Medical clearance of psychiatric patients
•Download as PPTX, PDF•
3 likes•1,891 views
The document discusses the concept of "medically clearing" psychiatric patients presenting to the emergency department. It notes that the term is poorly defined and can mean different things. The document outlines three situations where the term may be used and provides examples. It emphasizes the importance of a focused medical examination and thorough history for these patients, as medical illnesses could be exacerbated or the cause of their psychiatric symptoms. Two case examples are presented and discussed to illustrate the medical evaluation and clearance process. The conclusion reiterates that "medically cleared" is not an ideal term and emphasizes the need for detailed handovers when discharging psychiatric patients from the emergency department.
Report
Share
Report
Share
Recommended
Medical clearance for a psychiatric patient in ED
A document discusses medical clearance of psychiatric patients in the emergency department. It defines medical clearance as establishing there is no medical condition causing psychiatric symptoms and the patient is medically stable for transfer. The document outlines how to medically clear a patient by examining for medical illness, assessing treatment needs, and determining if intoxicated. It notes factors like poor examination that can lead to neglecting the physical exam. Two clinical scenarios are presented where thorough examination discovered fractures and a brain infarct requiring treatment. The conclusion emphasizes the importance of a detailed physical exam and history for psychiatric patients.
Case presentation nabhan
The document discusses a case of delirium tremens (DTs) in a 40-year-old Indian male prisoner brought to the emergency department displaying abnormal behavior. Initial examinations and tests revealed tachycardia, tremors, elevated glucose and liver enzymes. Treatment with benzodiazepines like diazepam and lorazepam failed to control his agitation and delirium, requiring intubation. He was started on antibiotics and a midazolam infusion in the ICU, and later extubated and discharged upon improvement after 4 days of treatment.
2016: Depression-Nasar
This document discusses several issues with modern psychiatry, including:
1) The diagnostic models used in psychiatry are unreliable and not validated by underlying biological mechanisms. Treatment efficacy is also limited and narrowly defined.
2) A holistic approach is needed that considers physical, mental, emotional, social, and spiritual factors rather than a narrow biochemical focus. Lifestyle interventions, supplements, energy therapies and other alternative treatments can be effective for depression.
3) Long term studies show most patients do not achieve remission with medication alone, and relapse is common after stopping treatment. A multidimensional approach tailored for the individual may provide better long term outcomes than the current model of psychiatry.
GIT J Club IBD- sexual dysfunction20.
- Sexual dysfunction and infertility are more prevalent in men with IBD compared to the general population.
- Depression is the most consistent negative predictive factor of sexual function among men with IBD.
- Sulfasalazine can reversibly reduce male fertility, so it is recommended to discontinue 3-4 months prior to conception. Most other IBD medications do not significantly impact fertility.
- Men with IBD have an increased risk of prostate cancer and prostate cancer screening guidelines for higher risk patients should be followed.
Dementia Delirium Julia Poole
Mr. TW, an 87-year-old man with multiple medical conditions and early dementia, has become confused, wandering at night, aggressive, and eating little over the past two days. His wife calls for nursing home placement but is distressed. His recent behavior change occurred after his dog died last month. He requires immediate medical evaluation to assess for potential underlying causes like delirium, a reversible acute confusion state often precipitated by illness, medication changes, or environmental stressors in vulnerable older adults like those with dementia.
Clozaril
1. The patient is a xx-year-old woman who was referred for psychiatric evaluation due to the many medications she was taking, including Clozapine.
2. The psychiatrist determined that the patient likely has schizophrenia rather than bipolar disorder as previously diagnosed.
3. It was recommended that the patient be taken off Clozapine, a high-risk antipsychotic, and switched to a different second-generation antipsychotic since she has not been properly tried on other medications in the past.
Dual Diagnosis
This document discusses dual diagnosis, which is when someone has both a mental illness and substance use disorder. It defines dual diagnosis and provides synonyms. It also gives statistics on the prevalence of dual diagnosis. It discusses the severity of dual diagnosis patients and characteristics like primary substance of abuse. It explores the relationship between mental disorders and substance use disorders. It outlines different types of dual diagnosis patients and discusses assessment and treatment approaches. Treatment involves integrated and coordinated care for both disorders simultaneously.
Case presentation 2
- A 50-year-old male presented with progressively diminishing vision in both eyes since childhood and sudden loss of vision in the right eye 20 days ago. Examination found high myopia, retinal detachment in the right eye, and mature cataract with total retinal detachment in the left eye. Investigations showed anemia. The patient was diagnosed with pathological myopia in both eyes, with retinal detachment in the right eye and cataract with retinal detachment in the left eye.
Recommended
Medical clearance for a psychiatric patient in ED
A document discusses medical clearance of psychiatric patients in the emergency department. It defines medical clearance as establishing there is no medical condition causing psychiatric symptoms and the patient is medically stable for transfer. The document outlines how to medically clear a patient by examining for medical illness, assessing treatment needs, and determining if intoxicated. It notes factors like poor examination that can lead to neglecting the physical exam. Two clinical scenarios are presented where thorough examination discovered fractures and a brain infarct requiring treatment. The conclusion emphasizes the importance of a detailed physical exam and history for psychiatric patients.
Case presentation nabhan
The document discusses a case of delirium tremens (DTs) in a 40-year-old Indian male prisoner brought to the emergency department displaying abnormal behavior. Initial examinations and tests revealed tachycardia, tremors, elevated glucose and liver enzymes. Treatment with benzodiazepines like diazepam and lorazepam failed to control his agitation and delirium, requiring intubation. He was started on antibiotics and a midazolam infusion in the ICU, and later extubated and discharged upon improvement after 4 days of treatment.
2016: Depression-Nasar
This document discusses several issues with modern psychiatry, including:
1) The diagnostic models used in psychiatry are unreliable and not validated by underlying biological mechanisms. Treatment efficacy is also limited and narrowly defined.
2) A holistic approach is needed that considers physical, mental, emotional, social, and spiritual factors rather than a narrow biochemical focus. Lifestyle interventions, supplements, energy therapies and other alternative treatments can be effective for depression.
3) Long term studies show most patients do not achieve remission with medication alone, and relapse is common after stopping treatment. A multidimensional approach tailored for the individual may provide better long term outcomes than the current model of psychiatry.
GIT J Club IBD- sexual dysfunction20.
- Sexual dysfunction and infertility are more prevalent in men with IBD compared to the general population.
- Depression is the most consistent negative predictive factor of sexual function among men with IBD.
- Sulfasalazine can reversibly reduce male fertility, so it is recommended to discontinue 3-4 months prior to conception. Most other IBD medications do not significantly impact fertility.
- Men with IBD have an increased risk of prostate cancer and prostate cancer screening guidelines for higher risk patients should be followed.
Dementia Delirium Julia Poole
Mr. TW, an 87-year-old man with multiple medical conditions and early dementia, has become confused, wandering at night, aggressive, and eating little over the past two days. His wife calls for nursing home placement but is distressed. His recent behavior change occurred after his dog died last month. He requires immediate medical evaluation to assess for potential underlying causes like delirium, a reversible acute confusion state often precipitated by illness, medication changes, or environmental stressors in vulnerable older adults like those with dementia.
Clozaril
1. The patient is a xx-year-old woman who was referred for psychiatric evaluation due to the many medications she was taking, including Clozapine.
2. The psychiatrist determined that the patient likely has schizophrenia rather than bipolar disorder as previously diagnosed.
3. It was recommended that the patient be taken off Clozapine, a high-risk antipsychotic, and switched to a different second-generation antipsychotic since she has not been properly tried on other medications in the past.
Dual Diagnosis
This document discusses dual diagnosis, which is when someone has both a mental illness and substance use disorder. It defines dual diagnosis and provides synonyms. It also gives statistics on the prevalence of dual diagnosis. It discusses the severity of dual diagnosis patients and characteristics like primary substance of abuse. It explores the relationship between mental disorders and substance use disorders. It outlines different types of dual diagnosis patients and discusses assessment and treatment approaches. Treatment involves integrated and coordinated care for both disorders simultaneously.
Case presentation 2
- A 50-year-old male presented with progressively diminishing vision in both eyes since childhood and sudden loss of vision in the right eye 20 days ago. Examination found high myopia, retinal detachment in the right eye, and mature cataract with total retinal detachment in the left eye. Investigations showed anemia. The patient was diagnosed with pathological myopia in both eyes, with retinal detachment in the right eye and cataract with retinal detachment in the left eye.
Behavioral
This document discusses the assessment and management of patients experiencing psychiatric and behavioral emergencies. It covers topics such as normal versus abnormal behavior, pathophysiology of common disorders, performing a mental status exam, diagnosing specific conditions like schizophrenia and depression, safely restraining violent patients, and general strategies for de-escalation and transport. The goal is to provide emergency personnel with knowledge and skills for responding effectively to mental health crises.
