Original ContributionsUnrecognized medical emergencies admitted to psychiatric units☆,☆☆,★,★★,♢
Section snippets
Methods
The records of 64 patients with alteration of mental status secondary to unrecognized medical emergencies who were inappropriately admitted from emergency departments to psychiatric units were reviewed. In these cases the patients had a serious underlying medical problem causing changes in mentation, but the changes were erroneously assumed to be attributable to a psychiatric problem. For the purposes of this study “medical emergency” was defined as the patient having significant enough medical
Results
The missed medical diagnoses in the 64 patients erroneously admitted from emergency departments to psychiatric units are shown in Table 1.
Severe intoxication with alcohol or other illicit substance 22 (34.4%) Drug or alcohol withdrawal or delirium tremens 8 (12.5%) Prescription drug overdose 8 (12.5%) Uremic encephalopathy 4 (6.3%) Hepatic encephalopathy 2 (3.1%) Diabetic ketoacidosis 2 (3.1%) Hypoglycemia 1 (1.6%) Wernicke's
Discussion
These findings demonstrate that unless a practitioner is systematic in his evaluation, he may incorrectly attribute altered mentation to a psychiatric problem when it is in fact caused by an underlying medical problem. Terms used to describe the state of acutely altered mental functioning include delirium, organic brain syndrome, and encephalopathy. The term “delirium” will be used in this article. Delirium is characterized by disturbance of consciousness, impaired attention, and changes in
Conclusions
Failing to perform an adequate mental status examination is a major error leading to misdiagnosis or lack of recognition of delirium. Physicians sometimes conclude too quickly that a psychiatric patient's alteration of mental status is due to an exacerbation of his or her psychiatric problem. Of the 64 cases reviewed, 43 (67.1%) carried a previous diagnoses of mental illness, suggesting that some psychiatric patients are given a less detailed evaluation than are other patients, possibly because
References (13)
- et al.
The “Mini-Mental State”: A practical method for grading the cognitive state of patients for the clinician
J Psychiatric Res
(1975) - et al.
Emergency Psychiatry
(1983) - et al.
Recognizing delirium in patients with psychiatric symptoms
South Med J
(1994) - et al.
Psychiatric presentations of medical problems
Fed Pract
(1998) Diagnostic and Statistical Manual of Mental Disorders
(1994)- et al.
Delirium, dementia, and amnestic and other cognitive disorders and mental disorders due to a general medical condition
Cited by (0)
- ☆
Supported in part by the VISN 16 Mental Illness Research, Education, and Clinical Center, Little Rock, AR.
- ☆☆
Returned October 1, 1999.
- ★
Address reprint requests to Roy R. Reeves, DO, PhD, VA Medical Center-Psychiatry (116A), 1500 E. Woodrow Wilson, Jackson, MS 39216.
- ★★
Am J Emerg Med 2000;18:390-393.
- ♢
0735-6757/00/1804-0007$10.00/0