Psychiatry in Urgent Care - PowerPoint Presentation

Slide1

Psychiatry in Urgent Care

Focus on anxiety and depression

Objectives

Understand management of anxiety in urgent care

-treatment (limited) and disposition

-medical mimics

Understand management of depression in urgent care

-assess for suicidality

-medication bridge? and disposition

Common psychiatric dx in U.S.

Anxiety

: GAD, OCD, panic d/o, PTSD

Depression

: Major, dysthymia

Bipolar

Schizophrenia

Personality disorders (borderline, histrionic, narcissistic)

Eating disorders

Substance abuse induced mental illness

Survey: what is your reaction to seeing any of these in chief complaint?

Anxiety

as presenting complaint

Generalized

: disorder = excessive anxiety and worry causing significant impairment in some area of functioning

-present with worsening

sx

such as feeling overwhelmed, unable to manage

Panic attack

: abrupt surge of intense fear or discomfort peaking within minutes;

Autonomic hyperarousal; sense of doom, SOB, CP, chest tightness, sweating, palpitations, hyperventilation,

paresthesias

, nausea, dizziness, trembling, sweating

(think: very negative adrenaline rush)

-Present to urgent care with need for immediate assistance, distress; may be

out of meds- no provider or can’t get appt; may want work note

-Why are they here? What do they need?

Anxiety

as presenting complaint

Key management points:

-take a deep breath! Stay calm.

-dim lights, cool cloth on forehead; no medication

tx

in UC.

-no benzodiazepines! Consider hydroxyzine 12.5-25 mg q6h, short term

rx

of 10 tablets.

-consider bridge

rx

of SSRI for patient who has a documented follow up appt; should not abruptly discontinue

-

ALWAYS

consider possible medical dx, even if

pt

has diagnosed d/o

-crisis, not coping, disposition to psychiatric ER- Duke Regional, secure section with multidisciplinary team to evaluate patient-only for crisis

-community resources (.

ucbhresources

)

Medical Mimics

Anxiety, panic attack

CV: angina, MI, SVT, arrythmia

pulmonary: PE, asthma

endocrine: hyperthyroid

drugs: caffeine, cocaine, theophylline, cannabis, steroids, herbs and supplements

otc

; drug or alcohol withdrawal

psychosocial: partner violence, sexual abuse, assault

How much testing? Use physical exam, vital signs, history, risk factors

Depression

as presenting complaint

Diagnosis

:

2 weeks or longer of persistent symptoms

one of

: diminished interest or anhedonia in almost all activities; depressed/irritable mood

four of

: change in appetite, sleep disturbance, psychomotor increase or decrease, fatigue, feelings of worthlessness, difficulty concentrating, recurrent thought of death or suicide

-

diagnosis is complex and beyond scope of urgent care

-

psychotherapy is also beyond the scope of urgent care-you are not their therapist

Always assess for suicidality or

homicidality

: risks

Intention, specific plan, means to carry out plan, past suicide attempt, substance abuse,

intoxication, impulsivity

High risk: Psychiatric ER with chaperone

Starting meds for depression NOT recommended

– can worsen depression initially or cause mania in

bipolar and need close follow up. If needed, patient not managing, then refer to Psychiatric ER

-What do they need? Community resources, work note

Wrap up

Anxiety or panic attack

Stay calm

Refer to Behavioral ER if crisis

Consider medical mimics

Depression

Assess for suicidality or

homicidality

Need chaperone if refer to Behavioral ER

Why are they here? What do they need? Community resources

Resources for patients

EAP

at work

Carolina Outreach behavioral health urgent care

Durham Recovery and Response Center

Wakebrook

Crises and Assessment

Wake Behavioral Health Urgent Care

Duke Behavioral Health ED at Duke Regional Hospital

18 private rooms in ED

Full list at .

ucbhresources

in Maestro

Resources for patients

www.nami.org

NAMI helpline 800-950-6264

In crisis can text NAMI to 741-741

Suicide prevention hotline 800-273-8255 or 800-273-TALK

Domestic violence 800-799-7233 or 800-799-SAFE

Sexual assault 800-656-4673 or 800-656-HOPE

Crisis Resources for Behavioral Health Patients

If you are having increased feelings of depression or are feeling like you want to harm yourself or anyone else, please go to the nearest emergency room or call 911.

You may also present to Durham Recovery and Response Center, formerly (Durham Center Access/DCA) for help with an emotional crisis situation or substance abuse detox. DRRC is a one story white building 2 blocks west of Duke Regional Hospital. It is located at: 309 Crutchfield St, Durham, NC.

You can call ahead at 919-560-7305 if you want to talk about what to expect. They are open 24/7/365.

If you don't think you are safe to get to DRRC by yourself, you can call 919-428-0819 for the Mobile Crisis Team. This team may be able to come to where you are and/or take you to DRRC. They will talk through your options with you and help you stay safe.

You can present to Carolina Outreach Behavioral Urgent Care (BHUC) for assistance with a mental health crisis. This Urgent Care facility is a walk-in clinic where you can get help with medication, see a mental health provider or establish outpatient services. They are located at 2670 Durham-Chapel Hill Blvd, Durham NC 27707. They are open Mon-Thurs 8am-7pm, Friday 8am-3pm and Saturday 9am-12pm. They can be contacted at 919-251-9009

In WAKE County, you may present to

Wakebrook

Crisis and Assessment for assistance with a mental health and or substance abuse crises. Services are available 24/7/365 day a year. They are located at 107 Sunnybrook Road, Raleigh NC 27610. They can be contacted at 984974-4800

7) In WAKE County, You may also present to the WAKE BEHAVIORAL HEALTH URGENT CARE

CLINIC for assistance with a mental health and or substance abuse crises. They are located at 319

Chapanoke

Road, STE 120, Raleigh NC. They can be contacted at (919-703-2845)