Delirium in elderly
An 83-year-old woman presented with fever, shortness of breath, and poor oral intake. She has a history of multiple medical conditions and is on several medications. On examination, she has a fever and signs of respiratory distress. The physician is concerned about pneumonia and increased depression, but her cognitive status was not assessed. Delirium is an acute fluctuating syndrome of altered attention, awareness and cognition, especially common in elderly hospitalized patients. It is often misdiagnosed as depression or dementia. Non-pharmacological prevention and treatment of underlying causes are most important, while antipsychotics may be used short-term for severe symptoms if needed.
From resistance to concordance
This document discusses the history and outcomes of schizophrenia. It traces the evolution of understanding and naming of the disorder from Morel in 1860 to Bleuler in 1908. Kraepelin originally termed it "dementia praecox" believing it had a deteriorating course, though long-term studies now show varied outcomes. Without treatment, 60-80% will relapse within 2 years and nearly all within 5 years, while with treatment only 20-40% relapse within 2 years and 50% within 5 years. The document also examines causes of non-compliance with medication, including factors related to the drugs' side effects, patients' attitudes and stigma, family influences, and health systems challenges. It defines the concepts of compliance, adherence
Psychiatric assessment; management & formulation
This document provides guidance on psychiatric formulation and management. It discusses conducting a descriptive formulation which provides an integrated summary of the patient's problems, history and examination findings. It also describes creating a dynamic etiological formulation to understand why the patient developed the disorder and potential predisposing, precipitating and perpetuating factors. Differential diagnoses, investigations and a provisional diagnosis using diagnostic criteria are also outlined. Management recommendations include both short and long-term approaches incorporating medical, psychological and social components. The document concludes with discussing prognostic factors for conditions like schizophrenia.
Haloperidol is the “Go To” Drug for Delirium: But are Atypicals a Better Option?
1) A randomized controlled trial compared haloperidol to placebo for treatment of delirium in critically ill patients. It found no significant differences between groups in days alive without delirium or coma, duration of delirium, or other outcomes.
2) Another randomized controlled trial compared quetiapine to placebo for treatment of delirium. It found that patients receiving quetiapine had significantly faster resolution of delirium compared to placebo.
3) While haloperidol is commonly used to treat delirium, evidence from randomized trials does not clearly support its use over alternatives like atypical antipsychotics.
Psychiatric assessment bird view
1) This document contains a psychiatric assessment form used to evaluate patients.
2) The form includes sections for collecting personal data, history of present illness, past psychiatric and medical history, family history, examination findings, formulation, differential diagnosis, investigations, provisional diagnosis, and management plan.
3) The formulation section involves developing both a descriptive formulation summarizing the patient's main issues, as well as a dynamic formulation exploring predisposing, precipitating and perpetuating factors for the patient's condition from biological, psychological and social perspectives.
Post stroke psychiatric symptoms
This document discusses post-stroke psychiatric disorders. It describes five frontosubcortical circuits that are involved in cognition, behavior and movement. Common post-stroke psychiatric conditions include depression, anxiety, apathy, psychosis and pathological laughing/crying. Lesion location can impact the type of psychiatric disorder, such as left anterior lesions increasing risk of depression. Treatment involves pharmacotherapy, such as antidepressants, and psychotherapy. Screening and ongoing monitoring of symptoms is important after a stroke to identify and manage post-stroke psychiatric complications.
Depression & epilepsy
Depression is one of the most common psychiatric disorders in epilepsy patients. It has many complications including increased risk of suicide, unemployment, and unhealthy behaviors. Risk factors for depression in epilepsy include high seizure frequency, temporal lobe epilepsy, unemployment, social impairment, and perceived stigma. Antiseizure medications can cause psychiatric side effects, and depression often presents atypically in epilepsy patients with irritability and brief euphoric episodes. Screening tools like the PHQ-9 and NDDI-E effectively diagnose depression. Antidepressants can and should be used cautiously in epilepsy, starting at low doses. Psychotherapy, especially CBT, and electroconvulsive therapy are also effective depression treatments for epilepsy patients.
Post stroke depression
This document discusses post-stroke depression. It notes that approximately 20-25% of stroke patients experience psychological symptoms initially from the shock and loss. Over time, patients must adjust to their new physical and cognitive limitations as well as changes in family roles and relationships. Post-stroke depression is common, affecting about one-third of patients, and is associated with poorer recovery outcomes, reduced quality of life, and increased mortality. Risk factors include a prior history of depression, female sex, social isolation, and greater functional impairment. Treatment involves antidepressants, psychotherapy, and lifestyle interventions, with the goal of improving mood and supporting recovery.
Psychiatric psychosocial emergencies
The document discusses various psychiatric and psychosocial emergencies including anxiety and panic reactions, bipolar disorder, depression, eating disorders, grief, homicidal or violent behavior, ineffective coping, psychotic behavior, and suicide. For each topic, it covers causes, assessments involving subjective and objective data collection, potential nursing diagnoses, and planning interventions and monitoring. Physical examinations, diagnostic tests, education, and pharmacological treatments are addressed.
Functional Disorders
This document summarizes an approach to managing patients with functional neurological symptoms. It discusses potential causes of functional symptoms from biological, psychological, and social perspectives. It also provides guidance on explaining the diagnosis of functional symptoms to patients in a clear, logical, and non-offensive way. The key points to cover in the explanation include emphasizing that the symptoms are common and reversible, that the patient's nervous system is not damaged, and introducing potential roles of depression, anxiety, and life stressors in making the symptoms worse.
Malingering
This chapter establishes the differential diagnosis between patients who are faking and malingering versus patients who are misdiagnosed, and mistakenly thought to be malingering because they are not getting well. Psychological myths about conversion are dispelled.
Pcom Aneurysm - Dr Sha Pamangadan
This document presents the case of a 42-year-old woman who presented with a two-week history of right-sided headaches and facial pain. Her symptoms did not initially improve with migraine treatment. She later returned with new symptoms of right eye pain, pressure, and blurry vision as well as right eyelid droopiness. Examination revealed ptosis and mydriasis of the right eye. A CT scan identified a 7mm bilobed posterior PCOM aneurysm. She underwent a craniotomy and clipping of the aneurysm, which provided immediate relief of her symptoms. At follow-up, her headaches, cranial nerve palsies, and vision had fully resolved, with the diagnosis being a PCOM aneurys
Scott Hirsch, MD
Depression and anxiety are common in people with epilepsy, occurring in up to 43% of patients. Untreated depression and anxiety can negatively impact quality of life and make achieving seizure control more difficult. Both psychological and biological factors may contribute to increased rates of mood disorders in people with epilepsy. Treatment options include therapy, lifestyle changes, and antidepressant medications, with SSRIs being a first-line pharmacological approach. Integrated treatment of both mood symptoms and epilepsy management is important.
Delerium in icu
This document discusses delirium, which is an acute disturbance of consciousness and cognition. It defines delirium and describes its subtypes. Delirium is associated with increased mortality, longer hospital stays, and permanent cognitive impairment in some patients. Risk factors include infection, withdrawal, metabolic abnormalities, trauma, and various medical conditions. Delirium results from neurotransmitter imbalances and inflammation in the brain. It should be monitored using scales like the Richmond Agitation Sedation Scale and Confusion Assessment Method. Treatment involves managing the underlying causes, minimizing sedation, promoting mobility, and in some cases using antipsychotics or dexmedetomidine. Delirium usually develops within the first 48 hours and can last up to two weeks.
Management of violent patient in emergency
This document provides guidance on managing violent patients in the emergency department. It discusses causes of violence including medical, psychiatric and social factors. Signs of escalating violence are outlined in three phases from anxiety to physical aggression. Recommendations are given for containment, assessment, de-escalation, restraint and seclusion. Medications that can be used for rapid tranquilization are also outlined along with their dosages and adverse effects. The document stresses safety, a team approach and avoiding floor restraints when possible. It seeks to balance controlling behavior with risks of sedation masking underlying illness.
Adult vaccination
The document discusses adult immunization and summarizes recommendations for various vaccines. It provides an overview of the history and pioneers of immunization like Jenner and Pasteur. Data is presented showing the success of vaccines in reducing cases of diseases like smallpox, diphtheria, and invasive pneumococcal disease. Recommendations are outlined for vaccines including influenza, pneumococcal, hepatitis A/B, meningococcal, MMR, HPV, Tdap, herpes zoster and others. Contraindications and special populations are also mentioned.
Adult Vaccine 2013 final
This document provides an overview and updates on various adult vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP). It discusses vaccines for influenza, pneumococcal disease, herpes zoster, Tdap, HPV, meningococcal disease, hepatitis A, and varicella. For each vaccine, it outlines the populations recommended to receive it, dosing schedules, and special considerations for immunocompromised individuals. The presentation emphasizes the importance of adult vaccinations in preventing disease and highlights changes to recommendations for the 2013-2014 season.
Medical clearance of the psychiatric patient
This presentation discusses medically clearing psychiatric patients. It defines what being "medically clear" means, including having no medical issues or having psychiatric issues dominate over any medical conditions. The presentation reviews how to declare a patient medically clear through history, exam, and observations. It discusses investigating patients based on being lower or higher risk. For lower risk young patients with no issues, further tests may not be needed. The presentation reviews evidence that "routine bloods" are often unnecessary. It presents a case of a patient whose altered mental state was ultimately found to be due to non-convulsive status epilepticus. The presentation concludes that clearly documenting medical clearance is important and requirements may differ by institution.
