Psychiatry in the emergency room: clinical experience in Perugia

We examined all psychiatric consultations carried out over 3 years at the Emergency Room (ER) of the hospital of Perugia, with the aim of describing the epidemiologic characteristics of patients with any psychiatric illness and their management. We also assessed the distribution of psychiatric emergencies over this period of observation.

We recruited patients consecutively admitted to the ER, between June the 20th 2011 and June the 20th 2014, for which a psychiatric consultation was required. We analysed socio-demographic and clinical data as well as the type of long-range plan after discharge. Continuous variables were presented as means and standard deviations. Categorical variables were presented as number and percentages. For comparing the means we used the Student's t-test. For analyzing the association between categorical variables we performed Pearson's chi-squared test or the Fisher's exact test where appropriate. We considered significant test results with p<0.05. The post-hoc analyses were carried out by means of standardized Pearson residuals, in order to assess the significance of the cell-wise divergences from homogeneity. Spearman's correlations were computed for reasons for a psychiatric consultation request across months. Multinomial logistics regression model was used for analyzing the variability of the reasons for the admission to the ER for the 12 months. Statistical analyses were performed using the R software v 3.1.

Neurotic, stress-related and somatoform disorders were the most represented. The most frequent approach to patients with psychiatric complaints did not imply the use of psychopharmacological treatments or coercive interventions. No particular seasonality of psychopathology was observed.

ERs may represent the place where the first psychiatric visit occurs and a point of reference for the chronic patients. It can also represent an opportunity for further examination of organic comorbidity.