1. General Approach to Assessment of Psychiatric Patients
Joe Marie Jardiolin, MD, FPCEM, FACEM
Liverpool and Fairfield Hospital
March 2016

2. SACCIT six essential processes in MH after triage
Safety
Assessment
Confirmation of Provisional Diagnosis
Consultation
Immediate Treatment
Transfer of Care
Mental Health for Emergency Departments: A Reference Guide.
NSW Health 2015

3. SAFETY
Ensuring that the patient’s risk of harm to self and others are well managed during the duration of their ED stay

4. Assessment Clear and reliable History MENTAL STATE EXAMINATION
Vital Signs
Physical Examination
RISK ASSESSMENT ( risk of harm to self/others, risk of absconding, risk of missed organic illness

5. Confirmation of Provisional Diagnosis
obtaining the vital information to assist in reaching a provisional or working diagnosis
2 essential elements:
Obtaining corroborative History ( Collateral History)
Investigations to include or exclude organic cause

6. Consultation ED Consultant initially
Accessing early the Mental Health Service /PECC
C/L Psychiatry
Drug and Alcohol
ICAMHS ( infant child adolescent MHS)
Rural services

7. Immediate Treatment Providing the right intervention
Organic treatment – medication, sedation, treat underlying cause (?infection, delirium)
Psychological – de-escalation, therapeutic engagement, counseling
Social – mobilizing support from family, community care, social worker/emergency accommodation

8. Transfer of Care
Ensuring safe and easy transfer of care to: Inpatient teams ( Medical or Psych) Community (GP, psychiatrist, ComMHET)

9. MENTAL STATE EXAMINATION
A - Appearance
B - Behaviour
C - Cooperation
Mood and Affect
Speech
Thought Form
Thought Content
Perception
Cognition
Insight
Judgment

10. MSE APPEARANCE BEHAVIOUR Posture Body appearance and general condition
grooming
BEHAVIOUR
Mannerisms, tics
Agitation, restlessness, aggressive
passive

11. MSE COOPERATION Friendly or extreme friendliness
Cooperative or uncooperative
Suspicious, hostile
Evasive
Seductive
perplexed

12. MSE MOOD AFFECT Patient description of how they fell ?Depressed
?Excited / elated
AFFECT
Clinician’s observation of patient appropriateness of patient’s emotion
Patient says he’s sad but is smiling

13. MSE SPEECH Rate – fast, slow Volume – loud, soft
Quantity – pressured, non verbal, talkative
Quality – accent, rhythm

14. MSE THOUGHT FORM THOUGHT CONTENT Poverty of content, racing thoughts
Flight of ideas, incoherence. tangential
THOUGHT CONTENT
Delusions
Pre-occupations
Obsession / compulsion

15. MSE PERCEPTION Hallucinations ( especially auditory) Delusions
Paranoid thoughts
Heightened perception

16. MSE COGNITION Level of Consciousness Memory Orientation
Attention and Concentration
Mini Mental State exam

17. MSE
INSIGHT
Patients awareness of their illness ( poor, partial or good)
JUDGEMENT
Patient ability to assess situation and act appropriately

18. THANKS ?QUESTIONS

19. Reference
Mental Health for Emergency Departments: A Reference Guide. NSW Ministry of Health 2015
Mental Health Act 2007