Advertisement

Undiagnosed Mental Illness in the Emergency Department

      Abstract

      Background

      Mental illness affects 8% of the population. The early identification and treatment of mental illness can reduce the progression and complications of the illness.

      Objective

      The objective of this study was to identify unsuspected psychiatric illness in patients presenting to the emergency department (ED) with non-psychiatric-related complaints. A comparison of the test results and the emergency physician assessments were then compared.

      Methods

      All consenting and stable patients who presented to the ED with non-psychiatric complaints were given the Mini-International Neuropsychiatric Interview (MINI). It was administered to the patient by a trained research fellow before the patient was seen by the physician. Before the patient's departure from the ED, the research fellow notified the emergency physician of the results of the MINI interview. After the emergency physician was notified of the diagnosis of the MINI, any change in the treatment was reviewed.

      Results

      A total of 211 patients were enrolled in the study. The majority of patients (55%) tested negative for all undiagnosed mental illnesses. The top diagnoses were as follows: major depression (24%), general anxiety (9%), and drug abuse (8%). Of all those patients who tested positive for an undiagnosed mental illness, only 2% were diagnosed by the ED attending.

      Conclusions

      The idea that the ED is a good place to identify undiagnosed mental health illnesses was confirmed. The use of an independent test such as the MINI was also shown to be useful to aid the emergency physician in identifying undetected mental illnesses.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Zeber J.
        • Copeland L.
        • Grazier K.
        Serious mental illness, aging and utilization patterns among veterans.
        Mil Med. 2006; 171: 619-626
        • Kessler R.
        • Barker P.
        • Colpe L.
        • et al.
        Screening for serious mental illness in the general population.
        Arch Gen Psychiatry. 2003; 60: 184-189
        • Grant B.F.
        • Dawson D.A.
        • Stinson F.S.
        • et al.
        The 12 month prevalence and trends in DSM-IV alcohol abuse and dependence 1991–2002.
        Drug Alcohol Depend. 2004; 74: 223-234
        • Jeste D.V.
        • Gladsjo J.A.
        • Lindamer L.A.
        • Lacro J.P.
        Medical comorbidity in schizophrenia.
        Schizophr Bull. 1996; 22: 413-430
        • Huffman J.
        • Pollack M.
        Predicting panic disorder among patients with chest pain: an analysis of the literature.
        Psychosomatics. 2003; 44: 222-236
        • Richmond T.S.
        • Hollander J.E.
        • Ackerson T.H.
        • et al.
        Psychiatric disorder in patients presenting to the Emergency Department for minor injuries.
        Nurs Res. 2007; 56: 275-282
        • Samele C.
        • van Os J.
        • McKenzie K.
        • et al.
        Does socioeconomic status predict course and outcome in patients with psychosis?.
        Soc Psychiatry Psychiatr Epidemiol. 2001; 36: 573-581
        • Kunen S.
        • Niederhauser R.
        • Smith P.
        Race disparities in psychiatric rates in emergency departments.
        J Consult Clin Psychol. 2005; 73: 116-126
        • Wynaden D.
        • McDonough S.
        • Capman R.
        • et al.
        Emergency department mental health triage consultancy service: a qualitative evaluation.
        Int Emerg Nurs. 2003; 11: 158-165
        • Vaswani M.
        • Linda F.K.
        • Ramesh S.
        Role of selective serotonin reuptake inhibitors in psychiatric disorders.
        Prog Neuropsychopharmacol Biol Psychiatry. 2003; 27: 85-102
        • Marchesi C.
        • Brusamonti E.
        • Giannini A.
        • et al.
        Anxiety and depressive disorders in an emergency department ward of a general hospital: a control study.
        Emerg Med J. 2004; 21: 175-179
        • Ly N.
        • McCaig L.F.
        National Hospital Ambulatory Medical Care Survey: 2000 outpatient department summary.
        Adv Data. 2002; : 1-27
        • Sheehan D.V.
        • Lecrubier Y.
        • Sheehan K.H.
        • et al.
        The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10.
        J Clin Psychiatry. 1998; 59 (quiz 34–57): 22-33
        • Pinninti N.R.
        • Madison H.
        • Musser E.
        • Rissmiller D.
        MINI International Neuropsychiatric Schedule: clinical utility and patient acceptance.
        Eur Psychiatry. 2003; 18: 361-364
        • Lecrubier Y.
        • Sheenan D.V.
        • Weiller E.
        • Amorin P.
        The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to CIDA.
        Eur Psychiatry. 1997; 12: 224-231
        • Marques J.M.A.
        • Zuardi A.W.
        Validity and applicability of the Mini International Neuropsychiatric Interview administered by family medicine residents in primary healthcare in Brazil.
        Gen Hosp Psychiatry. 2008; 30: 305-310
        • American Psychiatric Association
        Diagnostic and statistical manual of mental disorders, 3rd edition, revised (DSM-III-R).
        American Psychiatric Association, Arlington, VA1987
        • Black D.W.
        • Arndt S.
        • Hale N.
        • Rogerson R.
        Use of the Mini International Neuropsychiatric Interview (MINI) as a screening tool in prisons: results of a preliminary study.
        J Am Acad Psychiatry Law. 2004; 32: 158-162
        • Larkin G.L.
        • Beautrais A.L.
        • Spirito A.
        • Kirrane B.M.
        • Lippmann M.J.
        • Milzman D.P.
        Mental health and emergency medicine: a research agenda.
        Acad Emerg Med. 2009; 16: 1110-1119
        • Kalen G.D.
        Public Health Initiative in the emergency department: not so good for the public health.
        Acad Emerg Med. 2008; 15: 194-196
        • Claassen C.A.
        • Larkin G.L.
        Occult suicidality in an emergency department.
        Br J Psychiatry. 2005; 186: 352-353
        • Hockberger R.S.
        • Binder L.S.
        • Graber M.
        • Hoffman G.
        • Perina D.
        • Schneider S.
        The model of the clinical practice of emergency medicine: Core Content Task Forces II.
        Acad Emerg Med. 2001; 8: 660-681
        • Amorim P.
        • Lecrubier Y.
        • Weiller E.
        • Hergueta T.
        • Sheehan D.
        DSM-IH-R Psychotic Disorders: procedural validity of the Mini International Neuropsychiatric Interview (MINI). Concordance and causes for discordance with the CIDI.
        Eur Psychiatry. 1998; 13: 26-34
        • Pinninti N.
        • Madison H.
        • Musser E.
        • Rissmiller D.
        MINI international neuropsychiatric schedule: clinical utility and patient acceptance.
        Eur Psychiatry. 2003; 18: 361-364