Patients presenting for emergency psychiatric evaluation have
a high prevalence of combined general medical and psychiatric illness,
recent trauma, substance use and substance-related conditions,
and cognitive impairment (16–27). These diagnostic possibilities
deserve careful consideration. General medical and psychiatric evaluations
should be coordinated so that additional medical evaluation can
be requested or initiated by the psychiatrist on the basis of diagnostic
or therapeutic considerations arising from the psychiatric history and
interview. Although issues of confidentiality are sometimes raised,
in an emergency situation necessary information about the patient
can be communicated with the emergency medicine department staff.
In many emergency settings, patients initially are examined by a
nonpsychiatric physician to exclude acute general medical problems.
Such examinations usually are limited in scope and rarely are definitive
(18, 19, 28–30). Furthermore, psychiatrists and emergency
physicians sometimes have different viewpoints on the utility of
laboratory screening for substance use or medical disorders in psychiatric
emergency department patients (31, 32). Therefore, on the basis
of clinical judgment and the specific circumstances of the evaluation,
the psychiatrist may need to request or initiate further general
medical evaluation to address diagnostic concerns that emerge from
the psychiatric evaluation (12, 16, 18–27, 33–35).