10.30.08(b): Antipsychotic Drugs
This document summarizes key aspects of antipsychotic drugs used to treat schizophrenia and psychosis. It discusses how first and second generation antipsychotics work primarily by blocking dopamine D2 receptors. Second generation drugs tend to have fewer extrapyramidal side effects due to their additional receptor targets. The document also reviews evidence that schizophrenia may involve both excess dopamine and deficient glutamate neurotransmission, leading to new drug targets aimed at enhancing glutamatergic signaling.
More Related Content
What's hot
Behavioral
This document discusses the assessment and management of patients experiencing psychiatric and behavioral emergencies. It covers topics such as normal versus abnormal behavior, pathophysiology of common disorders, performing a mental status exam, diagnosing specific conditions like schizophrenia and depression, safely restraining violent patients, and general strategies for de-escalation and transport. The goal is to provide emergency personnel with knowledge and skills for responding effectively to mental health crises.
Delirium in elderly
An 83-year-old woman presented with fever, shortness of breath, and poor oral intake. She has a history of multiple medical conditions and is on several medications. On examination, she has a fever and signs of respiratory distress. The physician is concerned about pneumonia and increased depression, but her cognitive status was not assessed. Delirium is an acute fluctuating syndrome of altered attention, awareness and cognition, especially common in elderly hospitalized patients. It is often misdiagnosed as depression or dementia. Non-pharmacological prevention and treatment of underlying causes are most important, while antipsychotics may be used short-term for severe symptoms if needed.
From resistance to concordance
This document discusses the history and outcomes of schizophrenia. It traces the evolution of understanding and naming of the disorder from Morel in 1860 to Bleuler in 1908. Kraepelin originally termed it "dementia praecox" believing it had a deteriorating course, though long-term studies now show varied outcomes. Without treatment, 60-80% will relapse within 2 years and nearly all within 5 years, while with treatment only 20-40% relapse within 2 years and 50% within 5 years. The document also examines causes of non-compliance with medication, including factors related to the drugs' side effects, patients' attitudes and stigma, family influences, and health systems challenges. It defines the concepts of compliance, adherence
Psychiatric assessment; management & formulation
This document provides guidance on psychiatric formulation and management. It discusses conducting a descriptive formulation which provides an integrated summary of the patient's problems, history and examination findings. It also describes creating a dynamic etiological formulation to understand why the patient developed the disorder and potential predisposing, precipitating and perpetuating factors. Differential diagnoses, investigations and a provisional diagnosis using diagnostic criteria are also outlined. Management recommendations include both short and long-term approaches incorporating medical, psychological and social components. The document concludes with discussing prognostic factors for conditions like schizophrenia.
Haloperidol is the “Go To” Drug for Delirium: But are Atypicals a Better Option?
1) A randomized controlled trial compared haloperidol to placebo for treatment of delirium in critically ill patients. It found no significant differences between groups in days alive without delirium or coma, duration of delirium, or other outcomes.
2) Another randomized controlled trial compared quetiapine to placebo for treatment of delirium. It found that patients receiving quetiapine had significantly faster resolution of delirium compared to placebo.
3) While haloperidol is commonly used to treat delirium, evidence from randomized trials does not clearly support its use over alternatives like atypical antipsychotics.
Psychiatric assessment bird view
1) This document contains a psychiatric assessment form used to evaluate patients.
2) The form includes sections for collecting personal data, history of present illness, past psychiatric and medical history, family history, examination findings, formulation, differential diagnosis, investigations, provisional diagnosis, and management plan.
3) The formulation section involves developing both a descriptive formulation summarizing the patient's main issues, as well as a dynamic formulation exploring predisposing, precipitating and perpetuating factors for the patient's condition from biological, psychological and social perspectives.
Post stroke psychiatric symptoms
This document discusses post-stroke psychiatric disorders. It describes five frontosubcortical circuits that are involved in cognition, behavior and movement. Common post-stroke psychiatric conditions include depression, anxiety, apathy, psychosis and pathological laughing/crying. Lesion location can impact the type of psychiatric disorder, such as left anterior lesions increasing risk of depression. Treatment involves pharmacotherapy, such as antidepressants, and psychotherapy. Screening and ongoing monitoring of symptoms is important after a stroke to identify and manage post-stroke psychiatric complications.
Depression & epilepsy
Depression is one of the most common psychiatric disorders in epilepsy patients. It has many complications including increased risk of suicide, unemployment, and unhealthy behaviors. Risk factors for depression in epilepsy include high seizure frequency, temporal lobe epilepsy, unemployment, social impairment, and perceived stigma. Antiseizure medications can cause psychiatric side effects, and depression often presents atypically in epilepsy patients with irritability and brief euphoric episodes. Screening tools like the PHQ-9 and NDDI-E effectively diagnose depression. Antidepressants can and should be used cautiously in epilepsy, starting at low doses. Psychotherapy, especially CBT, and electroconvulsive therapy are also effective depression treatments for epilepsy patients.
Post stroke depression
This document discusses post-stroke depression. It notes that approximately 20-25% of stroke patients experience psychological symptoms initially from the shock and loss. Over time, patients must adjust to their new physical and cognitive limitations as well as changes in family roles and relationships. Post-stroke depression is common, affecting about one-third of patients, and is associated with poorer recovery outcomes, reduced quality of life, and increased mortality. Risk factors include a prior history of depression, female sex, social isolation, and greater functional impairment. Treatment involves antidepressants, psychotherapy, and lifestyle interventions, with the goal of improving mood and supporting recovery.
Psychiatric psychosocial emergencies
The document discusses various psychiatric and psychosocial emergencies including anxiety and panic reactions, bipolar disorder, depression, eating disorders, grief, homicidal or violent behavior, ineffective coping, psychotic behavior, and suicide. For each topic, it covers causes, assessments involving subjective and objective data collection, potential nursing diagnoses, and planning interventions and monitoring. Physical examinations, diagnostic tests, education, and pharmacological treatments are addressed.
Functional Disorders
This document summarizes an approach to managing patients with functional neurological symptoms. It discusses potential causes of functional symptoms from biological, psychological, and social perspectives. It also provides guidance on explaining the diagnosis of functional symptoms to patients in a clear, logical, and non-offensive way. The key points to cover in the explanation include emphasizing that the symptoms are common and reversible, that the patient's nervous system is not damaged, and introducing potential roles of depression, anxiety, and life stressors in making the symptoms worse.
Malingering
This chapter establishes the differential diagnosis between patients who are faking and malingering versus patients who are misdiagnosed, and mistakenly thought to be malingering because they are not getting well. Psychological myths about conversion are dispelled.
Pcom Aneurysm - Dr Sha Pamangadan
This document presents the case of a 42-year-old woman who presented with a two-week history of right-sided headaches and facial pain. Her symptoms did not initially improve with migraine treatment. She later returned with new symptoms of right eye pain, pressure, and blurry vision as well as right eyelid droopiness. Examination revealed ptosis and mydriasis of the right eye. A CT scan identified a 7mm bilobed posterior PCOM aneurysm. She underwent a craniotomy and clipping of the aneurysm, which provided immediate relief of her symptoms. At follow-up, her headaches, cranial nerve palsies, and vision had fully resolved, with the diagnosis being a PCOM aneurys
Scott Hirsch, MD
Depression and anxiety are common in people with epilepsy, occurring in up to 43% of patients. Untreated depression and anxiety can negatively impact quality of life and make achieving seizure control more difficult. Both psychological and biological factors may contribute to increased rates of mood disorders in people with epilepsy. Treatment options include therapy, lifestyle changes, and antidepressant medications, with SSRIs being a first-line pharmacological approach. Integrated treatment of both mood symptoms and epilepsy management is important.
Delerium in icu
This document discusses delirium, which is an acute disturbance of consciousness and cognition. It defines delirium and describes its subtypes. Delirium is associated with increased mortality, longer hospital stays, and permanent cognitive impairment in some patients. Risk factors include infection, withdrawal, metabolic abnormalities, trauma, and various medical conditions. Delirium results from neurotransmitter imbalances and inflammation in the brain. It should be monitored using scales like the Richmond Agitation Sedation Scale and Confusion Assessment Method. Treatment involves managing the underlying causes, minimizing sedation, promoting mobility, and in some cases using antipsychotics or dexmedetomidine. Delirium usually develops within the first 48 hours and can last up to two weeks.
Management of violent patient in emergency
This document provides guidance on managing violent patients in the emergency department. It discusses causes of violence including medical, psychiatric and social factors. Signs of escalating violence are outlined in three phases from anxiety to physical aggression. Recommendations are given for containment, assessment, de-escalation, restraint and seclusion. Medications that can be used for rapid tranquilization are also outlined along with their dosages and adverse effects. The document stresses safety, a team approach and avoiding floor restraints when possible. It seeks to balance controlling behavior with risks of sedation masking underlying illness.
