Clinical Features of Patients Newly Admitted to the Emergency Department of a Psychiatric Hospital with an Emphasis on Physical Examination

  • Shabnam Asadi School of Medicine, Iran University of Medical Sciences, Tehran, Iran
  • Mohammad Ghadirivasfi Research Center for Addiction and Risky Behaviors, Iran University of Medical Sciences, Tehran, Iran
  • Kaveh Alavi Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
  • Morteza Hassanzadeh Department of Internal Medicine, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
  • Fahimeh Hajiakhoundi Department of Neurology, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
  • Seyed Vahid Shariat Mail Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
Keywords:
Comorbidity, Emergency Service, Hospital, Neurologic Examination, Physical Examination, Psychiatric Department, Hospital, Symptom Assessment

Abstract

Introduction: Many medical diseases and their related signs and symptoms are not identified in routine assessments in emergency departments. Objective: We investigated the prevalence of abnormal findings in physical examination of the patients who were newly admitted to emergency department (ED) of a psychiatric hospital. Methods: We studied 200 patients (143 males, 71.5%) who were recently admitted to the ED of a psychiatric university hospital during a 4-month period in 2018. A thorough physical and neurological examination was performed on each subject. Results: Nearly all of the patients (99.3%) had at least one positive finding in physical (non-neurological) examination and 95% had at least one positive neurological finding. We also found at least one problem in gastrointestinal, respiratory or cardiac system of 22.1%, 24% and 33% of the subjects, respectively. The most frequent findings were in cranial nerve I (30%, more common in substance abuse disorder), and visual acuity (52.6%), as well as recent memory (%68.7), attention (%33.7), orientation to time (%29.5), hypokinetic movements (%28.1, more common in females and psychotic patients), akathisia (41.6%), and skin (%85.1, more common in substance abuse and personality disorders). T wave changes were seen in 31.9% and arrhythmia in 16% of the patients. Conclusions: Abnormal findings in examination of the patients admitted to EDs are very prevalent, but most of the abnormalities are not detected or reported in the routine ward examinations. More emphasis should be placed on the examination of olfactory nerve (especially in patients with substance abuse disorder), cognition (especially in older adults), extrapyramidal system, heart, abdomen and skin (especially in patients with personality disorder) during the first week of admission in a psychiatric emergency setting.

Downloads

Download data is not yet available.

