Some homeless patients without documented history of chronic psychiatric illness or substance dependence may present to the ED with psychiatric complaints. The stresses of sustaining life without a home are associated with a variety of diagnoses, including adjustment disorders, substance use, and major depression. 18 Alternatively, some homeless patients have a chronic history of psychiatric illness, including schizophrenia or bipolar disorder, that may be partially responsible for precipitating homelessness.19 The psychiatric assessment of homeless patients is important to providing adequate disposition of medical problems whose management may be compromised by mental illness. In addition, primary pharmacologic therapy can be evaluated or instituted in patients with chronic psychiatric disorders.
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