FLSEVIER Emergency Psychiatry in the General Hospital The emergency room is the interface between community and health care insti- tution, Whether through outreach or in-hospital service, the psychiatrist in the general hospital must have specialized skill and knowledge to attend the in- creased numbers of mentally ill, substance abusers, homeless individuals, and those with greater acuity and comorbidity than previously known. This Special Section will address those overlapping aspects of psychiatry, medicine, neurol- ogy, psychopharmacology, and psychology of essential interest to the psychia- trist who provides emergency consultation and treatment to the general hospital population. Coping and the Decision to Hospitalize in Emergency Psychiatry Ulrich Schnyder, M.D., Ladislav Valach, Ph.D., and Edgar Heim, M.D. Abstract: This study was done to clarify whether and in what way a patient‘s coping repertoire can be linked to the disposi- tion decision in a ~ych~af~c emergency service. For 1 year, all consultations (N = 24391 of a psych~af~‘c emergency service were documented in a detailed questionnaire covering socio- demographic and diagnostic data as well as information about the disposition decision. Depending on disposition, three groups were identi~ed: outpatients fN = 5301, inpatients (N = 482), and a non~nt~ention group (N = 4281. ln addition, over a 5-monthperiod, patients were requested to fill in the “Bernese Coping Modes” questionnaire. Thus, a sample of 28 patients undergoing ouf~atienfcrisisinte~ention and 28 pa- tients refired to i~~ti~t treatment was obfained. Sfatisti~l analysis included Chi square-test, t-test, Mann-Whitney U-test, and logisticregression analysis. Assessment of coping repertoire contributed more thanthediagnosis to thedecision to hospitalize. Outpatients have a largercopingrepertoire (t = 3.48, p = 0.002~ than inpatients and show higher values in *~acc~tance-stoicism,” “diss~mutation,f’ ‘*tackling,” “giving meaning, ” “altruism,” “optimism,” and “relativizing.” Lo- gistic regression revealed rektivizing, altruism, and optimism asbeing most ~m~rtanf. Self-r~~ral to emergency psychiat~ wasalsow~e~fed with out~tient treatments Other criteria such as being without work, living alone, history of previous hospitalization, and the diagnosis of a psychotic or mood dis- order were significantly correlated with referral to inpatient treatment.More attention should be paid to patients’ coping Psychiatrische Poliklinik, Universitatsspital, Ziirich, Switzer- land. Address reprint requests to: Dr. U. Schnyder, Psychiatrische PolikIinik, Universittitsspital, CuImannstrasse 8, 8091 Ziirich, Switzerland. 362 ISSN 0163-8343/951$9.50 SSDI Old-~3(95)~0~7-X repertoires in emergency services when deciding about the need for inpatient treatment. Introduction The choice between outpatient and inpatient treat- ment always presents a decision of major impor- tance in emergency psychiatry. An overhasty hos- pitalization can have just as far-reaching conse- quences as the omission of a clinically necessary hospitalization. Merson et al. [l] were able to prove, in a controlled clinical trial over a 3-month period, that outpatient management is superior to hospitalization from the viewpoint of development of symptoms and the satisfaction of the patients. Thus, in the emergency room it may well be that the tracks are laid for the future course of a pa- tient’s illness 121. Although decision-making pro- cedures of this kind are usually very complex, they are frequently made swiftly, despite a number of uncertainties [3-51. There are a series of criteria on which a decision is made for or against hospitalization. As long as 25 years ago, Tischler [6] pointed out the complex- ity of the interaction among the psychiatrist, the patient, and the patient’s family. Gerson and Bas- suk 171 distinguished among patient variables (age, sex, marital status, race, socioeconomic status, previous history, psychiatric diagnosis and current psychopathology, dangerousness, social net- General Hospital Psychiatry 17, 362370, 199.5 0 1995 Elsevier Science Inc. 655 Avenue of the Americas. New York. NY 10010