Urgent Medical Treatment Notification (T4)

Psychiatrist Urgent Medical Treatment Notification (T4) **Patient Details:** Patient Name: Sarah Jenkins Date of Birth: 15/03/1985 NHS Number: 123 456 7890 **Sending Clinician:** Name: Dr. Emily Carter Role: Consultant Psychiatrist Contact Number: 020 7946 0000 Date of Notification: 1 November 2024 **Receiving Medical Team/Department:** Name: Emergency Department Hospital: St. Bartholomew's Hospital Contact Number: 020 7946 1234 **Reason for Urgent Medical Treatment Notification:** Patient is presenting with severe acute agitation, suicidal ideation with a clear plan, and refusing oral medication. There are concerns about imminent self-harm if not managed urgently in a medical setting. This agitation is believed to be a severe manifestation of her underlying Bipolar Affective Disorder, currently in a manic episode with psychotic features, exacerbated by poor adherence to her prescribed mood stabiliser. **Key Medical History (Relevant to current presentation):** Bipolar Affective Disorder (Type I) - Diagnosed 2010 Previous hospital admissions for manic episodes (last 2022) Hypertension - Managed with Ramipril Asthma - Managed with Salbutamol inhaler PRN Allergies: Penicillin (rash) Medications: Lithium Carbonate 800mg daily (currently non-adherent), Ramipril 5mg daily, Salbutamol inhaler PRN. **Current Mental State Examination Findings:** Appearance and Behaviour: Dishevelled, restless, agitated, making frequent attempts to leave the consultation room, poor eye contact. Speech: Pressured, loud, tangential, flight of ideas. Mood and Affect: Elevated, irritable, labile affect. Thought Form: Disorganised, tangential, flight of ideas. Thought Content: Grandiose delusions (believes she can fly), paranoid ideation (believes staff are poisoning her), vivid suicidal ideation with a specific plan to jump from a height, without ambivalence. Perceptions: Auditory hallucinations (hearing voices telling her to jump). Cognition: Appears distracted, difficulty with concentration, estimated Mini-Mental State Examination (MMSE) score significantly impaired due to acute agitation. Insight and Judgment: Severely impaired insight into her illness and need for treatment. Poor judgment, impulsivity. Risk Assessment: High risk of self-harm due to intense suicidal ideation and plan, high risk of harm to others due to agitation and impulsivity, high risk of absconding. **Specific Medical Concerns/Instructions for Receiving Team:** 1. Urgent medical assessment to rule out physical causes for agitation (e.g., infection, metabolic disturbance, substance intoxication/withdrawal). 2. Management of acute agitation – consider rapid tranquilisation as per local guidelines, preferring IM Lorazepam or Olanzapine if oral not tolerated, considering patient's current medications and potential interactions. 3. Close monitoring of vital signs, especially after any sedative administration. 4. Ensure safety and constant observation due to high risk of self-harm and absconding. 5. Consideration for formal Mental Health Act assessment following medical stabilisation. 6. Review current medications, particularly Lithium levels, as non-adherence is suspected. **Actions Taken by Sending Clinician:** Attempted de-escalation verbally, offered oral medication (rejected). Contacted patient's next of kin (mother) to inform them of transfer. Arranged for safe transfer via ambulance with two staff escorts. Notified receiving Emergency Department Consultant of impending arrival and key concerns. **Urgency Level:** IMMEDIATE – patient poses significant and imminent risk to self and requires urgent medical and psychiatric intervention. **Expected Outcome of Transfer (if not already discussed):** Stabilisation of acute agitation, comprehensive medical workup, and Mental Health Act assessment for potential admission to an inpatient psychiatric unit.