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Where is Emergency Psychiatry in the scheme of things? Guns, Whistles and pens

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Emergency psychiatry does not seem to have a consolidated identity as are other sub specialties in psychiatry. There is neither consensus on where the service is to be provided, which specialty is to manage, and who qualifies as an emergency
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  Images purchased from shutterstock.com    Acknowledgement to Prof Zeinab Sarhan, Prof Mohamd El Sayed, Prof Fadya Ziada, and Sh.A who either supported tangibly in the development of the service or intangibly during the efforts to reinstate the service that was put to halt due to administrative corruption. Their participation shall be sought in the paper version of this work with the obligation to not jeopardize their work Where is mergency Psychiatry in the scheme of things? Guns, pens and whistles  inhomagetoWH,thepatientwhotaughtmeEmergencyPsychiatryNahedKhairy,M.D   Beyond the formal health system, stewardship means ensuring that other areas of government policy and legislation promote - or at least* do not undermine  - peoples' health. (WHO) N ot all consents are created equal : the many faces of dupig:  What happens for example if the doctor is motivated in his or her decision not to disclose a risk by a desire to ensure that the patient cosets to the edical teatet? (Batlett, 1997) pen is a double edge sword: It can be the vehicle of communication of health orders, the vehicle of whistleblowing or a vehicle of murder  : a strike of a pen ordering the discharge of a patient who is NOT fit for discharge but is deemed unfit for service at a particular facility in the absence of adequate professional     preparation  for the transfer is downright murder by omission.  And that death is a sentinel event first episode bipolar patient is admitted to adult psychiatric unit, given long acting antipsychotics, developed delirium, mistaken for manic features, given further parentral antipsychotics, developed NMS , discharged without arranging for transfer after family were coerced into discharge AMA. Patient returns, is admitted to PES, monitored one to one using Yacoub and Francis NMS scale (2006) 24/7 until ICU bed available. Admitted with CPK 3340 U/L , dialyzed, passes away after one week. E mergency Psychiatry certification and recognition as subspecialty : Communication with all accessible medical boards and or councils was done: Australia, Canada, Egypt, India, Iran, New Zealand, Pakistan, UK and US. Either no response or response confirming that Emergency Psychiatry is NOT recognized. What would drive the future process to recognize it as has other newly recognized specialties remains unclear.   T he model created was one of having a PES, within the psychiatric hospital in order to meet both walkins but also any developing emergencies in the psychiatric inpatients. For three months this service attended to outpatient emergencies and inpatient developing emergencies D ifficulties: burden on nurses who had to shift in orientation from acute patients to stablized/stabilizing patients, to protect patients from violence or witnessing falls. Residents torn between Emergency Psychiatry life style and other duties which they had to conduct in parallel   E mergencies related to Side effects of Psychiatric Medication have been extensively elaborated( Tueth, 1994 and Keltner 1997)). If the mainstay of recovery from Psychotropic side effects is Prevention, and early detection by maintaining a high index of suspicion and immediate intervention to prevent further development and deterioration with the awareness of harbingers of more lethal side effects (eg akathisia as harbinger of NMS), who is the best fit for this task but the Specialized Emergency Psychiatry Team   E mergency psychiatry is state of mind..a life style requiring Hypervigilance, a preventive/parsimonious approach to prescriptive power (ECT-psychotropics), Attention to Medication side effects mimicking codified disorders, A commitment to the fiduciary orientation: (Grubb, 1994) and training in non psychiatric causes of acute behavioral/perceptual/cognitive changes Certification and recognition as a subspecialty would have a direct impact on the quality of care. References and endnotesAlves,Marco Antonio (2010) : Psychiatric emergency services: a key part of healthcare network: S6 • Reista Basileia de Psiuiatia • ol 32 • “uppl II Bartlett, P (1997): Doctors as fiduciaries: Equitable regulation of the doctor patient relationship: Medical Law Review  , Volume 5, Issue 2, 1 July ,Pages 193  – 224,50 ;Psychiatr.Tijdschr) Emergency psychiatry in Belgium; a challenge for the mental health services], 2008et al ( , R Bruffaerts Spec no.:35-9 Grubb, A " The Doctor as Fiduciary" (1994) 47:2 Current Legal Problems  311 -340, B.A.Nicks and D.M.Manthey (2012) The Impact of Psychiatric Patient Boarding in Emergency Departments, Emerg Med Int. Keltner N  L(1997) Catastrophic consequences secondary to psychotropic drugs L: J psychosoc Nurs Ment Helath serv, apr 34(3) 41-45 Paterson, Ron (2012): The Good Doctor: what patients want: Auckland University Press Rebecca S Lipner et al (2013) Literature Review Specialty Board Certification in the United States: Issues and EvidenceJournal of continuing education in the health professions, p33 (S1) Tueth, M: (1997) : Emergencies caused by side effects of psychiatric medication Volume 12 (2) 212-216: American Journal Of Emergency Medicine Yacoub A, Francis A . Neuroleptic malignant syndrome induced by atypical neuroleptics and responsive to lorazepam. Neuropsychiatr Dis Treat 2006;2:235-40. http://www.who.int/healthsystems/stewardship/en/  [http://www.lhsc.on.ca/Patients_Families_Visitors/MHCP_Adult/Services/CEPS.htm *Endnotes: author has seious eseatios o the odig at least   This survey is further development of the subject: https://www.surveymonkey.com/r/WV8PS8C  The work is a continuous homage to the patient WH who has and will continue to teach us how to be trustworthy doctors     Psychiatric emergency (PE), although seen as a necessary component of psychiatric care, is not traditionally a relevant topic in the psychiatric literature (Alves, 2010) Mania like features may be delirium and more anti-manic medication given thus furthering the suffering of the patient  
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