Teaching Emergency Room Psychiatry

Concepts of crisis intervention and community psychiatry have greatly increased the importance of the emergency room rotation in a psychiatric residency program. Many of the techniques most appropriate to the emergency room are contrary to those taught in the traditional curriculum. The author outlines basic didactic principles to be taught in emergency room psychiatry in the areas of interviewing, communication skills, and medical skills. They include the need to develop a crisp, direct interviewing style, to seek information from a wide range of informants, to rely heavily on a formal mental status examination, and to use a concerned, supportive manner. The resident also must develop a knowledge of community resources and an understanding of bureaucracies. He must be alert for medical or neurological problems even if the problem appears to be psychiatric. The author briefly outlines management principles for the violent patient, the drifter, and the drug addict.