What's hot (18)
Haloperidol is the “Go To” Drug for Delirium: But are Atypicals a Better Option?
Haloperidol is the “Go To” Drug for Delirium: But are Atypicals a Better Option?
Viewers also liked
Adult vaccination
The document discusses adult immunization and summarizes recommendations for various vaccines. It provides an overview of the history and pioneers of immunization like Jenner and Pasteur. Data is presented showing the success of vaccines in reducing cases of diseases like smallpox, diphtheria, and invasive pneumococcal disease. Recommendations are outlined for vaccines including influenza, pneumococcal, hepatitis A/B, meningococcal, MMR, HPV, Tdap, herpes zoster and others. Contraindications and special populations are also mentioned.
Adult Vaccine 2013 final
This document provides an overview and updates on various adult vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP). It discusses vaccines for influenza, pneumococcal disease, herpes zoster, Tdap, HPV, meningococcal disease, hepatitis A, and varicella. For each vaccine, it outlines the populations recommended to receive it, dosing schedules, and special considerations for immunocompromised individuals. The presentation emphasizes the importance of adult vaccinations in preventing disease and highlights changes to recommendations for the 2013-2014 season.
Medical clearance of the psychiatric patient
This presentation discusses medically clearing psychiatric patients. It defines what being "medically clear" means, including having no medical issues or having psychiatric issues dominate over any medical conditions. The presentation reviews how to declare a patient medically clear through history, exam, and observations. It discusses investigating patients based on being lower or higher risk. For lower risk young patients with no issues, further tests may not be needed. The presentation reviews evidence that "routine bloods" are often unnecessary. It presents a case of a patient whose altered mental state was ultimately found to be due to non-convulsive status epilepticus. The presentation concludes that clearly documenting medical clearance is important and requirements may differ by institution.
10.30.08(b): Antipsychotic Drugs
This document summarizes key aspects of antipsychotic drugs used to treat schizophrenia and psychosis. It discusses how first and second generation antipsychotics work primarily by blocking dopamine D2 receptors. Second generation drugs tend to have fewer extrapyramidal side effects due to their additional receptor targets. The document also reviews evidence that schizophrenia may involve both excess dopamine and deficient glutamate neurotransmission, leading to new drug targets aimed at enhancing glutamatergic signaling.
Adult immunisation schedule
The document discusses adult immunization strategies in India. It notes there is a lack of consensus on optimal adult immunization strategies in developing countries like India due to a lack of reliable epidemiological data, efficacy and safety data of vaccination strategies, and data on monitoring immunization adequacy. The document provides guidance on recommended vaccines for different adult groups and schedules for vaccines including tetanus, diphtheria, pertussis, hepatitis A, hepatitis B, HPV, influenza, measles, mumps, rubella, varicella, herpes zoster and pneumococcal vaccines.
IMMUNIZATION SCHEDULE
The document discusses key terms related to immunization and vaccination. It defines terms like immunization, vaccine, vaccination, full immunization, partial immunization, non-immunization, ring immunization, and herd immunity. It also summarizes milestones in immunization in India and provides vaccination charts detailing the various vaccines recommended at different ages. Barriers to immunization like physical barriers and psychological barriers are highlighted. Reasons for low immunization coverage like failures to provide immunization, dropouts, and unreached populations are discussed.
Psychiatric emergency
The document discusses guidelines for handling psychiatric emergencies, noting that physical causes should always be ruled out first and that patients exhibiting disturbing behavior may have conditions like anxiety, depression, bipolar disorder, or schizophrenia. It provides tips for assessment, emphasizing safety, calm communication, and restraint only when necessary to prevent harm. Proper management includes addressing any medical issues and transporting patients to an appropriate facility for further evaluation and treatment.
Neurotransmitter - Dopamine
Dopamine is a neurotransmitter that plays a key role in reward processing, motor control, and addiction. It acts through two families of G protein-coupled receptors and is synthesized and transported via specific pathways in the brain, notably the mesolimbic pathway associated with reward. Dopamine neurons fire in response to unexpected rewards and encode reward prediction errors, helping to reinforce rewarding behaviors. Imbalances in dopamine signaling are implicated in various disorders like addiction, Parkinson's disease, and schizophrenia.
Vaccination
The document discusses the history and types of vaccination. It describes how Edward Jenner observed that milkmaids exposed to cowpox did not get smallpox, leading him to develop the smallpox vaccine in 1796. Since then, vaccines have been developed for over 20 diseases and have saved millions of lives worldwide by training the immune system to recognize and fight pathogens. Vaccines can be live attenuated, inactivated, toxoid, subunit, polysaccharide or genetic based.
Viewers also liked (9)
Similar to Medical clearance of psychiatric patients
Schizophrenia - Psychiatry Case Presentation
J.K. is a 34-year-old man with a 16-year history of schizophrenia who was admitted to the hospital after becoming unpredictable and threatening violence. He had been refusing medications and experiencing auditory hallucinations telling him to harm himself. Upon examination, he displayed symptoms of loose thought processes, depression, and diminished judgment. His condition is thought to have decompensated due to medication noncompliance, which has led to multiple hospital admissions in the past.
Initial Psychiatric InterviewSOAP Note TemplateCriteriaCl.docx
Initial Psychiatric Interview/SOAP Note Template
Criteria
Clinical Notes
Informed Consent
Informed consent given to patient about psychiatric interview process and psychiatric/psychotherapy treatment. Verbal and Written consent obtained. Patient has the ability/capacity to respond and appears to understand the risk, benefits, and (Will review additional consent during treatment plan discussion)
Subjective
Verify Patient
Name: Susan
DOB: not provided
Minor: NA
Accompanied by: self
Demographic: NA
Gender Identifier Note: Female
CC: “I have been feeling anxious, depresssed, high blood pressure, irregular heartbeat, elevated body temperature, crying spells for the last 2 days”
.
HPI: Susan is a midde aged woman who reports to the healthcare clinic reporting several symptoms that she has observed over the period of the last two days. She reports having high blood pressure, an irregular heartbeat, depression, anxiety, and an increase in body temperature. Susan doesn't realize that she shows signs of alcohol dependence and physiological dependence, which downplays the seriousness of her alcohol usage. This diagnosis is supported by the withdrawal symptoms that appear to be becoming more tolerable as well as by the sustained and increased alcohol consumption despite the harm it does to social interactions and job performance. She has also increased her alcohol consumption to ease withdrawal symptoms. s He has a history of drinking, which has caused him to skip work and even get arrested. She downplays her alcohol consumption and justifies how often and how much she drinks.
Pertinent history in record and from patient: Alcohol withdrawal
During assessment: Patient is cam and corparative
Patient seemed to be suffering from serious cases of both anxiety and despair judging from her crying spells.
Patient denies hallucinating. The patient has nomal thought process. .
SI/ HI/ AV: patient denies signs of suicidal ideation and violent behavior.
Allergies: NKDFA.
(medication & food)
Past Medical Hx:
Medical history: Denies cardiac, respiratory, endocrine and neurological issues, including history head injury.
Patient denies history of chronic infection, including MRSA, TB, HIV and Hep C.
Surgical history no surgical history reported
Past Psychiatric Hx:
Previous psychiatric diagnoses: NKDA
Describes stable course of illness.
Previous medication trials: not reported
Safety concerns:
History of Violence
to Self:none reported
History of Violence t
o Others: none reported
Auditory Hallucinations: not reported
Mental health treatment history discussed:
History of outpatient treatment: not reported
Previous psychiatric hospitalizations: not reported
Priorsubstance abuse treatment: not reported
Trauma history: Client reveals no history of traumatic experiences (such as abuse, domestic violence, or exposure .
Psych
This document summarizes psychiatric disorders that are more prevalent in HIV-infected patients compared to the general population. It discusses how psychiatric illness can both increase the risk of HIV infection and negatively impact outcomes for HIV patients. Common psychiatric issues in HIV patients include depression, anxiety, substance abuse, and mania. Screening tools and treatment options are also reviewed.
Chief Complaint Follow upHistory of Presenting IllnessMr
Chief Complaint: Follow up
History of Presenting Illness:
Mr. Gerald is 58-year-old AA male admitted to SBGC on 10/8/21 due to history of HTN, chronic ETOH use, tobacco use, Wernicke's encephalopathy and unspecified psychiatric history. He was seen for follow up via telemedicine. He was selectively mute and could not talk to us much. Nodded head to most questions. Patient is a poor historian and has a history of given conflicting information. Staff report that appetite and sleep varies. He is being managed with Aricept 5mg for dementia and Cogentin 0.5mg for EPS. Ativan 1mg PRN for agitation. Nursing to continue to document behavior to direct further treatment plan. Verbalized understanding. No change in status. Denies suicidal or homicidal ideation. Denies any issue or discomfort currently. Patient denies current SI/HI/AVH/Paranoia/Delusion.
Current Medication: As per Matrix medication lists for medical.
