Emergency psychiatry: Crisis and organization of interventions

The approach to Psychiatric Emergencies and crisis situations has now become an essential element in the context of the definition of a coherent psychiatric care policy. This paper seek to provide a more comprehensive review of the literature about Emergency Psychiatry. In this context it's possible to Identify some areas of interest: definitions, factors influencing recovery's decision, type of patients, aggressiveness and violence, ethical problems, therapeutic approaches. In the definition of emergency authors underline the importance of concepts of crisis, seriousness and necessity for Immediate intervention. Different studies demonstrated the influence of factors such as psychiatrist's experience, psychosocial elements, symptoms seriousness in determining decision for hospitalization. The patients of the Psychiatric Emergency Services (PES) are represented mostly by patients which repeatedly use the Psychiatric Services (heavy users, revolving door patients). The international literature develops the theme of aggressiveness of psychiatric patients around problems connected with the patient himself (existence of a relation between illness ad violence; risk factors) and with the risk for the medical staff, with references to the most exposed categories and to aspects of prevention. In therapeutic approaches, particular attention is paid to psycotherapeutic interventions that are usually indicated with the generic term of Crisis Intervention (CI) which has been used by several therapists with different aims and models of intervention. In conclusion it is essential to recognize the importance of the Psychiatric Emergency Services, that, according to Mendoza, acts as a barometer it measures the integrity of the entire health care system.