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Competently managing a psychiatric emergency demands the effective utilization of complex skills, which must be learned and honed during residency training. Psychiatrists must assess patients in crisis for serious psychiatric concerns, exclude medical causes, manage behavioral emergencies through verbal de-escalation and pharmacological means, foster a positive therapeutic alliance, deliver trauma-informed care, and engage in safety and disposition planning. Managing violence and safety risk are areas that are crucial to the safe delivery of emergency care and especially ripe for the enhancement of resident training.

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a.“To understand what another person is saying, you must assume that it is true and try to imagine what it could be true of.” Richmond JS, Berlin JS, Fishkind AB, Holloman GH Jr, Zeller SL, Wilson MP, et al. Verbal de-escalation of the agitated patient: consensus statement of the American Association for Emergency Psychiatry project BETA de-escalation workgroup. West J Emerg Med 2012;13(1):17-25 (quoting Elgin SH. Language in Emergency Medicine: A Verbal Self-Defense Handbook. Bloomington, IN: XLibris Corporation; 1999).


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