Psychiatric medication: None
Past Psychiatric History: Unknown
Past Psychiatric Hospitalization: Unknown
History of Suicide Attempts or Thoughts- Unknown
Previous Psychiatric Medications: None PTSD: Y/N- Unknown.
Family Psychiatric History: Unknown
Medical History/Review of Systems: See Matrix for medical diagnosis.
Allergies Drug: NKDA.
Food Allergies: NKFA
Surgery: Y/N- Unknown. Sleep and Appetite Varies.
Normal Developmental History: None
Exposure to Drugs/medication/Alcohol: Y/N-Unknown
Speech/Language delays: Y/N- Yes
Sexual Abuse or Physical abuse: Y/N-Unknown
Social History: Unknown
Sexually active. Are you in relationship: Unknown?
Family Structure: Unknown
Favorite/Leisure activity: Y/N: Unknown
Educational History/Career: Unknown
Work history: Unknown
Substance Use History: Unknown.
Legal History: Y/N- Unknown
Mental Status Examination:
General Appearance: Neat & clean, casually dressed in good hygiene.
Eye contact: Normal Psychomotor Activity: Normal
Memory: Long term and short-term memory not intact. Attention: Reduced
SPEECH: Decreased speech in amount, rate, and volume.
MOOD: objectively Poor.
AFFECT: Flat and anxious.
THOUGHT PROCESS: Not appropriate.
THOUGHT CONTENT: Denies SI/HI.
PERCEPTIONS: Denies AVH sensorium.
INSIGHT: Poor
JUDGMENT: Poor
COGNITION: Poor
Language. normal.
Diagnosis:
F03.20 Dementia.
Suicidal ideation/HI - Denies Suicidal or homicidal ideation.
PROTECTIVE FACTORS: Family support
RISK ASSESSMENT: Low
SAFETY PLAN RECOMMENDATIONS: Notify staff if feeling Suicidal and call 911 for suicidal attempt.
Psychosis: - Denies Paranoia and delusional.
Prescription: No medication at this time.
Medication Education: Aricept 5mg at bed time for dementia. Cogentin 0.5mg for EPS. Ativan 1mg every 6hrs PRN.
Non-Pharmacological Education Recommended: Continue to use positive coping skills as needed. Identify triggers and address them proactively.
Plan: In 90 days, there will be improvement in memory and concentration.
Fall precaution in place
Follow up in 2 to 4 weeks.
NRNP/PRAC 6645 Comprehensive Psychiatric Evaluation ...
Comprehensive Psychiatric EvaluationTina CherryColle
Comprehensive Psychiatric Evaluation
Tina Cherry
College of Nursing-PMHNP, Walden University
NRNP 6635: Psychopathology and Diagnostic Reasoning
Dr. Clark
April 4, 2022
1
7
Subjective
CC: “it works a little too well. It makes me sleepy.”
HPI: The patient is a White female who is 26 years old. She says that she was given medication that made her sleepy during her recent admission to an inpatient psychiatric facility. She says that she was struggling with sleep before she was treated at the facility. She also reports that she was diagnosed with bipolar disorder. She says that within one week, she has lost 14 pounds. She complains that she sleeps too much at night. She rates her happiness in life at an eight out of ten and denies suicide and homicide ideation. The patient reports that she has highs and lows in her moods.
Past Psychiatric History
General Statement: The patient has been previously diagnosed with bipolar disorder.
Caregivers: not reported.
Hospitalizations: Prior inpatient admission at a psychiatric facility.
Medication Trials: Lithium during last inpatient visit
Previous Psychiatric Diagnosis: Bipolar disorder
Substance Use History: The patient does not drink, abuse illicit drugs, and has never smoked.
Family History: Both her parents are alive, and her father has skin cancer that has metastases to the brain.
Psychosocial History: No reported psychosocial history.
Medical History:
Current Medications: Gabapentin 600mg in the morning and noon, and 1200mg at night. Abilify 5mg at night
Allergies: Lithium causes her to have diarrhea.
Reproductive Hx: No reported childern.
Past Medical History: Hyperlipidemia.
ROS:
GENERAL: The patient is alert and well oriented to time, place, and person.
HEENT: The patient does not have any swellings on the head, audio and visual acuity is normal, no sinus infections, and no swollen lymph nodes in the throat.
SKIN: The skin does not have any breakages or rashes. It is also sufficiently moist with normal pigmentation.
CARDIOVASCULAR: The patient does not experience any discomfort in the chest.
RESPIRATORY: The patient has steady breathing and does not experience shortness of breath. The rising and falling of her chest are expected, with no dyspnea or respiratory issues.
GASTROINTESTINAL: The patient does not have any nausea, abdominal pains, running stomach, or vomiting episodes
GENITOURINARY: The patient can pass urine without experiencing any pain or discomfort.
MUSCULOSKELETAL: The patient has a full range of ambulatory movements with no pain in her joints. She moves freely with no constraints or pain.
HEMATOLOGIC: The patient does not have anemia.
LYMPHATICS: There is no splenectomy or swollen lymph nodes present.
ENDOCRINOLOGIC: There are no endocrinal conditions noted or any unusual hormonal changes.
Objective
Physical Examination: Vitals are as follows: Ht: 5’11” Wt: 169 lbs BMI: 23.57 Pain: 0/10
Diagnostic results: Blood and urine tests returned unremarkable results, and the MRI ...
Assessing Clients Discussion Paper.docx
M.A. is a 68-year-old Hispanic woman who presented with increased psychosis and auditory hallucinations telling her to harm herself or others. She has a history of substance abuse and non-compliance with psychiatric treatment. A comprehensive assessment was performed, noting her medical and psychiatric history, current symptoms, and mental status. Differential diagnoses included opioid-induced psychosis or alcohol-induced psychosis. A treatment plan was developed using antipsychotic medication and psychotherapy. A genogram of her family extending back three generations was also created.
456585540-schizophrenia-clinical-case-study.docx
This case study describes a 45-year-old female patient, J.W., who has been diagnosed with schizophrenia. She has a history of psychotic breaks and hospitalizations. Prior to her most recent admission, she displayed increased paranoia, decreased motivation, and had stopped taking her medications. On admission, she exhibited flat affect, auditory hallucinations, and disorganized speech. Her treatment plan involves medication management and encouraging compliance. Discharge planning is being considered, which may involve returning to her mother's home or a group home. The goal is for J.W. to safely manage her symptoms and participate in treatment.
Sychosis and schizophrenia.pdf
1) Schizophrenia and psychosis greatly impact normal brain processes and functioning, making it difficult for clients to think clearly and function in daily life.
2) Proper diagnosis and treatment under close supervision from a mental health practitioner can help clients thrive.
3) Assessing client history and factors is important to develop personalized treatment plans, considering how medications may impact each client differently based on pharmacokinetic and pharmacodynamic processes.
Psych NP Didactic Assignment 2.docx
This document discusses three case studies involving patients with various physical and mental health conditions. For the first case, a methamphetamine-addicted woman with hepatitis C, the summary would include a physical exam focusing on cardiac, respiratory, neurological and gastrointestinal systems. It also discusses appropriate lab tests and the potential for group CBT therapy. The second case involves an HIV-positive man with anxiety disorder. His exam and labs would assess for signs of anxiety and rule out other conditions. Group CBT is again suggested. The third case is a homeless schizophrenic man with metabolic syndrome. His symptoms would be differentiated from metabolic syndrome criteria. His medications could be adjusted due to interactions and weight.
Comprehensive Psychiatric Evaluation Essay Discussion Paper.docx
This document provides instructions and an exemplar for writing a comprehensive psychiatric evaluation. The evaluation should include subjective, objective, and assessment sections. In the subjective section, details about the patient's chief complaint, history, psychiatric history, and social history should be included. The objective section should contain results from a physical exam and any diagnostic tests. The assessment section requires a mental status exam, listing of at least three differential diagnoses from highest to lowest priority with supporting evidence, and an explanation of the primary diagnosis selected through critical thinking. A reflection on the case is also required discussing what was learned and any legal/ethical considerations.
Drug dependance maha
P. Harish, a 22-year-old male coolie, was admitted to the psychiatry unit for drug dependence and polysubstance abuse. He had been talking irrelevantly, misbehaving, and experiencing sleep disturbances for a week. His treatment plan included antipsychotics like haloperidol, carbamazepine, and diazepam. Over 7 days of treatment, his condition improved and he was sleeping well and talking relevantly by days 5-6, though he became irritable on day 7. The goals of reducing symptoms and improving quality of life were achieved through counseling and medication.
Bipolar Blog Discussion Paper.docx
S.N. is a 15-year-old female who was brought to a facility by her uncle for evaluation of bipolar disorder type 1. She has a history of risky behaviors like substance use and unsafe sexual encounters. Her current medications are not effective and she is non-compliant. The treatment plan aims to simplify her medication regimen to improve compliance and provide psychotherapy and education to support her safety, well-being and recovery.
