Psychiatric consultation in out-of-hours casualty/emergency department

Background: Psychiatric emergencies are acute situations of sufficient gravity to warrant immediate assessment and treatment. In addition to major mental disorders, various life threatening illnesses, unpredictable psychophysiological stressors along with various other clinical variables like side-effects of drugs may be responsible for bringing the patients to psychiatric emergency. Method: This is a descriptive study with sampling in a tertiary centre where the diagnoses were made based on the text revision of the fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and were evaluated for sociodemographic as well as immediate clinical variables. Results:Most of the patients belonged to age group 20-40 years (62%), were from rural area (74%), nuclear families (74%), married (62%), education from class V to X (40%), homemakers (40%) and from lower socioeconomic status (58%). Dramatic presentation, sudden onset and adolescent age group made conversion disorder the commonest emergency psychiatry problem (46%) and schizophrenia ranked second (26%). Fourteen per cent patients had personality disorder and ten per cent had mental retardation. Forty six per cent of patients had coexistent medical illness out of which ten per cent were anaemic; in addition peptic ulcer, diabetes mellitus, tuberculosis, hypertension etc. were also associated. Regarding immediate clinical variables, seizure/pseudoseizure (26%), refusal of food (24%) and loss of consciousness (22%) are the commonest factors. Conclusion: Within the limitations of difficulty in using rating scales, sampling problems, time and resource constraints, creative approaches may enable us to move the field of emergency psychiatric intervention forward.