Undiagnosed mental illness in the emergency department

Mental illness affects 8% of the population. The early identification and treatment of mental illness can reduce the progression and complications of the illness.

The objective of this study was to identify unsuspected psychiatric illness in patients presenting to the emergency department (ED) with non-psychiatric-related complaints. A comparison of the test results and the emergency physician assessments were then compared.

All consenting and stable patients who presented to the ED with non-psychiatric complaints were given the Mini-International Neuropsychiatric Interview (MINI). It was administered to the patient by a trained research fellow before the patient was seen by the physician. Before the patient's departure from the ED, the research fellow notified the emergency physician of the results of the MINI interview. After the emergency physician was notified of the diagnosis of the MINI, any change in the treatment was reviewed.

A total of 211 patients were enrolled in the study. The majority of patients (55%) tested negative for all undiagnosed mental illnesses. The top diagnoses were as follows: major depression (24%), general anxiety (9%), and drug abuse (8%). Of all those patients who tested positive for an undiagnosed mental illness, only 2% were diagnosed by the ED attending.

The idea that the ED is a good place to identify undiagnosed mental health illnesses was confirmed. The use of an independent test such as the MINI was also shown to be useful to aid the emergency physician in identifying undetected mental illnesses.