Acute Care Psychiatry: Diagnosis & Treatment

The hospital inpatient service is no longer the only site for acute psychiatric care. Instead, crisis units now receive and evaluate acute care patients. Many patients still go into hospital care, but many are held briefly, stabilized and "discharged" to intensive (not inpatient) levels of care. These include 24-hour residential programmes, partial hospital (day programmes) and intensive (more than twice a week) outpatient follow-ups. For those hospitalized, their stays are typically brief and patients are "stepped down" to other services. The domain of inpatient psychiatry has expanded. The value of this expansion has been to reduce the unnecessary utilization of hospital stays, which reduces the regressions common to lengthy internment and also reduces costs. This text aims to educate on the complex subject of managing acute patients across the spectrum of services. It begins by addressing the crucial subject of assessment, with a model of four questions - diagnosis, character diagnosis, formulation and focal problem. Assessment in the primary care is included as well as additional psychiatric setting. The specific disorders that represent the largest number of patients requiring acute care are covered. Specific interventional treatments are covered in a separate section.