Leslie S. Zun, MD, MBA

Dr Leslie Zun discusses factors associated with accessing services for patients undergoing psychiatric challenges during the pandemic.

There is an impressive array of presentations and speakers at an upcoming meeting, the only one in the country to address behavioral emergencies in the acute care setting.

The role of every emergency clinician is to determine whether the patient has a condition that threatens life or limb. Determining this in patients who malinger can be quite a challenge, because the malingering patient presents with false or exaggerated symptoms for secondary gain.

Alcohol and substance use disorders take a tremendous toll on society as a whole and also require significant emergency department (ED) resources. Alcohol use and abuse in the United States accounts for over 100,000 deaths each year1 and costs more than $185 billion annually.2 A study of the effects of alcohol-related disease and injuries found that the number of patients who presented with these conditions increased by 18% from 1992 to 2000.3

Many physicians who work in the emergency department (ED) consider the agitated patient the bane of their existence. These patients are frequently difficult to deal with, are uncooperative, and can bring an already busy ED to its knees. Although it is easy to understand why severely agitated patients are commonly placed in restraints or seclusion, it is essential that cooler minds prevail when an agitated patient presents to the ED. The patient should be treated with dignity, respect, and understanding. Because these patients often cannot express their feelings adequately, many who work in the ED do not realize that these patients do not like the feeling of being out of control.

Restraints and seclusion have been used for many years in emergency departments (EDs) and psychiatric emergency services (PESs), but anecdotal case reports and newspaper investigations as well as clinical advances have led to restrictions in their use.