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==Background==
*Be wary of diagnostic overshadowing (e.g. erroneously attributing symptoms of ''medical'' illness to psychiatric disease)
**Compared to overall population, patients with mental illness have significantly higher rates of stroke<ref>Leucht S, Burkand T, Henderson J, Maj M, Sartorius N (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 116: 317– 333</ref>, CAD<ref>Leucht S, Burkand T, Henderson J, Maj M, Sartorius N (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 116: 317– 333. </ref>, DM<ref>Mai Q, D’Arcy C, Holman J, Sanfilippo FM, Emery JD, et al. (2011) Mental illness related disparities in diabetes prevalence, quality of care and outcomes: a population-based longitudinal study. BMC Med 9: 118. 
</ref>, cancer<ref>https://www.cdc.gov/mentalhealth/data_stats/mental-illness.htm</ref>, HIV, HCV<ref>Disability Rights Commission (2006) Equal Treatment: Closing the Gap. A Formal Investigation into Physical Health Inequalities Experienced by People with Learning Disabilities and/or Mental Health Problems. Disability Rights Commission. London.</ref>

==Clinical Features==
Mental Status Exam
*General Appearance
*Orientation and Attention
*Speech
*Mood and affect
*Thought Patterns (process, content)
*Psychomotor behavior
*Insight and Judgement

==Differential Diagnosis==
{{Psych DDX}}

==Evaluation==
*Rule out medical pathology as cause or exacerbating factor for presentation

{{General ED Psychiatric Workup}}
*[[Sad person's score]]

===ACEP Guidelines 2005===
*Class B recommendations
*Routine laboratory testing is of low yield and unnecessary 
*Routine urine toxicology need not be performed
*Pending results should not delay transfer or evaluation
*Patient’s cognitive abilities, rather than specific blood alcohol level, should dictate initiation of psychiatry evaluation

===Risk Assessment===
Use clinical judgment along with structured tools (e.g., SAD PERSONS, Columbia Suicide Severity Rating Scale) to assess:
* Suicide risk (plan, means, intent)
* Homicidal ideation or violent behavior
* Gravely disabled or unable to care for self
* Risk to others (e.g., psychosis, [[Hallucinations|command hallucinations]])
* Access to firearms or lethal means

==Management==

{{General ED Psychiatric Management}}

==Disposition==
Disposition should be guided by clinical stability, psychiatric risk, support systems, and local resources. Consider:

=== Admit to Inpatient Psychiatry ===
* Active suicidal or homicidal ideation with intent or plan
* Severe psychosis, mania, or behavioral dysregulation that poses danger to self/others
* Unable to care for self due to psychiatric decompensation (gravely disabled)
* Failure of outpatient or partial hospitalization treatment with acute worsening
* Severe withdrawal or detox needs (e.g., alcohol or benzodiazepine)
*
=== Medical Admission ===
* Unstable vital signs, toxic ingestion, or altered mental status from organic cause
* Requiring ongoing medical treatment (e.g., infection, injury, metabolic derangement)

=== Observation or Crisis Stabilization Unit ===
* Milder psychiatric symptoms needing short-term containment
* Awaiting collateral or outpatient placement/clearance
* Requires reassessment after sobering, medication trial, or de-escalation

=== Potentially Safe for Discharge ===
* No suicidal/homicidal ideation, stable mental status
* Good insight and follow-up plan in place
* No grave disability and clear understanding of safety plan
* Collateral contact and outpatient psychiatric follow-up confirmed

==== Key Considerations Before Discharge ====
* Evaluate safety at home: living situation, family support
* Review access to weapons or harmful substances
* Provide printed discharge instructions and crisis resources (e.g., suicide hotline)
* Consider short-term outpatient bridge prescriptions if appropriate
* Document clearly: capacity, decision-making, and risk assessment

==See Also==

==External Links==

==References==
<references/>

[[Category:Psychiatry]]