PSYCHOBEHAVIORAL DISORDERSTHE DSM-IV CLASSIFICATIONThe DSM-IV classification aids in making a comprehensive assessment of
disease and in organizing complex clinical disorders.
Axis I: Clinical syndromes of mental disorders (eg, schizophrenia, depression)
Axis II: Personality disorders and developmental disorders
Axis III: General medical conditions (eg, diabetes, hypertension)
Axis IV: Psychosocial and environmental stressors or problems
Axis IV: Global assessment of functioningTHE EMERGENCY CARE OF PSYCHIATRIC PATIENTSThe Emergency Petition (EP)
An emergency petition is indicated for patients who require immediate treat-
ment to save their lives or to prevent imminent serious harm to themselves or
to others. It is also indicated when an unanticipated situation arises where the
patient’s behavior presents an immediate and serious threat to the safety of the
patient, other patients, and staff.
Thetwo essential elementsof an EP are: (1) a serious and imminent situation
exists because of (2) the patient’s psychiatric condition.
INDICATIONS FORSECLUSION ANDRESTRAINT
■ To preventclear and imminentharm to patient or others
■ To prevent significant disruption to treatment program and physical
surroundings
■ To assist in treatment as part of ongoing behavioral therapy
■ To decrease sensory overstimulation
■ To comply with patient’s voluntary reasonable request
INDICATIONS FORINVOLUNTARYHOSPITALIZATION/CIVILCOMMITMENT
■ Mentally ill
■ Dangerto self or others
■ Unable to provide basic needs of food, clothing, and shelter, ie, gravely
disabled
A patient likely to sign out against medical advice (AMA) should be involun-
tarily hospitalized if the clinician believes the criteria have been met for
involuntary commitment.
SUBSTANCE ABUSE DISORDERS/ADDICTIONSubstance Abuse
DEFINITIONS
■ Intoxication:Reversible substance-specific syndrome, with maladaptive
behavioral or psychological changes that are due to the effect of the sub-
stance on the central nervous system (CNS)
■ Tolerance:Repeated exposure requires a larger doseto produce intoxica-
tion, and the initial dose produces less intoxication.
The presence of
dangerousness without severe
mental illness is not sufficient
to involuntarily hospitalize a
patient. Such persons are the
responsibility of the police,
NOT the psychiatrist!