Treatment resistant schizophrenia
This document discusses treatment resistant schizophrenia. It begins by defining schizophrenia and its symptoms. It then discusses the prevalence of schizophrenia in different populations. It notes that treatment resistant schizophrenia is defined as an inadequate response to at least two different antipsychotic medications. Clozapine is considered the treatment of choice for treatment resistant schizophrenia due to evidence from randomized controlled trials. However, clozapine also carries risks of adverse effects like agranulocytosis that require monitoring. The document discusses various treatment strategies and predictors of treatment resistant schizophrenia.
Malingering and how to spot it
Malingering accounts for millions of dollars lost in the workplace. This chapter, from the past president of the American Academy of Pain Management, and former Johns Hopkins Hospital staff member, appeared in a book edited by Dr. Kathy Foley from Cornell. It tells an attorney or insurance adjuster how to spot a malingerer or a faker, and how this differs from other disorders. It also recommends an Internet test at www.MarylandClinicalDiagnostics.com, which can identify malingerers with 85% to 95% accuracy and can be used in court.
A Clinical Case Report Schizophrenia
This case report describes a 35-year-old female patient who was diagnosed with schizophrenia. She presented with symptoms of sleep disturbances, loss of appetite, hallucinations, and hearing voices. Her symptoms had gradually worsened over the past 1.5 years. After examination, she was diagnosed with schizophrenia and admitted to the hospital for treatment. Her treatment included antipsychotic medications, antidepressants, family therapy, yoga, and cognitive behavioral therapy. With this comprehensive treatment, her symptoms minimized and she was eventually discharged from the hospital with ongoing monitoring. The case report aims to demonstrate the identification and treatment of schizophrenia symptoms.
Metyrosine in Adolescent Psychosis Associated with 22q11.2 Deletion Syndrome
"Metyrosine in Adolescent Psychosis Associated with 22q11.2 Deletion Syndrome,"
Halifax, Nova Scotia, Canada; June 7, 2006
Dalhousie University, Department of Psychiatry, Clinical Conference
*Learn clinical features of velocardiofacial syndrome (VCFS)
*Learn association of psychosis with VCFS
*Learn genetic and biochemical abnormalities leading to psychosis in VCFS
*Discuss case report of metyrosine in psychosis associated with VCFS
*What can we learn from the association between VCFS and schizophrenia to design candidate gene studies for polygenic syndromes?
Depression based on a case. Prepared by medical students
The patient, a retired government officer, is experiencing early morning waking and feelings of depression with no previous physical or psychiatric illnesses. The document defines depression and lists its causes such as genetic and biochemical factors. It discusses the pathophysiology of depression involving the hypothalamic-pituitary-adrenal axis and neurotransmitters like serotonin. Diagnostic criteria and questions to ask patients with potential depression are provided. Laboratory tests to investigate depression and rule out other conditions are also outlined.
Hospital and Community Psychiatry October 1989 Vol. 40 No. 10 .docx
Hospital and Community Psychiatry October 1989 Vol. 40 No. 10 1025
dictive Behaviors. Edited by Donovan
DM, Marlart GA. New York, Guilford,
1988
35. Grant I, Reed R: Neuropsychology of
alcohol and drug abuse, in Substance
Abuse and Psychology. Edited by Alter-
man A!. NewYork, Plenum, 1985
36. Vardy MM, Kay SR: LSD psychosis or
LSD-induced schizophrenia? A multi-
method inquiry. Archives of General
Psychiatry 40:877-883, 1983
37. Castellani 5, Petnie WM, Ellinwood E:
Drug-induced psychosis: neurobiologi-
cal mechanisms, in Substance Abuse and
Psychology. Edited by Alterman A!.
New York, Plenum, 1985
38. McLellan AT, Woody GE, O’Brien CP:
Development ofpsychiatnic disorders in
drug abusers. New England Journal of
Medicine 301:1310-1314, 1979
39. Ellinwood E, Duarte-Escalante 0:
Chronic methamphetamine intoxication
in three species ofexperimental animals,
in Current Concepts on Amphetamine
Abuse. Edited by Ellinwood E, Cohen S.
Rockville, Md, National Institute of
Mental Health, 1972
40. BeIIDS: The experimental reproduction
of amphetamine psychosis. Archives of
General Psychiatry 30:35-40, 1973
41. Alterman A!: Substance abuse in psychi-
atnic patients, in Substance Abuse and
Psychology. Edited by Alterman A!.
New York, Plenum, 1985
42. Kendler KS: A twin study of individuals
with both schizophrenia and alcoholism.
BritishJournal ofPsychiatry 147:48-53,
1985
43. Hesselbrock MN, Hesselbrock VM,
Tennen H, et al: Methodological con-
sidenations in the assessment of depres-
sion in alcoholics. Journal of Consulting
and Clinical Psychology 51:399-405,
1983
44. HimmelhochJM, Hill 5, Steunberg B, et
al: Lithium, alcoholism, and psychiatric
diagnosis. Journal of Psychiatric Treat-
ment and Evaluation 5:83-88, 1983
45. Mayfield D: Substance abuse in theaffec-
sive disorders, in Substance Abuse and
Psychology. Edited by Alterman A!.
New York, Plenum, 1985
46. Schuckit MA: The importance of family
history ofaffective disorder in agroup of
young men. Journal of Nervous and
MentalDisease 170:530-535, 1982
47. Robertson MJ: Mental disorder among
homeless persons in the United States:
an overview of recent empirical liters-
tare. Administration in Mental Health
14:14-27, 1986
48. Blashfield BK Propositions regarding
the use of cluster analysis in clinical re-
search.JournalofConsultingand Clinical
Psychology 48:456-459, 1980
49. Blashfield RK, Money LC:The classifica-
tion of depression through cluster anal-
ysis. Comprehensive Psychiatry 20:516-
527, 1979
50. OverallJE, Hollister LE, Johnson M, et
al: Nosology ofdepression and differen-
tial response to drugs. JAMA 195:946-
948, 1966
51. Spitzer RL, Williams JBW: Having a
dream: a research study for DSM-IV.
Archives ofGeneral Psychiatry 45:871-
874, 1988
Treatment of Patients With
Psychiatric and Psychoactive
Substance Abuse Disorders
Fred C. Osher, M.D.
Lial L. Kofoed, M.D.
The treatment ofindividuals with
coexisting psychoactive substance
abuse and severepsy ...
Illness anxiety disorder pps
Somatoform disorder include different entities. One of complex and difficult to treat ailment among the somatoform disorder is illness anxiety disorder, formerly known as hypochondriasis. My power point presentation is an attempt to simplify the mystery of this common psychiatric diagnosis. (Dr Satyajeet Singh, MD, Neuropsychiatrist, Aiims Patna)
1bipolar disorder8Captain of the Ship Bipolar DisorderT
1
bipolar disorder 8
Captain of the Ship: Bipolar Disorder
The following case study details the treatment approach for a 35-year-old Caucasian male who presented to the clinic for help with his mood disorder. The assessment and intake supported the diagnosis of bipolar disorder, subtype II. The following analysis presents the details related to both pharmacology and psychotherapy, as well as information related to medical management, community support resources, and appropriate follow-up.
Chief Complaint
The client came to the clinic reporting that he “could no longer deal with his up-and-down mood swings and that he was at the end of his rope.”
History of Presenting Problem
This client stated that he has had mood swings for as long as he could remember, and that right now he was in the “up” phase of this alternating mood pendulum. From an inspection of the genogram that the client provided, there was a noticeable inheritance pattern of the bipolar. Notably, this client had evidence of bipolar on both maternal and paternal sides of his genogram. Research has shown that bipolar has a high heritability rate. Kern (2014) reported on the concordance rates of twins with bipolar, stating the rate was from 60-80%. In other studies, the heritability of bipolar is demonstrated albeit at lower rates (Maier et al. (2005).
The DSM-V characterizes bipolar II disorder as one in which individuals experience a period of at least 4 days of hypomanic symptoms; once this criterion is met, the person fits the diagnosis of bipolar II regardless of the duration of future hypomanic episodes (APA, 2013). Additional symptoms to support this diagnosis were the client’s admission that he was taking on several projects and tasks at work simultaneously; sleeping little; experiencing racing thoughts; and feeling invincible. The intake showed the client’s extremely fast talking, switching subjects haphazardly, and admission of both depressive and hypomanic episodes, all of which point to a diagnosis of bipolar II (296.89 F31.81) (APA, 2013).
Current Medications
This client denied taking any medications, either over the counter or from a doctor. Although he claimed he was in good health, he did report that he frequently got headaches but not of migraine proportions. He described them as more of an annoyance than a health problem. He gained relief from either Motrin or Tylenol during these headache episodes. He denied taking any vitamins or herbs or any other OTC substances.
Relevant History
The client reported that his mood swings began when he was in his early 20s. As he witnessed other family members suffering from these mood swings, he came to believe they were normal. The client appeared to be in good health, was not overweight, and appeared to take good care of himself. He was dressed well and was oriented x4. He stated that he earned a good living working as a financial consultant, enjoyed his work, but could not deal with the revolving mood swings anymore. His p ...
