First Presentation with Psychotic Symptoms to the Emergency Department

• Published in: The Journal of emergency medicine Vol. 55; no. 1; pp. 78 - 86
• Main Authors: Etlouba, Yousef, Laher, Abdullah, Motara, Feroza, Moolla, Muhammed, Ariefdien, Nazeema
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2018
• Subjects: Adult; Emergency Service, Hospital - organization & administration; Female; first-episode psychosis; first-presentation psychosis; Humans; index presentation psychosis; Male; mental health; Middle Aged; psychosis; Psychotic Disorders - diagnosis; Psychotic Disorders - physiopathology; Retrospective Studies; index presentation psychosis; first-presentation psychosis; mental health; psychosis; first-episode psychosis
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2018.04.014

Mental health conditions account for 52.8 million (4.9–6.3%) emergency department (ED) visits in the United States. Psychotic conditions are responsible for approximately 10% of all mental health presentations. We aimed to determine the underlying etiology and characteristics of patients presenting to the ED with a first episode of psychotic symptoms. Medical records of 159 African, Asian, white, and mixed-race patients were prospectively reviewed. Subjects were classified into one of three groups; psychosis due to an underlying medical condition (UMC), substance-induced psychotic disorders (SIPDs), and psychosis due to other primary psychiatric disorders (OPD). Demographic details and presenting features were described and compared. Overall mean (standard deviation [SD]) age of all study subjects was 34.3 (13.4) years. A UMC was responsible for a first presentation with psychotic features in more than half of the study subjects (n = 87 [54.7%]), while SIPD (n = 37 [23.3%]) and OPD (n = 35 [22.0%]) were responsible for the remainder of cases. The majority of subjects were male (n = 95 [59.7%]), unemployed (n = 105 [66.0%]), and had not completed secondary school (n = 109 [68.6%]). More than one-third of subjects tested positive for human immunodeficiency virus infection (n = 63 [39.6%]). Mean (SD) duration of psychotic symptoms before ED presentation was 16.6 (26.3) days. UMC is a common etiology in patients presenting to the ED with a first episode of psychotic symptoms.