The College Student Psychiatric Emergency: II Diagnosis and Disposition

Abstract

Student psychiatric emergencies are a cause of great concern on college campuses, and they merit further study. The authors elucidate some of the characteristics of 1,156 visits to a hospital psychiatric emergency department made by 933 students over an eight-year period. The diagnoses given to students in emergencies were found to be equally divided among psychosis, neurosis, personality disorder, and “other.” Only about 30% of the students' visits to the psychiatric emergency department resulted in admission to the hospital; the implications, for college mental health programs, of having 70% of psychiatric emergencies returned to campus is discussed.

“Prevention of Acute Mountain Sickness by Dexamethasone,” T. Scott Johnson, et al. Acute mountain sickness is a syndrome that occurs when unacclimatized persons ascend rapidly to high altitudes. It is postulated that cerebral edema causes its symptoms. Since dexamethasone is useful in treating some forms of cerebral edema, we investigated its role in the prevention of acute mountain sickness. Using a double-blind crossover design, we exposed eight young men to a simulated altitude of 4570 m (15,000 ft) on two occasions. By random assignment, each subject received dexamethasone (4 mg every 6 hours) or placebo for 48 hours before and throughout the 42-hour exposure. The presence of symptoms of acute mountain sickness was established by two methods: a questionnaire and an interview by a physician. Dexamethasone significantly reduced the symptoms of acute mountain sickness. During dexamethasone treatment, the cerebral-symptom score (mean ± S.E.) decreased from 1.09 ± 0.18 to 0.26 ± 0.08, and the respiratory-symptom score decreased from 0.64 ± 0.09 to 0.31 ± 0.06 (both, P < 0.05). As judged by the interviewing physician, the symptom score decreased from 1.10 ± 0.11 to 0.28 ± 0.07 (P = 0.01). We conclude that dexamethasone may be effective in preventing the symptoms of acute mountain sickness. (New England Journal of Medicine 1984;310:683–6.)