Dr. Erika Kube
I was returning to my desk after seeing another patient in the emergency department (ED) when the police walked in with a very well-dressed young man. He was cooperative with the police officers who were escorting him, but he repeatedly yelled that he needed to leave, that they needed to release him.
Police took the patient to his room in the ED and informed the nurse that he had been placed in a “pink slip.” length of time.
A policeman who was with John said the police were called by the store manager because John was hanging out at the back door of the store, and are there to check the store for poison being sent by a group of bad people. said to the workers. They ignored him the first day and thought he would leave, but when he didn’t leave on the second day and started showing signs of agitation and pressured speech, they called 911. Did.
Certain professionals, including the police and paramedics, may not allow a person to comply with their will if they have reason to believe that the person is mentally ill and poses a substantial risk of physical harm to themselves or others. Conversely, it can take you to the ED. This allows patients who are presumed to have a mental illness, who are under the influence of drugs or alcohol, who are suicidal, or who are unable to care for themselves because of their mental illness, to be “restrained”. “can. This hold exists to ensure that the evaluation occurs when there are concerns about the patient’s health or the health of others, even if the patient does not want the evaluation.
I went to see John as soon as he arrived. As I walked into his room, I saw him walk in and out of the room and he spoke very quickly. I introduced myself to him and asked him to sit down. He reluctantly sat on the edge of the bed and asked me when he could get out. He was tapping the floor quickly with his toes. I said I would be very upset. If someone got hurt by the poison, it was my fault because he wasn’t there to stop the poison.
John denied any history of drug or alcohol use. When asked about his past medical history, he said he had just finished school and was on his first job. He had a very hard time answering my questions directly and was clearly frustrated that I didn’t understand what he was trying to convey.
John had blood drawn by our phlebotomist and had a CT scan of his brain. Because he had no prior history of this behavior, he needed to make sure there was no tumor in his brain. His nurse called me after a while asking if I could give him something to calm him down as he escalated further, refused to stay in the room and started screaming I asked. He kept talking about poisons and bad people trying to hurt people. I put him on an oral antipsychotic to help him calm down.
About an hour later, I returned to check on John. Everything in his lab was normal, and his CT scan of his brain showed no abnormalities. He was lying on the bed under the blanket and watching TV. When I asked him about his sleeping habits, he said he hadn’t slept much last week because he had to be in the store day and night.
I told John that I would remain in the emergency department until the psychiatrist’s evaluation was complete. I spoke with his mom on the phone and explained why John was taken to the emergency department. She said she had noticed a change in his behavior in the past few months. I was used to him not being at home. She said she actually hadn’t seen him in a week and she hadn’t been home to eat. She confirmed that John had no medical problems and that he had never behaved like this before.
John continued to have delusions about the poison and seemed to be talking to people he thought were in the room when in fact he was alone. hospitalization was recommended. John started taking regular antipsychotics and medication to regulate his sleep. He attended group therapy sessions during his hospital stay. He showed rapid improvement in symptoms, became less paranoid and more organized in his thoughts.
He was diagnosed with psychosis, a mental disorder characterized by disconnection from reality. Psychosis can be the result of a mental illness, such as schizophrenia, or it can be caused by a medical condition as a side effect of medication or drug use. Symptoms of psychosis include hallucinations, delusions, agitation, and incoherent speech. People with this condition are usually unaware that their behavior is abnormal.
John was able to leave the hospital after about a week. He was to continue his medication and attend outpatient counseling sessions. He made a follow-up appointment with a psychiatrist a few days after he was discharged from the hospital to make sure he was adjusting to life and stable.
Dr. Erika Kube is an emergency physician working for Central Ohio Emergency Services and OhioHealth.
drerikakubemd@gmail.com