Clinical Features of Patients Newly Admitted to the Emergency Department of a Psychiatric Hospital with an Emphasis on Physical Examination

Many medical diseases and their related signs and symptoms are not identified in routine assessments in emergency departments. 

We investigated the prevalence of abnormal findings in physical examination of the patients who were newly admitted to emergency department (ED) of a psychiatric hospital. 

We studied 200 patients (143 males, 71.5%) who were recently admitted to the ED of a psychiatric university hospital during a 4-month period in 2018. A thorough physical and neurological examination was performed on each subject. 

Nearly all of the patients (99.3%) had at least one positive finding in physical (non-neurological) examination and 95% had at least one positive neurological finding. We also found at least one problem in gastrointestinal, respiratory or cardiac system of 22.1%, 24% and 33% of the subjects, respectively. The most frequent findings were in cranial nerve I (30%, more common in substance abuse disorder), and visual acuity (52.6%), as well as recent memory (%68.7), attention (%33.7), orientation to time (%29.5), hypokinetic movements (%28.1, more common in females and psychotic patients), akathisia (41.6%), and skin (%85.1, more common in substance abuse and personality disorders). T wave changes were seen in 31.9% and arrhythmia in 16% of the patients. 

Abnormal findings in examination of the patients admitted to EDs are very prevalent, but most of the abnormalities are not detected or reported in the routine ward examinations. More emphasis should be placed on the examination of olfactory nerve (especially in patients with substance abuse disorder), cognition (especially in older adults), extrapyramidal system, heart, abdomen and skin (especially in patients with personality disorder) during the first week of admission in a psychiatric emergency setting.