Similar to Medical clearance of psychiatric patients (20)
Initial Psychiatric InterviewSOAP Note TemplateCriteriaCl.docx
Initial Psychiatric InterviewSOAP Note TemplateCriteriaCl.docx
Chief Complaint Follow upHistory of Presenting IllnessMr
Chief Complaint Follow upHistory of Presenting IllnessMr
Comprehensive Psychiatric EvaluationTina CherryColle
Comprehensive Psychiatric EvaluationTina CherryColle
Comprehensive Psychiatric Evaluation Essay Discussion Paper.docx
Comprehensive Psychiatric Evaluation Essay Discussion Paper.docx
Metyrosine in Adolescent Psychosis Associated with 22q11.2 Deletion Syndrome
Metyrosine in Adolescent Psychosis Associated with 22q11.2 Deletion Syndrome
Depression based on a case. Prepared by medical students
Depression based on a case. Prepared by medical students
Hospital and Community Psychiatry October 1989 Vol. 40 No. 10 .docx
Hospital and Community Psychiatry October 1989 Vol. 40 No. 10 .docx
1bipolar disorder8Captain of the Ship Bipolar DisorderT
1bipolar disorder8Captain of the Ship Bipolar DisorderT
More from SCGH ED CME
Trauma teams
The document discusses trauma teams and their roles. It defines a trauma team as a multidisciplinary group that works together to assess and treat severely injured patients. A team approach has been shown to significantly reduce resuscitation times compared to individual doctors. The roles of trauma team members are outlined, as well as techniques for effective communication, briefing, handover, and speaking up if concerns arise. Statistics from Western Australia in 2015 show the most common causes of death for major trauma patients were head injuries and brain death. Overall mortality rates were lower than the national average.
Haemostatic resuscitation
This document provides an overview of haemostatic resuscitation for trauma patients. It discusses the goals of haemostatic resuscitation which include rapidly correcting hypothermia, hypocalcaemia, acidosis and other factors impairing haemostasis. It also aims to resuscitate patients with a balanced combination of blood products resembling whole blood to avoid dilutional coagulopathy. The document reviews the components of blood, various blood products used in resuscitation and their effects, and studies supporting haemostatic resuscitation approaches. It also discusses practical considerations for haemostatic resuscitation in the emergency department setting.
Arthrocentesis
Mr. Arthur Ritis, a 52-year-old man with diabetes, hypertension, and a history of gout, presented with a hot, swollen, and painful right knee for 24 hours. Examination found a warm knee with a large effusion and mild tenderness. Blood tests showed elevated white blood cell count and C-reactive protein. Arthrocentesis of the knee found cloudy yellow synovial fluid containing urate crystals on microscopy. This confirms the diagnosis of an acute gout attack in the knee requiring treatment.
Ultrasound in cardiac arrest
This document discusses the use of echocardiography during cardiac arrest and peri-arrest situations. It provides an overview of basic echo views that can be useful. Echo can help identify the cause of arrest such as tamponade, pulmonary embolism, or wall motion abnormalities. Findings on echo such as hypovolaemia or myocardial activity can help guide management decisions. The document reviews where echo fits within the ACLS algorithm and issues surrounding its use during cardiac arrest. It provides examples of echo findings that may indicate treatable versus non-treatable causes of arrest.
Goals of patient care introduction
The document discusses the goals of implementing a new Goals of Patient Care (GOPC) form across hospitals in Western Australia to improve end-of-life care and decision making. It provides background on the form's trial implementation at various sites. The new form aims to have goals of care discussions with patients or their surrogates to determine appropriate treatment based on probable outcomes, not just resuscitation status. It outlines the form's structure with sections on baseline information, goal of care selection, discussion summary, and extended use. The document emphasizes improving communication around goals of care and ensuring treatment aligns with patients' values and preferences.
Physiology Directed CPR
This document discusses physiology directed CPR and haemodynamically directed CPR. It notes that cardiac arrest is not a diagnosis and various underlying pathologies must be considered. During closed chest compressions, a proportion of cardiac output is generated through cardiac and thoracic pumping. Studies show that targeting specific blood pressure and coronary perfusion pressure goals during CPR improves survival outcomes compared to standard AHA guidelines. Monitoring diastolic blood pressure and central venous pressure can help guide interventions like fluid administration or vasopressor use to meet haemodynamic targets and optimize circulation during CPR.
Ultrasound confirmation of ETT placement
This document discusses using ultrasound to confirm endotracheal tube placement. It states that ultrasound is a simple, fast, and reliable adjunct technique that can be used when other confirmation methods like capnography are unreliable or not available. There are two ultrasound techniques described - direct (transtracheal) ultrasound looks inside the trachea or esophagus to see if the tube is correctly placed, while indirect (transthoracic) ultrasound looks for movement of the pleura indicating lung ventilation. Ultrasound is not meant to replace capnography and auscultation but can be a helpful additional method in emergency situations or for patients who are not responding as expected after intubation. The document provides details on how to
Palliative care in the emergency department
This document provides guidance on symptom management for palliative patients in the emergency department. It outlines approaches for managing common symptoms like pain, delirium, dyspnea, nausea and vomiting. It recommends opiate medications for pain management, depending on whether the patient is opiate naïve or tolerant. It also provides guidance on managing other symptoms like bladder and bowel issues, secretions and more uncommon complications. The document emphasizes the importance of palliative care consultation and ensuring patients are not left to die alone.
Wilderness crisis and decision making weekend April 2018
This document announces a wilderness crisis and decision making weekend to take place in Margaret River, Australia from April 20-22, 2018. The weekend aims to build teamwork skills through quotes about collaborating, working together, and making decisions as a group. Activities will involve solving problems as a team rather than individuals.
Patient confidentiality in emergency department
Patient confidentiality must be maintained in the ED. Personal information about patients cannot be disclosed without consent, except in emergencies or if required by law. Duty consultants should be aware of any VIP patients but provide the same standard of care. Confidentiality must be respected even for those not under the practitioner's direct care. Mandatory notifications to regulatory bodies are required only for specific conduct issues. Advice can be sought from designated hospital staff if questions arise about disclosing information.
Abscess management
This document summarizes several studies on the use of antibiotics for abscess management. A 2016 RCT of over 1000 patients found that high-dose Bactrim led to higher cure rates of abscesses over 2cm compared to placebo, especially for those with MRSA, fevers, or immunosuppression. A 2017 RCT of under 800 patients found Bactrim and clindamycin had similar cure rates of abscesses under 5cm as placebo. However, antibiotics were associated with higher adverse gastrointestinal events. Overall, meta-analyses show antibiotics reduce treatment failures and new skin infections compared to incision and drainage alone, but with a risk of serious drug side effects.
Hyperthermia and hypothermia
This document discusses hyperthermia and hypothermia. It defines hyperthermia as a core body temperature above 41.5°C and describes the pathophysiology and various causes, including exercise-associated collapse, heatstroke, and drug-related illnesses. It also discusses hypothermia, defined as a core temperature below 35°C, and covers causes, clinical features at different temperature stages, complications, investigations, and management approaches including warming techniques. The prognosis depends on factors like maximum temperature reached and duration of temperature elevation.
Electrical injury
- This document contains information on various electrical injury cases presented to the emergency department, including details on mechanisms of injury, clinical presentations, investigations, and management strategies. Key points include treating electrical injury patients as trauma patients, avoiding premature withdrawal of resuscitation due to the unreliable signs of death, monitoring for cardiac dysrhythmias, rhabdomyolysis, and neurovascular compromise of injured extremities. High voltage or lightning injuries can cause severe internal injuries despite minor external burns and require prolonged cardiac monitoring and aggressive IV fluid resuscitation.
D-dimer audit
This document summarizes an audit of CTPA scans ordered without a D-Dimer test for patients over 50. Of 53 CTPA scans reviewed, 49 did not have a D-Dimer. For most scans, the decision not to order a D-Dimer was appropriately documented. However, for 8 scans (16%) there was no documented reason for not ordering a D-Dimer. The audit concluded that CTPA scans are generally being ordered appropriately to diagnose PE, but better documentation of the reasons for not ordering D-Dimers could help reduce unnecessary CTPA use.
It's all about the documentation
Good clinical documentation is critical for continuity of patient care, patient safety, legal records, and supporting accurate medical coding. The documentation provides information on why the patient was admitted and what treatments they received. The coders assign diagnosis and procedure codes based solely on the documented information. Ambiguous or incomplete documentation can result in inaccurate coding that affects funding. Ensuring documentation clearly specifies diagnoses, management plans, and interventions helps ensure patients are assigned to the appropriate Diagnosis Related Group (DRG) and the hospital receives appropriate funding for the services provided.
Paediatric rashes
This document provides an overview of common paediatric rashes. It begins with describing the anatomy of the skin and definitions of common rash morphologies such as macules, papules, vesicles and pustules. Common rashes that are described include scabies, acne, contact dermatitis, atopic dermatitis, impetigo, tinea and nonspecific viral rashes. Specific viral exanthems like measles, rubella and scarlet fever are also reviewed. Emergent rashes like erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis are discussed in terms of their presentations, causes and treatments. References are provided at the end.
