Psychopharmacologic management of the psychiatric emergency patient

The general hospital emergency room has become the locus of care for many psychiatric patients. It has become essential for emergency department personnel to be able to manage the behavioral emergency. Critical to this management is the rational use of psychotropic drugs. The author offers guidelines for the use of antipsychotic drugs and minor tranquilizers. The importance of differential diagnosis and the correlation of drug use with patient variables are stressed. The section on anti-depressants addresses the issues of when, and under what conditions the treatment of a depressive disorder can be initiated in an emergency setting. An approach to the toxic-behavioral-confusional state is offered. The final section reviews the approach to the patient who is a diagnostic dilemma and/or mute.