Schizophrenia and the Emergency Department


The number of patients with psychiatric disorders, such as schizophrenia, at emergency departments is increasing. In fact, according to Vinay Parekh, attending physician for psychiatric emergency services at The Johns Hopkins Hospital, “the volume of behavioral health patients at the hospital has increased more than 60 percent since 2012, to about 400 patients a month” (Nitkin, 2018). So, with the growing amount of patients with schizophrenia on the unit, ER nurses must be knowledgeable of the illness, its symptoms, beneficial interventions, pharmacological considerations, safety, and supportive care.

Background and risk factors

Schizophrenia has multiple definitions so there’s not a one size fits all answer of what it is. Multiple types of as Schizophrenias make this a spectrum disorder but what all types do share, is that symptoms last at least six months (Boyd, 2017). These symptoms can range from psychosis and hallucinations to other behavioral events. So, why would a schizophrenic patient be more likely to result in the emergency department? Those answers are clearer.

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One reason is that due to their unpredictable and unstable behavioral illness, people with schizophrenia cumulate in the lowest socioeconomic groups and have few employment chances. This causes individuals to not have a way to provide for themselves and become homeless. The problem with these patients being homeless is that they are not obtaining the adequate treatment of their symptoms so they present those symptoms in public spaces where they can become disruptive and or dangerous. This, in turn, causes law enforcement to get involved and determine that further professional psychiatric evaluation is needed.

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Another reason is that many schizophrenic patients do not acknowledge and deny having a mental health problem. This becomes challenging to family members that believe those individuals should seek professional help. So, with limited knowledge, the family members take the individual to the most immediate form of professional care, the emergency department. Lastly, people can have schizophrenic symptoms induced by substances such as drugs. Similar to the first reason, law enforcement will be involved and bring them to the emergency department for further evaluation and treatment.

Symptom Assessment

The types of symptoms seen in schizophrenia are characterized as positive and negative. Delusions, hallucinations, disorganized speech and or behavior, and diminished emotional expression fall into these categories. Positive symptoms include hallucinations and delusions, which are distorted functions, whereas negative symptoms include abnormal emotional behavior such as a flat expression, flight of ideas, and agitation (Boyd, 2017). A symptom commonly seen in the emergency department with schizophrenic patients is agitation. To assess this and other symptoms, the nurse must conduct a psychiatric mental status examination (MSE). This will allow the nurse to identify the individual’s areas of concern as well as strengths.

Evidence-based nursing recommendations

Emergency room nurses have a slightly different yet equally crucial role of care to a schizophrenic patient than a psychiatric nurse. The ER nurse’s role is to stabilize the patient in urgent situations. So, when an individual presents with agitation associated with schizophrenia, the nurse’s initial intervention should be to try to de-escalate and calm the patient. This is recommendation involves skills like listening to the patient, respecting their space, “utilizing a clear voice, and showing attentiveness; their posture should be non-threatening, relaxed and open” (Lowry et al., 2016). Although tedious at times, the de-escalation strategy has proven to be successful because it “reduc[es] resource use, costs, and staff and patient injuries, and better patient–physician relationships” (Zeller & Citrome 2016).

Another recommendation would be to monitor the patient frequently once stabilized. This consists of not only assessing the patient’s mental status but also checking other aspects of care such as their psychosocial assessment which is also impacted by the illness. This approach will allow the implementation of the best interventions to create a holistic and solid treatment plan for the patient.

Medication considerations

For patients with schizophrenia, the medications of choice are antipsychotics. These medications block psychotic symptoms and decrease behavioral symptoms such as aggression or agitation. Although preferred, each patient will have individualized management of these medications. A consideration when administering this class of medications is the extrapyramidal effects it may cause. Effects such as Parkinsonians and Dystonic reactions must be monitored because they can complicate the care of the patient as well as cause the patient to not adhere to their medication regimen.

Safety and further supportive measures

Nurses are responsible for assessing suicide risk with any patient that has experienced psychosis, especially schizophrenic patients. The nurses also must make sure that no dangerous items such as shoelaces, belts or jewelry, or sharp objects are of access to the patient with high suicide risk (Nitkin, 2018). As stated previously, to ensure the safety of staff and the patient, the best recommendation is for the nurse to utilize the de-escalation methods to calm an aggressive or agitated patient before resorting to any form of restraints.

As for supportive measures in an emergency department, the nurse should contemplate the type of long-term care necessities of the patient. For example, inpatient focused care, support groups, and psychosocial rehabilitation programs. These efforts enforce the emergency nurse’s overall goal to make sure each patient is treated and eventually transferred or discharged to continue their plan of care.


  1. Boyd, M. A. (2017). Essentials of psychiatric nursing. Philadelphia: Wolters Kluwer.
  2. Lowry, M., Lingard, G., & Neal, M. (2016, July 25). De-escalating anger: a new model for practice. Retrieved from
  3. Nitkin, K. (2018, October 19). The Changing Dynamics of Emergency Psychiatric Care. Retrieved from
  4. Zeller, S. L., & Citrome, L. (2016, March 2). Managing Agitation Associated with Schizophrenia and Bipolar Disorder in the Emergency Setting. Retrieved from

Cite this page

Schizophrenia and the Emergency Department. (2022, Nov 07). Retrieved from

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