Anxiety

The general principles useful in approaching most psychiatric emergencies are equally applicable to the handling of the anxious patient. Establish rapid contact because anxious patients should not be left waiting. Expedite talking to reduce tension because putting thoughts and emotions into words invariably reduces initial tension. Make a quick first assessment of the anxious patient's general appearance, level of consciousness, level of tension, and leading affect or mood. Choose a private and relaxed setting for the interview if possible. Allow for a slow final evaluation because many initially overwhelmed anxious people may reconstitute within a matter of hours when allowed to talk, rest, or even sleep. Take the anxious patient's chief complaint seriously. A brief physical examination should be performed routinely in almost all cases, especially when there is a physical complaint. Every attempt should be made to rule out an organic etiology for the anxiety. Listening is an active but demanding process. Most of the time it means sitting down and giving all of one's attention to the patient, even if it is for just a few minutes. What patients find most comforting is the feeling of being understood. The emergency medicine physician should be careful to avoid a judgmental or punitive approach. Every attempt should be made to engage the family in caring for the patient while in the Emergency Department. It is equally important to recognize that relatives and friends may need assistance to help cope with the anxious patient once discharged. The emergency medicine physician needs to assess the degree of social support available in the patient's environment because a sensible disposition will depend on it.