References

1. Chennapan K, Mullinax S, Anderson E, Landau MJ, Nordstrom K, Seupaul RA, et al. Medical screening of mental health patients in the emergency department: a systematic review. J Emerg Med. 2018;55(6):799-812.
2. Tintinalli JE, Peacock FWt, Wright MA. Emergency medical evaluation of psychiatric patients. Ann Emerg Med. 1994;23(4):859-62.
3. Fenton WS, Stover ES. Mood disorders: cardiovascular and diabetes comorbidity. Curr Opin Psychiatry. 2006;19(4):421-7.
4. Leucht S, Burkard T, Henderson J, Maj M, Sartorius N. Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand. 2007;116(5):317-33.
5. Lwin AM, Symeon C, Jan F, Sule A. Morbidity and mortality in schizophrenia. Br J Hosp Med. 2011;72(11):628-30.
6. Mitchell AJ, Malone D. Physical health and schizophrenia. Curr Opin Psychiatry. 2006;19(4):432-7.
7. Saha S, Chant D, McGrath J. A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Arch Gen Psychiatry. 2007;64(10):1123-31.
8. Latoo J, Mistry M, Dunne FJ. Physical morbidity and mortality in people with mental illness. Br J Med Pract. 2013;6(3):621-3.
9. De Hert M, Cohen DA, Bobes J, Cetkovich‐Bakmas MA, Leucht S, Ndetei DM, et al. Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World psychiatry. 2011;10(2):138-51.
10. Felker B, Yazel JJ, Short D. Mortality and medical comorbidity among psychiatric patients: a review. Psychiatr Serv. 1996;47(12):1356-63.
11. Krummel S, Kathol RG. What you should know about physical evaluations in psychiatric patients: Results of a survey. Gen Hosp Psychiatry. 1987;9(4):275-9.
12. McIntyre JS, Romano J. Is there a stethoscope in the house (and is it used)? Arch Gen Psychiatry. 1977;34(10):1147-51.
13. Summers WK, Munoz RA, Read MR. The psychiatric physical examination - Part I: methodology. J Clin Psychiatry. 1981;42(3):95-8.
14. Victoroff VM, Mantel SJ, Jr., Bailetti A, Bailetti M. Physical examinations in psychiatric practice in Ohio. Hosp Community Psychiatry. 1979;30(8):536-40.
15. Rao PP, Rebello P, Safeekh AT, Mathai PJ. Medical Comorbidity in Inpatients with Psychiatric Disorders. Int J Res Rev. 2019;6(8):222-33.
16. Wilson MP, Nordstrom K, Anderson EL, Ng AT, Zun LS, Peltzer-Jones JM, et al. American Association for Emergency Psychiatry Task Force on medical clearance of adult psychiatric patients. Part II: controversies over medical assessment, and consensus recommendations. West J Emerg Med. 2017;18(4):64-6.
17. Conigliaro A, Benabbas R, Schnitzer E, Janairo M-P, Sinert R. Protocolized Laboratory Screening for the Medical Clearance of Psychiatric Patients in the Emergency Department: A Systematic Review. Acad Emerg Med. 2018;25(5):566-76.
18. Olshaker JS, Browne B, Jerrard DA, Prendergast H, Stair TO. Medical Clearance and Screening of Psychiatric Patients in the Emergency Department. Acad Emerg Med. 1997;4(2):124-8.
19. Boesveldt S, Postma EM, Boak D, Welge-Luessen A, Schöpf V, Mainland JD, et al. Anosmia—a clinical review. Chem Senses. 2017;42(7):513-23.
20. Negoias S, Croy I, Gerber J, Puschmann S, Petrowski K, Joraschky P, et al. Reduced Olfactory Bulb Volume and Olfactory Sensitivity in Patients with Acute Major Depression. Neuroscience. 2010; 169(1):415-21.
21. Foster AA, Hylwa SA, Bury JE, Davis MD, Pittelkow MR, Bostwick JM. Delusional infestation: Clinical presentation in 147 patients seen at Mayo Clinic. J Am Acad Dermatol. 2012;67(4):673.e1-10.
22. Mukhtar IG, Salisu AI. Electrocardiographic recordings of psychiatric patients attending Dawanau Psychiatric hospital, Kano-Nigera. Bayero J Pure ApplSci. 2018;11(2):205-9.
23. Peralta V, Cuesta MJ. Motor abnormalities: from neurodevelopmental to neurodegenerative through “functional”(neuro) psychiatric disorders. Schizophr Bull. 2017;43(5):956-71.
24. Ferguson B, Dudleston K. Detection of physical disorder in newly admitted psychiatric patients. Acta Psychiatr Scand. 1986;74(5):485-9.
25. Crede A, Geduld H, Wallis L. Assessment of routine laboratory screening of adult psychiatric patients presenting to an emergency centre in Cape Town. S Afr Med J. 2011;101(12):891-4.
26. Richards JR, Farias VF, Clingan CS. Association of leukocytosis with amphetamine and cocaine use. The Sci World J. 2014;2014:207651.
27. Hsu JH, Chien IC, Lin CH. Increased risk of hyperlipidemia in patients with bipolar disorder: a population-based study. Gen Hosp Psychiatry. 2015;37(4):294-8.
28. Alosaimi FD, Abalhassan M, Alhaddad B, Alzain N, Fallata E, Alhabbad A, et al. Prevalence of metabolic syndrome and its components among patients with various psychiatric diagnoses and treatments: A cross-sectional study. Gen Hosp Psychiatry. 2017;45:62-9.
Published
2020-05-24
How to Cite
1.
Asadi S, Ghadirivasfi M, Alavi K, Hassanzadeh M, Hajiakhoundi F, Shariat SV. Clinical Features of Patients Newly Admitted to the Emergency Department of a Psychiatric Hospital with an Emphasis on Physical Examination. Adv J Emerg Med.
Section
Original article