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Suicidal thoughts and behaviors (STB) and emergency department (ED) utilization are prevalent in autistic youth. The current study surveyed clinicians in a pediatric psychiatric ED to examine differences in attitudes on suicide-related care for autistic and non-autistic patient populations. While clinicians rated addressing STB in ASD as important and adaptations to care as necessary, less than half identified ASD as a suicide risk factor and confidence ratings were significantly lower for autistic patients. Previous ASD training predicted confidence and accounted for approximately 25% of the variance in confidence scores. Findings highlight the urgency to develop and disseminate ED clinician training, and address the lack of validated assessment tools, adapted suicide prevention practices, and evidence-based treatments for STB in autistic youth.

Emergency department (ED) crowding has been shown to increase throughput measures of length of stay (LOS), wait time, and boarding time. Psychiatric utilization of the ED has increased, particularly among younger patients. This investigation quantifies the effect of ED demand on throughput times and discharge disposition for pediatric psychiatric patients in the ED. Using electronic medical record data from 1,151,396 ED visits in eight North Carolina EDs from January 1, 2018, through December 31, 2020, we identified 14,092 pediatric psychiatric visits. Measures of ED daily demand rates included overall occupancy as well as daily proportion of non-psychiatric pediatric patients, adult psychiatric patients, and pediatric psychiatric patients. Controlling for patient-level factors such as age, sex, race, insurance, and triage acuity, we used linear regression to predict throughput times and logistic regression to predict disposition status. We estimated effects of ED demand by academic versus community hospital status due to ED and inpatient resource differences. Most ED demand measures had insignificant or only very small associations with throughput measures for pediatric psychiatric patients. Notable exceptions were that a one percentage point increase in the proportion of non-psychiatric pediatric ED visits increased boarding times at community sites by 1.06 hours (95% CI: 0.20–1.92), while a one percentage point increase in the proportion of pediatric psychiatric ED visits increased LOS by 3.64 hours (95% CI: 2.04–5.23) at the academic site. We found that ED demand had a minimal effect on disposition status, with small increases in demand rates favoring <1 percentage point increases in the likelihood of discharge. Instead, patient-level factors played a much stronger role in predicting discharge disposition. ED demand has a meaningful effect on throughput times, but a minimal effect on disposition status. Further research is needed to validate these findings across other state and healthcare systems.

Background Psychiatric emergency assessment of minors can be a complex process, especially for professional staff who are not specifically trained in handling child and adolescent emergency patients. As minors cannot usually express their feelings and experiences as well as adults, it is difficult to form an accurate picture of their condition and to determine what kind of emergency care is needed, for instance whether or not a psychiatric emergency admission is necessary. We lack insight in what professionals at emergency departments need to adequately assess these minors and their families. The aim of this study was to explore staff members’ experiences with assessing minors and explore recommendations for improving their ability to provide appropriate support. Methods Guided by a topic list with open-ended questions, we conducted 11 semi-structured interviews with staff working at psychiatric emergency services. Thematic analysis enabled us to identify five main themes: (1) young age and the crucial role of parents; (2) professionals’ feelings, especially uncertainty; (3) psychiatric emergency admissions and the alternatives to them; (4) regional differences in organization and tasks; and (5) options for improving care. Results The staff interviewed all agreed that it was often complicated and time consuming to take full responsibility when assessing minors with serious and urgent psychiatric problems. Most found it difficult to determine which behaviors were and were not age-appropriate, and how to handle systemic problems during the assessment. When assessing minors and their families in crisis, this led to uncertainty. Professionals were especially insecure when assessing children under age 12 and their families, feeling they lacked the appropriate knowledge and routine. Conclusion Customized expertise development and improved regional embedding of the psychiatric emergency service in the child and adolescent services will reduce professionals’ uncertainty and improve psychiatric emergency care for minors.

