Differences

Last edited on February 20, 2023

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--- teaching:3-medical-clearance-screening [on February 20, 2023]
psychdb
+++ teaching:3-medical-clearance-screening [on February 20, 2023]
psychdb [History]
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 ==== History ====
-The historic goal of “medical clearance” was to categorize patients as having organic versus functional causes for their symptoms. The reality is that it is impossible to rule out all medical conditions that //could// mimic psychiatric illness within the course of a single visit, especially in an emergency setting, and there are increasingly medical conditions that bridge the gap between both medical and psychiatric domains (e.g. - [[cl:0-autoimmune-encephalitis:home|autoimmune encephalitis]]). Thus, the term “medically clear” is inaccurate and misleading. The term focussed medical assessment (FMA) is the preferred term and is endorsed by the American Association of Emergency Physicians (ACEP).[([[https://pubmed.ncbi.nlm.nih.gov/16387222/|Lukens, T. W., Wolf, S. J., Edlow, J. A., Shahabuddin, S., Allen, M. H., Currier, G. W., & Jagoda, A. S. (2006). Clinical policy: critical issues in the diagnosis and management of the adult psychiatric patient in the emergency department. Annals of emergency medicine, 47(1), 79-99.]])] A FMA thus is meant to determine with //reasonable certainty// whether the patient's symptoms could be caused by a medical condition that, unless identified, could place the patient at risk if admitted to a psychiatric ward rather than a medical ward.[([[https://pubmed.ncbi.nlm.nih.gov/16387222/|Lukens, T. W., Wolf, S. J., Edlow, J. A., Shahabuddin, S., Allen, M. H., Currier, G. W., & Jagoda, A. S. (2006). Clinical policy: critical issues in the diagnosis and management of the adult psychiatric patient in the emergency department. Annals of emergency medicine, 47(1), 79-99.]])]
+The historic goal of “medical clearance” was to categorize patients as having organic versus functional causes for their symptoms. The reality is that it is impossible to rule out all medical conditions that //could// mimic psychiatric illness within the course of a single visit, especially in an emergency setting, and there are increasingly medical conditions that bridge the gap between both medical and psychiatric domains (e.g. - [[cl:0-autoimmune-encephalitis:home|autoimmune encephalitis]]). Thus, the term “medically clear” is inaccurate and misleading. The term focused medical assessment (FMA) is the preferred term and is endorsed by the American Association of Emergency Physicians (ACEP).[([[https://pubmed.ncbi.nlm.nih.gov/16387222/|Lukens, T. W., Wolf, S. J., Edlow, J. A., Shahabuddin, S., Allen, M. H., Currier, G. W., & Jagoda, A. S. (2006). Clinical policy: critical issues in the diagnosis and management of the adult psychiatric patient in the emergency department. Annals of emergency medicine, 47(1), 79-99.]])] A FMA thus is meant to determine with //reasonable certainty// whether the patient's symptoms could be caused by a medical condition that, unless identified, could place the patient at risk if admitted to a psychiatric ward rather than a medical ward.[([[https://pubmed.ncbi.nlm.nih.gov/16387222/|Lukens, T. W., Wolf, S. J., Edlow, J. A., Shahabuddin, S., Allen, M. H., Currier, G. W., & Jagoda, A. S. (2006). Clinical policy: critical issues in the diagnosis and management of the adult psychiatric patient in the emergency department. Annals of emergency medicine, 47(1), 79-99.]])]
 ===== Pearls =====
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 Although most guidelines recommend that patients with psychiatric symptoms and no neurological symptoms to not have neuroimaging,[([[https://www.ncbi.nlm.nih.gov/pubmed/18462577|Albon, E., Tsourapas, A., Frew, E., Davenport, C., Oyebode, F., Bayliss, S., ... & Meads, C. (2008). Structural neuroimaging in psychosis: a systematic review and economic evaluation.]])] there are many case reports of neurologic lesions masquerading as psychiatric illness in the absence of neurological symptoms. This is especially true in those with atypical psychiatric symptoms.
+==== CNS Lesions ====
   * [[https://www.ncbi.nlm.nih.gov/pubmed/16400253|Moise, D., & Madhusoodanan, S. (2006). Psychiatric symptoms associated with brain tumors: a clinical enigma. CNS spectrums, 11(1), 28-31.]]
-  * [[https://www.ncbi.nlm.nih.gov/pubmed/19037181|Bunevicius, A., Deltuva, V. P., Deltuviene, D., Tamasauskas, A., & Bunevicius, R. (2008). Brain lesions manifesting as psychiatric disorders: eight cases. CNS spectrums, 13(11), 950-958.]]
+  * [[https://www.ncbi.nlm.nih.gov/pubmed/19037181|Bunevicius, A. et al. (2008). Brain lesions manifesting as psychiatric disorders: eight cases. CNS spectrums, 13(11), 950-958.]]
-  * [[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314926/|Yakhmi, S., Sidhu, B. S., Kaur, J., & Kaur, A. (2015). Diagnosis of frontal meningioma presenting with psychiatric symptoms. Indian journal of psychiatry, 57(1), 91.]]
+  * [[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314926/|Yakhmi, S. et al. (2015). Diagnosis of frontal meningioma presenting with psychiatric symptoms. Indian journal of psychiatry, 57(1), 91.]]
-  * [[http://www.gjpsy.uni-goettingen.de/gjp-article-sarkheil.pdf|Sarkheil, P., Werner, J. C., Mull, M., Schneider, F., & Neuner, I. (2010). Depressive episode induced by frontal tumor culminating in suicidal ideation. Ger J Psychiatry, 13, 150-3.]]
+  * [[http://www.gjpsy.uni-goettingen.de/gjp-article-sarkheil.pdf|Sarkheil, P. et al. (2010). Depressive episode induced by frontal tumor culminating in suicidal ideation. Ger J Psychiatry, 13, 150-3.]]
-  * [[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4287917/|Arifin, M. Z., Yudoyono, F., Setiawan, C., Sidabutar, R., Sutiono, A. B., & Faried, A. (2014). Comprehensive management of frontal and cerebellar tumor patients with personality changes and suicidal tendencies. Surgical neurology international, 5.]]
+  * [[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4287917/|Arifin, M. Z. et al. (2014). Comprehensive management of frontal and cerebellar tumor patients with personality changes and suicidal tendencies. Surgical neurology international, 5.]]
   * [[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1989489/|Hunter, R., Blackwood, W., & Bull, J. (1968). Three cases of frontal meningiomas presenting psychiatrically. Br Med J, 3(5609), 9-16.]]