European Psychiatry - Volume 33 - March 2016

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S552 24th European Congress of Psychiatry / European Psychiatry 33S (2016) S349–S805
EV633
Neurologic and psychopathologic
symptom presentation at psychiatry
emergency
N. Trovão ∗, A.S. Coutinho
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.
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.
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.