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Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry

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Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland
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Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, 15121 Alessandria, Italy
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Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals (HUG), 1211 Geneva, Switzerland
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Faculty of Psychology, University of Geneva (UNIGE), 1206 Geneva, Switzerland
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Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
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IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
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Mood Disorders Program, Tufts Medical Center, Boston, MA 02111, USA
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Emergency Department, Emergency Medicine Unit, Geneva University Hospitals, 1211 Geneva, Switzerland
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Department of Psychiatry and Emergency Department, Emergency Psychiatric Unit, Geneva University Hospitals, 1211 Geneva, Switzerland
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Author to whom correspondence should be addressed.
Medicina 2020, 56(6), 295; https://doi.org/10.3390/medicina56060295
Received: 11 April 2020 / Revised: 27 May 2020 / Accepted: 10 June 2020 / Published: 13 June 2020
(This article belongs to the Section Psychiatry)
Background and Objectives: Psychiatric disorders constitute frequent causes of emergency department (ED) admissions and these rates are increasing. However, referring to ED a whole range of conditions that could or should be dealt with elsewhere is imposing itself as a problematic situation. We aimed: (1) to provide a descriptive picture of the socio-demographic and diagnostic characteristics of the visits among adults at the psychiatric ED; (2) to estimate the clinical pertinence of these visits. Materials and Methods: Retrospective analysis of diagnostic/socio-demographic characteristics and clinical trajectories of patients admitted for a psychiatric condition at the adult psychiatric ED of the University Hospital of Geneva (HUG), Switzerland, during a 6-week timespan. Results: In our sample (n = 763 total admissions for psychiatric conditions; n = 702 for inclusion of patients having received a medical evaluation), depression/anxiety, suicidal behavior (SB), psychotic episode, and substance use disorder (SUD), in descending order, were the most common diagnoses for referral. Patients belonged to younger age groups (≤65 years), had a familial status other than married/in couple, and did not present an unfavorable socio-demographic profile. Concerning the pertinence for a psychiatric ED, primary diagnosis of depression/anxiety is the only variable significantly associated with different grade of degree. By the examination of the patients’ trajectory from admission to discharge, the clinical pertinence for a psychiatric ED admission existed for cases assigned to the Echelle Suisse du Tri (EST®) scale degree 1 (corresponding to most urgent and severe conditions), particularly for diagnoses of depression/anxiety associated with SB, SB as primary or comorbid diagnosis, and psychotic and manic/hypomanic episode. However, diagnoses of depression/anxiety without urgent and severe features (degrees 2, 3, 4) constituted the most frequent mode of presentation. Conclusions: Ambulatory and community-integrated settings could be more appropriate for the majority of patients admitted to adult psychiatric EDs. Moreover, the implementation of telepsychiatry strategies represents a very promising opportunity to offer these patients care continuity, reduce costs and filter the demand for psychiatric ED. View Full-Text
Keywords: psychiatric emergency; suicidal behavior; depression; psychotic episode; substance use disorder; telepsychiatry; public mental health psychiatric emergency; suicidal behavior; depression; psychotic episode; substance use disorder; telepsychiatry; public mental health
MDPI and ACS Style

Costanza, A.; Mazzola, V.; Radomska, M.; Amerio, A.; Aguglia, A.; Prada, P.; Bondolfi, G.; Sarasin, F.; Ambrosetti, J. Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry. Medicina 2020, 56, 295.

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