Pediatric emergency medicine trisk 1039

when necessary. Staff should be aware of child protection laws and the
procedures for emergency intervention in situations of abuse and neglect.


TABLE 126.1
MEDICAL CONDITIONS THAT MAY MANIFEST WITH
NEUROPSYCHIATRIC SYMPTOMS


Neurologic
Cerebrovascular disorder
(hemorrhage, infarction)
Head trauma (concussion,
posttraumatic hematoma)
Epilepsy (especially complex partial
seizures)
Narcolepsy
Brain neoplasms (primary or
metastatic)
Normal-pressure hydrocephalus
Multiple sclerosis
Metachromatic leukodystrophy
Migraine
Autoimmune encephalitis (e.g.,
NMDA receptor)
Endocrine
Hypothyroidism
Hyperthyroidism
Hypoadrenalism
Hyperadrenalism
Hypoparathyroidism

Hyperparathyroidism
Hypoglycemia
Hyperglycemia
Diabetes mellitus
Panhypopituitarism
Pheochromocytoma
Gonadotropic hormonal disturbances
Pregnancy
Metabolic and systemic

Toxic
Intoxication or withdrawal
associated with drug or alcohol
abuse
Adverse effects of prescribed and
over-the-counter medications
Environmental toxins (volatile
hydrocarbons, heavy metals,
carbon monoxide,
organophosphates)
Nutritional
Vitamin B12 deficiency (pernicious
anemia)
Nicotinic acid deficiency (pellagra)
Folate deficiency (megaloblastic
anemia)
Thiamine deficiency (Wernicke–
Korsakoff syndrome)
Trace metal deficiency (zinc,
magnesium)

Nonspecific malnutrition and
dehydration
Celiac disease
Infectious
AIDS
Viral meningitides and
encephalitides (e.g., herpes
simplex)
Brain abscess
Viral hepatitis
Infectious mononucleosis
Tuberculosis


Fluid and electrolyte disturbances
(e.g., syndrome of inappropriate
antidiuretic hormone secretion)
Hepatic encephalopathy
Uremia
Porphyria
Hepatolenticular degeneration
(Wilson disease)
Hypoxemia (chronic pulmonary
disease)
Hypotension
Hypertensive encephalopathy

Systemic bacterial infections
(especially pneumonia) and
viremia

Streptococcal infections
Pediatric infection–triggered,
autoimmune neuropsychiatric
disorders
Autoimmune
Systemic lupus erythematosus
Autoimmune encephalitis
Neoplastic
Central nervous system primary and
metastatic tumors
Endocrine tumors
Pancreatic carcinoma
Paraneoplastic syndromes

Adapted with permission from Sadock BJ, Sadock VA, eds. Kaplan & Sadock’s Synopsis of Psychiatry
. 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2003:2.

EVALUATION
The evaluation of the psychiatric patient should include a medical history,
physical examination including a detailed neurologic examination, mental
status examination, and an interview of family members.

Medical History and Physical Examination
“Medical clearance” of psychiatric patients is one of the prime reasons
children with psychiatric emergencies are referred to EDs. As with all ED
patients, unstable medical conditions or acute injuries are identified and
treated first. Most psychiatric facilities do not have the capacity to care for
acute medical problems; thus they must be stabilized prior to transfer to the
psychiatric facility. The second aim is to consider possible medical causes
for psychiatric symptoms. Many medical conditions, as well as acute

intoxications, can mimic psychiatric disorders ( Table 126.1 ). Failing to
diagnose an underlying medical condition may result in significant
morbidity to the patient. It is important to note that psychiatrically ill