Psychiatrists on call often evaluate patients’ complaints of stiffness, tremor, rigidity, and other abnormal movements. The causes vary, and the clinician should be prepared to manage both commonly encountered and reversible problems such as acute dystonia and more lethal conditions…
A patient’s confusion in the general medical setting is most often a result of delirium or dementia. Delirium indicates the presence of an acute underlying medical problem (or combination of problems). Less commonly, confusion may be due to conditions such…
When considering the psychotic patient in the hospitalized setting, it is helpful to recall that while psychosis is a characteristic of some psychiatric disorders (e.g., schizophrenia, schizoaffective disorder, mood disorders with psychotic features), not every patient with psychosis has a…
Helping a team manage suicidal patients is one of the most important tasks of the psychiatrist. It is also one of the most anxiety-provoking situations we face. Expect powerful emotional responses from the patient’s family, hospital staff, and yourself. When…
Being called to manage a violent patient can be one of the most anxiety-provoking and difficult tasks asked of a psychiatrist. Often, the phone call is from a nurse or another physician who is frightened of a patient and in…
When receiving a call for anxiety, it is useful to distinguish between fear, anxiety, and panic. These are all states characterized by a feeling of apprehension and are often accompanied by physiologic signs of autonomic arousal. Fear is a normal…
“Agitation” is a word commonly used in the colloquial setting; however, people often use it to mean different things. Per Cummings et al., “There is no consensus definition of agitation and no widespread agreement on what elements should be included…
The evaluation of children and adolescents differs from that of adults in several ways. Consult questions may include evaluation of a newly emergent psychiatric condition, assessment of psychological response to a serious medical condition, management of agitation, assessment of suicidality,…
Introduction Few calls inspire more dread in the on-call psychiatrist than those regarding a “difficult patient.” It can be tempting to quickly determine via phone that a clash between a patient and treatment team is not driven by mania, delirium,…
This chapter discusses issues of capacity, competency, informed consent, and confidentiality, as well as types of psychiatric admissions, involuntary treatment, and discharge. State laws vary, so the physician should be familiar with the statutes and institutional policies that govern the…