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Although a new paradigm can radically improve the rate at which psychiatric disorders are diagnosed in the ED, there is much ED managers can do short of a major staffing overhaul that can enhance the ability to identify such problems, says Seth Kunen, PhD, PsyD, director of research at Louisiana State University emergency medicine residency program at Earl K. Long Medical Center in Baton Rouge.

You don’t need a new paradigm to improve care

May 1, 2005

You don’t need a new paradigm to improve care

Although a new paradigm can radically improve the rate at which psychiatric disorders are diagnosed in the ED, there is much ED managers can do short of a major staffing overhaul that can enhance the ability to identify such problems, says Seth Kunen, PhD, PsyD, director of research at Louisiana State University emergency medicine residency program at Earl K. Long Medical Center in Baton Rouge.

Depression is fairly easy to diagnose, Kunen asserts. "It takes a little time, and we know that ED docs are very busy and EDs are overcrowded, but there are a few simple questions that can help you get at the problem quickly, and there are a number of screening tools available to help you do that," he says.

Those tools, says Kunen, include the following, all of which are available on the Resource Centers for Minority Aging Research (RCMAR) web site (www.musc.edu/dfm/RCMAR/DepressionTools.html):

  • the Beck Depression Inventory II, $75;
  • Center for Epidemiological Studies Depression Scale, no charge;
  • Zung Self-Rating Depression Scale, no charge.

Psychoses are fairly easy to diagnose, Kunen continues, while substance abuse "may or may not be easy."

Anxiety disorders "require a little bit of skill," he says. However, he adds, there are tests that can be purchased to aid in diagnosis, including the aforementioned Beck scale and the State-Trade Anxiety Inventory, available on the Mind Garden web site (www.mindgarden.com/products/staisad.htm). A sample set of the State-Trade Anxiety Inventory is $30.

The problem with anxiety disorders is that there are so many of them, Kunen explains. "Some studies show, for example, that if panic disorder drives a patient to the ED, it may take eight or more visits before it is diagnosed," he notes. "The most common diagnosis is atypical chest pain; however, if the right diagnosis is made, you could save a lot of repeat visits."

For more information on psychiatric diagnoses in the ED, contact:

  • Seth Kunen, PhD, PsyD, Director of Research, Louisiana State University Emergency Medicine Residency Program, Earl K. Long Medical Center, 5825 Airline Highway, Baton Rouge, LA 70805. Phone: (225) 358-3942. E-mail: [email protected].
  • Harmut Gross, MD, FACEP, Associate Professor, Medical College of Georgia, 1120 15th St., AF-2056, Augusta, GA 30912-4007. Phone: (706) 721-2613. E-mail: [email protected].