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 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 ... encephalopathy Systemic bacterial infections (especially pneumonia) and viremia Streptococcal infections Pediatric infection–triggered, autoimmune neuropsychiatric disorders Autoimmune Systemic lupus erythematosus