In the ideal setting, all emergency departments would have psychiatric consultation available at all times. However, in many instances, the physician in the emergency department will be forced to rely on more limited resources. Many psychiatric problems leading to emergency department presentation do not require immediate definitive treatment. In many instances, disposition following initial screening can be made to a variety of secondary sources of evaluation and treatment. Judgments regarding referral depend on assessment of a patient's likelihood of becoming violent toward self or others. Clues that suggest potential violence include hostile behavior, verbal aggressiveness, or statements about violent intent. Such patients need immediate hospitalization. Marked disorientation and confusion require evaluation for organic components. In the absence of such indications, referral can be made to a psychiatrist or a psychiatric facility. Results of the emergency department medical and psychiatric evaluation should be summarized in writing and provided to the consultant. The patient should receive clear discharge instructions and should have a follow-up interval for any medical or surgical disorders that were identified.
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