Choosing Wisely - Rational Antibiotic Usage
This document summarizes a case study of a 28-year-old Australian woman who developed a rash and respiratory symptoms after returning from travel to Thailand. Initial testing ruled out common infections like malaria, dengue fever, and influenza. Her rash and symptoms were consistent with measles. Further diagnostic testing confirmed infection with herpes simplex virus 1 via a positive PCR test. The case highlights the importance of considering uncommon infections in returning travelers who present with rashes and respiratory symptoms.
What's Hot in Emergency Medicine June 2018
This document summarizes several hot topics in emergency medicine:
1) A study found imaging and blood cultures are often inappropriate for evaluating uncomplicated cellulitis according to guidelines.
2) A new pulmonary embolism pathway was introduced in 2018.
3) The Surviving Sepsis Campaign updated their sepsis bundles to a single 1-hour bundle in 2018.
4) There is debate around the evidence and recommendations of the Surviving Sepsis Campaign.
5) The terms used to describe new oral anticoagulants, like NOAC, are still appropriate according to hematology experts.
Emergency ophthalmology
- The document appears to be a slide presentation on ophthalmic examination techniques. It includes descriptions of examining the orbit, extraocular movements, pupils, anterior segment, cornea, anterior chamber, iris, lens, and discs using a slit lamp. It also mentions assessing vision, intraocular pressure, and performing direct ophthalmoscopy.
- The presentation notes that the value of experience is not just seeing much, but seeing wisely. It asks if the viewer sees what the presenter sees.
- A list of time-critical conditions that require urgent attention is provided, including acute angle closure glaucoma, penetrating eye injuries, endophthalmitis, and retinal artery occlusion.
Code Brown - Disaster Medicine in the ED
The document outlines the emergency department's response plan for a "Code Brown", which refers to mass casualty incidents that exceed the hospital's normal capacity. The 4 phases of response are notification, standby/preparation, reception of casualties, and stand down. Key steps include activating staff call backs, setting up triage and treatment areas, prioritizing patient care, and addressing issues like family inquiries, transportation bottlenecks, and media relations. The plan emphasizes timely triage, treatment and flow of patients. A post-incident debriefing within 7 days allows for evaluating the response and making improvements.
More from SCGH ED CME (20)
Wilderness crisis and decision making weekend April 2018
Wilderness crisis and decision making weekend April 2018
Recently uploaded
Journal Article Review on Rasamanikya
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS). Parc Taulí. Sabadell
A Classical Text Review on Basavarajeeyam
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Top Effective Soaps for Fungal Skin Infections in India
Swisschem Dermacare has mentioned the List of The Best Antifungal Soap In India 2022. All of these soaps are trusted by various Dermatology Experts.
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Learn about body grief and ways to cope with it. We will also explore methods to heal from this challenging experience.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
It includes regulation of combination products and medical devices. FDA and industry liaisons.
share - Lions, tigers, AI and health misinformation, oh my!.pptx
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.The Best Ayurvedic Antacid Tablets in India
Treat the symptoms of indigestion, heartburn and stomach reflux with the 10 Best Ayurvedic Antacid Tablets in India.
Histololgy of Female Reproductive System.pptx
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Recently uploaded (20)
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
Top Effective Soaps for Fungal Skin Infections in India
Top Effective Soaps for Fungal Skin Infections in India
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
Medical clearance of psychiatric patients
- 1. Presented by Dr Wen Guha 16/10/2014
- 3. Commonly used term by clinicians, but poorly defined and potentially confounding. Means three situations: 1) there is no medical illness present; Example: 23yo Schizoaffective disorder female, did not take medications for last 2 weeks. Brought in by family because of worsening auditory hallucination symptoms. Denies illicit drug or alcohol use.
- 4. 2) a medical illness is known to be present but is not thought to be the primary cause of the patient’s symptoms; Example: 65yo male has Bipolar disorder and T2DM. Feels more depressed for last 2 months and wants to be reviewed by psychiatry team. Has BSL 18mmol/L for last a few weeks, nil signs of infection.
- 5. 3)the medical illness that was present no longer needs medical treatment. Example: 43yo male has chronic suicidal ideation and worsening over last 2 days. PMHx Cauda equina syndrome, wheel chair bound due to previous back injury.
- 6. To establish if a patient’s symptoms are caused or exacerbated by a medical illness: i.e delirium, absence seizure, hyperthyroidism. To assess and treat any medical situation that needs acute intervention. To determine if the patient is intoxicated , thereby preventing an accurate psychiatric evaluation. In some hospitals/facilities, the ED examination may be the only medical assessment that patient receives during the entire hospitalisation.
- 7. Focused medical assessment: Comprehensive history including collateral history from family/carer/case office Thorough physical examinations: vital signs, BSL, GCS Brief and short mental status examination Signs of intoxication Review patient’s medications
- 8. Blood tests? Several studies suggested no indication for routine laboratory testing in ED in patients who have no self-identified medical complaints and a past psychiatric history High risk groups: elderly; substance abuse; no previous psychiatry history; psych patient with new medical complaint; lower socioeconomic status Screen tools and hospital policy
- 9. A SCREENING TOOL TO MEDICALLY CLEAR PSYCHIATRIC PATIENTS IN THE EMERGENCY DEPARTMENT; Shah et al. The Journal of Emergency Medicine, Vol. 43, No. 5, pp. 871– 875, 2012
- 10. Does the patient need a urine drug screen? Alcohol level Further investigations: CT, MRI EEG
- 11. Patient factors Uncooperative and difficult patient Poor historian Hostile and violent
- 12. Medical staff factors Lack of documentation of vital signs and BSL on observation chart Diagnostic assumptions Familiarity with patients who frequently present to ED: frequent flyers
- 13. 45yo female from home with fulltime carer PMHx: schizophrenia Medications: Clozapine Brought in by sister, patient deteriorates over last 2 weeks, difficult to engage in a conversation, strange behaviours (wandering in house, urination on the floor), refuses her medications sometimes in last 2 weeks. Denies recent infective illness/fall/head injury
- 14. Examination: Unkempt Caucasian female HR 80, BP 120/60, RR 16, O2sats 100% RA, BSL 6.0mmo/L, urinalysis: NAD Difficult to perform physical examination :uncooperative, but she has equal power on all limbs, normal gait, nil facial droop. Can not engage patient in a conversation. She does not follow any verbal commands and speaks words with no meaning.
- 15. Is patient medically cleared? CT head under GA: Large right side frontal infarct
- 16. 43yo female BIBP PMHx: depression, borderline personality disorder Homeless BAL 0.2, crying and wants to kill her self because had argument with ex partner. Code Black at triage: patient striped herself and running away from ED Escorted back by security and 5mg diazepam PO given
- 17. Patient calms down after PO diazepam and becomes cooperative Vitals: afebrile, HR 105, BP 150/90, RR 20, O2sats 96% RA, BSL 10mmol/L Can we medically clear this patient?
- 18. While she was telling you how horrible her ex partner treat her, you saw she has a red patch on her right hand and the hand looks a bit swollen. What happened? She said she was drunk and angry 3 days ago, punched a wall. Also said she hurt her right foot as well, but she was too drunk, cannot recall the injury X-ray right hand and foot: Right 4th metacarpal bone displaced neck fracture Right cuneiform bone undisplaced fracture
- 19. Plaster applied and referred patient to Ortho Clinic for follow up. Medically cleared after the plaster and admitted to D20.
- 20. “Medically clear” is a poor definition, better handover with a detailed discharge summary. Focused medical examination and thorough history is important when reviewing patients presenting to ED with mental health issues. Beware of “frequent flyers”. They might actually present with a genuine medical issue.
- 21. “MEDICALLY CLEARED”: HOW WELL ARE PATIENTS WITH PSYCHIATRIC PRESENTATIONS EXAMINED BY EMERGENCY PHYSICIANS? Szpakowicz et al. The Journal of Emergency Medicine, Vol. 35, No. 4, pp. 369 –372, 2008 MEDICAL CLEARANCE OF THE PSYCHIATRIC PATIENT IN THE EMERGENCY DEPARTMENT ; Janiak et al. The Journal of Emergency Medicine, Vol. 43, No. 5, pp. 866 – 870, 2012 A SCREENING TOOL TO MEDICALLY CLEAR PSYCHIATRIC PATIENTS IN THE EMERGENCY DEPARTMENT; Shah et al. The Journal of Emergency Medicine, Vol. 43, No. 5, pp. 871– 875, 2012 Clinical Policy: Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department; From the American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department; Annals of Emergency Medicine Volume 47, no. 1 : January 2006 Evaluation of the Psychiatric Patient; Sood et al. Emerg Med Clin N Am 27 (2009) 669–683 EVIDENCE-BASED EVALUATION OF PSYCHIATRIC PATIENTS; Zun, The Journal of Emergency Medicine, Vol. 28, No. 1, pp. 35–39, 2005 Value of Mandatory Screening Studies in Emergency Department Patients Cleared for Psychiatric Admission; Parmar et al. Western Journal ofEmergency Medicine Volume XIII, NO.5 : November 2012 388-393