Journal Article Annotations
2019, 1st Quarter
Annotations by Naomi Schmelzer, MD MPH
Clin Pract Cases Emerg Med. 2019 Jan 10;3(1):27-32.
This paper introduces a structured framework for a single-session psychotherapy model to be applied as a crisis intervention from the Emergency Department. A case report of a high-functioning college student presenting in crisis with suicidal ideation serves to illustrate the use of this brief intervention, and descriptions summarizing the working steps and therapeutic process comprising the one-session crisis-intervention therapy are included.
Strength and weaknesses:
This is designed with the concept of crisis as the target of treatment and fits well for use in the ED setting. The intervention does have a limited scope, ideal for patients with a higher level of psychological functioning at baseline, with intact social supports to mobilize, and who are experiencing a discrete crisis. In addition, this intervention would need to be administered by either an experienced practitioner, or by those in training or willing to learn (such as an ED clinician) with supervision. This model is used in conjunction with other clinical interventions such as a written safety plan.
For a subset of patients, this structured brief intervention can be a valuable add to any emergency psychiatry clinician’s toolkit. With increasing numbers of patients presenting to the ED with a wide-range of behavioural health needs, using brief psychotherapies to stabilize and support patients is a practical approach to provide treatment and facilitate discharge to lower levels of care.
Type of study: case report
Also of interest:
Reference: Gerson R, Malas N, Feuer V, Silver GH, Prasad R, Mroczkowski MM, De Pena-Nowak M, Feuer V, Gaveras G, Goepfert E, Gerson R. 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. Western Journal of Emergency Medicine. 2019 Mar;20(2):409.
PMID:30881565 PMCID:PMC6404720 DOI:10.5811/westjem.2019.1.41344
This is a consensus statement developed by a joint workgroup between the American Association of Emergency Psychiatry and the American Academy of Child and Adolescent Psychiatry Emergency Child Psychiatry Committee, and outlines practice guidelines for assessment and management of acute agitation of youths in the emergency room setting. As a companion paper to the Project BETA series, this article offers expert recommendations for both non-pharmacologic and pharmacologic interventions. This publication includes practical guidance such as a comprehensive algorithm for medication use based on underlying etiology of agitation. The primary target audience is psychiatrists, though it can also serve as a resource for paediatricians and emergency medicine physicians.
Type of study: Practice Guideline