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First Presentation with Psychotic Symptoms to the Emergency Department [2017]

Background Mental health conditions account for 52.8 million (4.9–6.3%) emergency department (ED) visits in the United States. Psychotic conditions are responsible for approximately 10% of all mental health presentations. Objective We aimed to determine the underlying etiology and characteristics of patients presenting to the ED with a first episode of psychotic symptoms. Methods Medical records of 159 African, Asian, white, and mixed-race patients were prospectively reviewed. Subjects were classified into one of three groups; psychosis due to an underlying medical condition (UMC), substance-induced psychotic disorders (SIPDs), and psychosis due to other primary psychiatric disorders (OPD). Demographic details and presenting features were described and compared. Results Overall mean (standard deviation [SD]) age of all study subjects was 34.3 (13.4) years. A UMC was responsible for a first presentation with psychotic features in more than half of the study subjects (n = 87 [54.7%]), while SIPD (n = 37 [23.3%]) and OPD (n = 35 [22.0%]) were responsible for the remainder of cases. The majority of subjects were male (n = 95 [59.7%]), unemployed (n = 105 [66.0%]), and had not completed secondary school (n = 109 [68.6%]). More than one-third of subjects tested positive for human immunodeficiency virus infection (n = 63 [39.6%]). Mean (SD) duration of psychotic symptoms before ED presentation was 16.6 (26.3) days. Conclusions UMC is a common etiology in patients presenting to the ED with a first episode of psychotic symptoms. Yousef Etlouba MBBCh, Abdullah Laher MBBCh, MMed, FCEM, Cert Critical Care, EDIC, DipPEC, DCH, DipAllerg, DipHIVMan, Feroza Motara BA, MBBCh, MFamMed, FCFP, ACEM, DipHIVMan, Muhammed Moolla MBBCh, FECM, Cert Critical Care, EDIC, DipAllerg, Nazeema Ariefdien MBBCh, FC Psych The Journal of Emergency Medicine, Volume 55, Issue 1, July 2018 https://doi.org/10.1016/j.jemermed.2018.04.014 https://www.sciencedirect.com/science/article/pii/S0736467918303524