Table of Contents Table of Contents
Previous Page  556 / 812 Next Page
Information
Show Menu
Previous Page 556 / 812 Next Page
Page Background

S552

24th European Congress of Psychiatry / European Psychiatry 33S (2016) S349–S805

EV633

Neurologic and psychopathologic

symptom presentation at psychiatry

emergency

N. Trovão

1 ,

, A.S. Coutinho

2

1

Centro Hospitalar Vila Nova de Gaia Espinho, Psychiatry, Vila Nova

de Gaia, Portugal

2

Centro Hospitalar Vila Nova de Gaia/Espinho, Psychiatry, Vila Nova

de Gaia, Portugal

Corresponding author.

Introduction

Due to current deinstitutionalization of psychiatric

patients, emergency services are assuming an important role in

early intervention on acute or subacute psychopathology. At this

setting, where the psychiatrist has a limited range of subsidiary

tests, differential diagnosis between the symptoms of primary

psychiatric illness and psychopathologic features secondary to

medico-surgical pathology, especially if with systemic involve-

ment, becomes particularly challenging.

Aims

To deepen knowledge on differential diagnosis of acute

episodes of behavioral disorganization.

Methods

This work stands on the clinical case of a patient pre-

senting in the emergency room with symptoms of psychomotor

agitation, dysphoria and heterologous activity. Preliminary diag-

nostic hypothesis are of synergistic neurological and iatrogenic

etiologies. We then proceed to a critical reflection on the bound-

aries between psychiatry and other branches of medicine, under

the light of a brief literature review on the topic.

Results

The patient has backgrounds of chronic kidney disease,

already transplanted and treated with immunosuppressants. In

addition to the psychopathological symptoms described, subacute

gait impairment, sensorineural deafness on the right and important

weight loss were found. She was admitted in neurology ward for

diagnostic assessment. At present, we could exclude potential neo-

plastic and metabolic causes, confirm the presence of toxic levels

of tacrolimus and important neuroimagiologic anomalies, leading

to a possible Susac syndrome diagnosis.

Conclusions

A meticulous clinical reasoning that keeps in mind

the need to exclude potential medical, toxicological or iatrogenic

causes is of particular relevance in emergency services where

patients directly present to the psychiatrist, without prior evalu-

ation by other specialties.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.1618

EV634

Psychiatric emergencies and

admissions in Ciudad Real Area.

Statistic study. A reflection on use of

emergency resources and admission

criteria

J. Martínez Arnaiz

, C. García Blanco , B. Vallejo-Sánchez

Santa Barbara Hospital, Mental Health Unit, Puertollano, Ciudad

Real, Spain

Corresponding author.

Introduction

Ciudad Real is an area of approximately 500,000

inhabitants, with a University Hospital and several district hos-

pitals. Psychiatric services and emergencies are centralized in the

University Hospital. We analysed the totality of area admissions

during 2014, establishing different categories according to ICD 10

diagnosis.

Objective

We want to compare different categories of patients

who are admitted to hospital (severe mental illness versus

non-severe mental illness), morbidity in different areas and read-

mission rates according to diagnosis.

Aims

To establish a correspondence between attention and

severity of psychiatric pathology, diagnostic criteria and how

we manage both severe and non-severe mental illness and the

repercussion in terms of assistance and pressure in psychiatric

emergencies.

Methodology

Initially, we made a simple statistic analysis of all

admission (400 approximately) in 2014 based on ICD-10 diagno-

sis, socio-demographic parameters, area, admission stay, number of

admissions. We compare both groups: severe and non-severemen-

tal illness according to international criteria. We apply a Pearson

correlation searching for relation between severity and attendance

to psychiatric emergencies.

Results

Around a 60% of admissions are not due to severe men-

tal illness, these conditions have twice the readmission rate than

severe mental illness. We did not find a correlation between atten-

dance to psychiatric emergencies and severity of the condition.

Other factors seem to have an important role in re-admissions.

Conclusions

Non-severe mental illness is consuming an impor-

tant part of emergency psychiatric resources. Criteria of admission

need to be reviewed or apply rationally.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.1619

EV635

Non-compliance in the emergency

department: Is there a difference

between medical and psychiatric

patient’s reasons and use of the

emergency department

L. Zun

Mount Sinai Hospital, Emergency Medicine, Chicago, USA

Background

It is estimated that on average up to 50% of patients

are non-compliant with their medication, resulting in 28% emer-

gency room visits costing about $8.5 billion annually.

Objectives

The purpose of this study was to examine, what, if

any, differences there are between medical versus psychiatric non-

compliant patientswith regard to use of the emergency department

(ED).

Methods

A random sample of patients who present to the ED

for medical or psychiatric illnesses and who state that they were

non-compliant with their medicine were given the National Health

Access Survey. Theywere asked about sources of medical care, drug

compliance and reason for non-compliance.

Results

There were a total of 300 participants in the study. There

was no significant difference in the reason bothmedical and psychi-

atric patients gave for being non-compliant with their medications

that resulted in their ED visit. Each group cited cost as the num-

ber one reason for not taking their medication as prescribed. The

psychiatric participants who were more likely to get admitted dis-

position (

P

= .00), not afford mental health care (

P

= .01), were not

able to get care from other places and used the ED for their psychi-

atric care (

P

= .02).

Conclusion

Therewas no difference between the two populations

with regards to their reasons for non-compliance that brought them

to the ED. Non-compliance of the psychiatric patients compared to

the medical patients lead to a higher admission rate.

Disclosure of interest

The author has not supplied his declaration

of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.1620