ABSTRACT
There are many instances in a busy office practice when patients present with symptoms severe enough to benefit from hospitalization. Third-party payers may refer a severely ill patient directly to the office for emergency psychiatric evaluation and management. Third-party payers, especially managed care companies, understandably expect the physician to treat increasingly sick patients effectively in the office. For all of these reasons, the physician should be well-versed in rapid management strategies for treating severely emotionally disordered patients in the office. Mild psychosis requires only low doses of antipsychotic medications and can also be safely managed in the office. With prompt and aggressive office management and the use of a combination of medications, many hospitalizations can be prevented. The choice of combinations of medications is based on presenting symptoms, clinical reasoning, and psychopharmacological principles. The medications should be complementary, and together improve all of the symptoms without side effects.