IntroductionCOVID-19 had direct and indirect impacts on both mental health and healthcare systems. Evaluating urgent psychiatric consultations may be useful to determine the effects of COVID-19 pandemic since it reflects the condition of psychiatric patients and healthcare systemsObjectivesThis study aims to determine the quantitative or qualitative changes in emergency psychiatry consultations after COVID-19 pandemic.MethodsThe socio-demographic characteristics and clinical features of two hundred thirty three patients were retrospectively collected and analyzed in order to compare the emergency psychiatry consultations before (between the dates 11th of March 2019-10th of March 2020) and after (between 11th of March 2020-10th of March 2021) the COVID-19 pandemic.ResultsThe ratio of patients consulted to psychiatry to total emergency department increase after pandemic (%0.03 vs %0.07). Among these patients, the diagnosis of ‘alcohol and substance use disorder’ (%6.1 vs. %15.4) (p=0.03) increased while the diagnoses of ‘obsessive compulsive disorder (5.3% vs. 0%)(p=0.01) and bipolar disorder (%21.1 vs. %20.5) (p=0.02) decreased. Hostility among patient during consultation increased (%19.1 vs. %30.8)(p=0.04). Suicidal thoughts decreased (%25.2 vs. %14.5) (p=0.04). Furthermore, voluntary inpatient treatment (%20.9-%34.2) (p =0.02) increased, transfer to another clinic (%25.2 vs. %12) (p=0.01) and outpatient treatment (%46.1 vs. %42.7) (p=0.01) decreased. An increase in oral treatments (%10.4 vs. %26.5) (p=0.02) and decrease in parenteral treatments (%71.3 vs. 54.7) ( p=0.01) were also reported.ConclusionsOur findings confirmed that after COVID-19 spread the clinical features diagnosis, and treatment modality have changed among urgent psychiatric consultations.DisclosureNo significant relationships.

Coronavirus disease (COVID-19) presents two urgent health problems: the illness caused by the virus itself and the anxiety, panic and psychological problems associated with the pandemic. Both problems present substantial challenges for our patients, their families, our multidisciplinary teams and our psychiatrist colleagues. We need good psychiatry, now more than ever.

Background Emergency departments are important points of intervention, to reduce the risk of further self-harm and suicide. A national programme to standardise the management of people presenting to the emergency department with self-harm and suicidal ideation (NCPSHI) was introduced in Ireland in 2014. The aim of this study was to evaluate the impact of the NCPSHI on patient outcomes and provision of care. Methods Data on self-harm presentations were obtained from the National Self-Harm Registry Ireland from 2012 to 2017. The impacts of the NCPSHI on study outcomes (3-month self-harm repetition, biopsychosocial assessment provision, admission, post-discharge referral, and self-discharge) were examined at an individual and aggregate (hospital) level, using a before and after study design and interrupted time series analyses, respectively. The 15 hospitals that implemented the programme by January 2015 (of a total of 24 between 2015 and 2017) were included in the analyses. Results There were 31,970 self-harm presentations during the study period. In hospitals with no service for self-harm (n = 4), risk of patients not being assessed reduced from 31.8 to 24.7% following the introduction of the NCPSHI. Mental health referral in this hospital group increased from 42.2 to 59.0% and medical admission decreased from 27.5 to 24.3%. Signs of a reduction in self-harm repetition were observed for this hospital group, from 35.1 to 30.4% among individuals with a history of self-harm, but statistical evidence was weak. In hospitals with a pre-existing liaison psychiatry service (n = 7), risk of self-discharge was lower post-NCPSHI (17.8% vs. 14.8%). In hospitals with liaison nurse(s) pre-NCPSHI (n = 4), medical admission reduced (27.5% vs. 24.3%) and there was an increase in self-harm repetition (from 5.2 to 7.8%. for those without a self-harm history). Conclusion The NCPSHI was associated with improvements in the provision of care across hospital groups, particularly those with no prior service for self-harm, highlighting the need to consider pre-existing context in implementation planning. Our evaluation emphasises the need for proper resourcing to support the implementation of clinical guidelines on the provision of care for people presenting to hospital with self-harm.

