ph.D., and
Scott L. Zeller, M.D.

Pages:18–27
Published Online:16 January 2023

https://doi.org/10.1176/appi.focus.20220074

Abstract
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How a community responds to behavioral health emergencies is both a public health issue and a social justice issue. Individuals experiencing a behavioral health crisis often receive inadequate care in emergency departments, boarding for hours or days ...

Articles

January 2023

Contemporary Practices for Medical Evaluation of the Psychiatric Patient in the Emergency Department

Michael P. Wilson, M.D., Ph.D.,
Edward Hamrick, M.D.,
Victor Stiebel, M.D.,
Kimberly Nordstrom, M.D., J.D.

Pages:28–34
Published Online:16 January 2023

https://doi.org/10.1176/appi.focus.20220063

Abstract
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Although emergency department (ED) visits for patients with mental illness are frequent, medical evaluation (i.e., “medical screening”) of patients presenting with psychiatric complaints is inconsistent. This may largely be related to differing goals for ...

January 2023

Updates in the Assessment and Management of Agitation

Ashley Curry, M.D.,
Nasuh Malas, M.D., M.P.H.,
Megan Mroczkowski, M.D.,
Victor Hong, M.D.,
Kimberly Nordstrom, M.D., J.D.,
Christina Terrell, M.D.

Pages:35–45
Published Online:16 January 2023

https://doi.org/10.1176/appi.focus.20220064

Abstract
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Agitated patients can be dangerous to themselves and others. In fact, severe medical complications and death can occur with severe agitation. Because of this, agitation is considered a medical and psychiatric emergency. Regardless of the treatment setting,...

January 2023

Safe Spaces: Mitigating Potential Aggression in Acute Care Psychiatry

Layla Soliman, M.D.,
Abhishek Jain, M.D.,
John Rozel, M.D.,
James Rachal, M.D.

Pages:46–51
Published Online:16 January 2023

https://doi.org/10.1176/appi.focus.20220069

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Awareness of potential aggression and violence is crucial when treating patients experiencing mental health crises in psychiatric emergency and inpatient settings. To provide a practical overview for health care workers in acute care psychiatry, the ...

Ask the Expert

January 2023

The Entanglements of Substance Use Disorders and Emergency Departments

David Pepper, M.D.

Pages:52–53
Published Online:16 January 2023

https://doi.org/10.1176/appi.focus.20220075

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Communication Commentary

January 2023

Psychiatric Emergencies: Empowering Connections to De-escalate Aggression

Dorothy E. Stubbe, M.D.

Pages:54–57
Published Online:16 January 2023

https://doi.org/10.1176/appi.focus.20220079

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Ethics Commentary

January 2023

Famous in the Emergency Department: Emergency Psychiatry, Law, and Ethics

Jacob M. Appel, M.D.

Pages:58–62
Published Online:16 January 2023

https://doi.org/10.1176/appi.focus.20220068

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21st-Century Psychiatrist

January 2023

Biofeedback and Treatment for Borderline Personality Disorder

Karen Jacob, Ph.D., and
Jaya Gatchell, B.A.

Pages:63–69
Published Online:16 January 2023

https://doi.org/10.1176/appi.focus.20220070

Abstract
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Empirically validated treatments for borderline personality disorder rely on fostering self-awareness of one’s internal experience for treatment success, yet these treatments do not include objective tools to assess self-awareness. Integrating biofeedback ...

Bibliography

January 2023

Emergency Psychiatry: Updates, Future Directions, and Core Concepts

Pages:70–71
Published Online:16 January 2023

https://doi.org/10.1176/appi.focus.23022003

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Abstracts

January 2023

Emergency Psychiatry: Updates, Future Directions, and Core Concepts

Pages:72–73
Published Online:16 January 2023

https://doi.org/10.1176/appi.focus.23022008

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Influential Publications

January 2023

Boarding of Mentally Ill Patients in Emergency Departments: American Psychiatric Association Resource Document

Kimberly Nordstrom, M.D., J.D.,
Jon S. Berlin, M.D.,
Sara Siris Nash, M.D.,
Sejal B. Shah, M.D.,
Naomi A. Schmelzer, M.D., M.P.H.,
Linda L. M. Worley, M.D.

Pages:74–79
Published Online:16 January 2023

https://doi.org/10.1176/appi.focus.23022001

Abstract
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The treatment of severe mental illness has undergone a paradigm shift over the last fifty years, away from a primary emphasis on hospital-based care and toward community-based care. Some of the forces driving this deinstitutionalization have been ...

January 2023

Best Practices for Evaluation and Treatment of Agitated Children and Adolescents (BETA) in the Emergency Department: Consensus Statement of the American Association for Emergency Psychiatry

Ruth Gerson, M.D.,
Nasuh Malas, M.D., M.P.H.,
Vera Feuer, M.D.,
Gabrielle H. Silver, M.D.,
Raghuram Prasad, M.D.,
Megan M. Mroczkowski, M.D.

Pages:80–88
Published Online:16 January 2023

https://doi.org/10.1176/appi.focus.23022005

Abstract
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Introduction:Agitation in children and adolescents in the emergency department (ED) can be dangerous and distressing for patients, family and staff. We present consensus guidelines for management of agitation among pediatric patients in the ED, including ...

January 2023

Physical Assault in the Psychiatry Emergency Room

Ryan E. Lawrence, M.D.,
Stephanie A. Rolin, M.D.,
Diane V. Looney, R.N., M.P.H.,
Adriane R. Birt, M.D.,
Ellen M. Stevenson, M.D.,
Dianna Dragatsi, M.D.,
Paul S. Appelbaum, M.D., and
Lisa B. Dixon, M.D., MPH.

Pages:89–99
Published Online:16 January 2023

https://doi.org/10.1176/appi.focus.23022004

Abstract
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Previous studies of physical assaults in hospitals focused primarily on inpatient psychiatric units, leaving unanswered questions about the extent to which findings generalize to psychiatric emergency rooms. Assault incident reports and electronic medical ...

January 2023

Exploring Bias in Restraint Use: Four Strategies to Mitigate Bias in Care of the Agitated Patient in the Emergency Department

Rowen O. Jin, M.D.,
Tiffany C. Anaebere, M.D.,
Rohini J. Haar, M.D., M.P.H.

Pages:100–105
Published Online:16 January 2023

https://doi.org/10.1176/appi.focus.23022007

Abstract
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Agitation is a routine and increasingly common presentation to the emergency department (ED). In the wake of a national examination into racism and police use of force, this article aims to extend that reflection into emergency medicine in the management ...

January 2023

Clinical Issues in the Assessment of Competency

Paul S. Appelbaum, M.D., and
Loren H. Roth, M.D., M.P.H.

Pages:106–110
Published Online:16 January 2023

https://doi.org/10.1176/appi.focus.23022006

Abstract
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The evaluation of a patient's competency to consent to treatment, regardless of the test of competency used, can be substantially affected by a number of clinical factors. The authors point out that, in assessing competency, the clinician must consider 1) ...

Self-Assessment and CME

Take the Winter 2023 Focus CME quiz:
Emergency Psychiatry: Updates, Future Directions, and Core Concepts

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