During the current COVID-19 disease emergency, it is not only an ethical imperative but also a public health responsibility to keep the network of community psychiatry services operational, particularly for the most vulnerable subjects (those with mental illness, disability, and chronic conditions). At the same time, it is necessary to reduce the spread of the COVID-19 disease within the outpatient and inpatient services affiliated with Mental Health Departments. These instructions, first published online on 16 March 2020 in their original Italian version, provide a detailed description of actions, proposed by the Italian Society of Epidemiological Psychiatry, addressed to Italian Mental Health Departments during the current COVID-19 pandemic. The overall goal of the operational instructions is to guarantee, during the current health emergency, the provision of the best health care possible, taking into account both public health necessities and the safety of procedures. These instructions could represent a useful resource to mental health providers, and stakeholders to face the current pandemic for which most of Mental Health Departments worldwide are not prepared to. These instructions could provide guidance and offer practical tools which can enable professionals and decision makers to foresee challenges, like those already experienced in Italy, which in part can be avoided or minimised if timely planned. These strategies can be shared and adopted, with the appropriate adjustments, by Mental Health Departments in other countries.

IntroductionAfter World Health Organization declared that COVID-19 disease became a pandemic; like most, people in Turkey were affected by the emotionally challenging atmosphere. Previous outbreaks negatively effected mental health, increased suicide attempts and completed suicides.ObjectivesOur study aimed to investigate psychiatry consultations from emergency service in a university hospital, to determine differencies in pandemia.MethodsWe conducted a monocenter retrospective study by examining the patients who applied to emergency servise and consulted to psychiatry department in three periods: between 11 March- 11 July, in 2018, 2019, and 2020. Patient’s sociodemographic and clinical variables were assessed.ResultsThere were no difference in distributions of applicants’ following variables between periods; age, sex, marital status, experiencing a first attack or an exacerbation, or outcome treatment. Among applicants with suicide attempts, there were no difference between periods in terms of the presence of recurrent suicide attempt (χ² = 0.297 p = 0.862). While emergency admissions with behavioral disorders increased, admissions with depressive symptoms decreased. Admissions with suicide attempts were statistically significantly higher in 2020 (Table 1). Recommendation of psychiatric inpatient treatment did not change between periods, while refusal of hospitalization recommendation decreased (Table 2).ConclusionsIn our sample, emergency psychiatry admissions with behaviour disorders and suicide attempts increased in pandemic period.DisclosureNo significant relationships.

IntroductionLittle is known about the need for mechanical restraint during non-voluntary transfers from patient’s homes to the psychiatric emergency department in patients diagnosed with Paranoid Schizophrenia. Although there is no evidence of its efficacy, one of the main tools used for the reduction of mechanical restraints is verbal de-escalation training.ObjectivesThe aim is to describe which symptoms predispose to mechanical restrain in patients with Paranoid Schizophrenia transferred in a non-voluntary manner from home to the psychiatric emergency department, and the effect on reducing mechanical restraints after receiving verbal de-escalation training.MethodsAll patients with Paranoid Schizophrenia who, after being visited by a home psychiatry team, have required non-voluntary transfer from their homes to the psychiatric emergency department were selected (N = 442).ResultsYoung age, being male, having a poor adherence to treatment, higher scores for de following variables; Excitement, Grandiosity, Suspiciousness, Hostility, Abstract thinking, Motor tension, Uncooperativeness, Poor attention, Lack of insight and Poor impulse control as well as lower scores in motor retardation on the PANSS, are related to a higher frequency of mechanical restrain (P<0,005). Before the verbal de-escalation training, 43.9% of the transferred patients required mechanical restraint, after the training, the need for restraints was reduced to 25.5% (P<0.001).ConclusionsTraining in verbal de-escalation has allowed an important reduction in mechanical restraints in patients with schizophrenia who have required non-voluntary transfers from home to the psychiatric emergency department.DisclosureNo significant relationships.

Catatonia is a poorly understood and underrecognized psychomotor condition characterized by three or more catatonic symptoms, commonly including abnormalities in speech, affect, and movement. Catatonia is generally associated with psychiatric disorders such as bipolar disorder and schizophrenia, but may be seen in general medical conditions and rarely after physical trauma. Here, we present the first pediatric case of catatonia following traumatic brain injury as well as the first case of catatonia in any patient following minor traumatic brain injury.