Hospital - Psychiatric Emergency Consultation (PEC)

PEC - 3 West, Room 12 ID: - 45, Female - Level of Care B (discussed) Reason for admission: - Acute psychosis Past Medical History: - Hypertension, Type 2 Diabetes Medication: In hospital: - Olanzapine 10mg daily At home: - Metformin 500mg twice daily Allergies - Penicillin - From home Review of Hospital Progress: - Presented to the emergency department on 1 November 2024 with confusion and hallucinations. Triage noted elevated blood pressure and disorientation. Emergency physician's impression: acute psychosis. - Psychiatry: Impression of acute psychosis, recommended initiation of antipsychotic medication. - Neurology: No neurological deficits noted, ruled out seizure activity. - 1 November 2024: Patient remains disoriented, hallucinations persist. Today: - Reports auditory hallucinations, disorganized thoughts. OE: Good General State, no distress, no work for breathing Heart: normal S1, normal S2 with no murmurs No LL Edema Lungs: Normal Vesicular breathing, No crackles, No wheezing Abdomen: Soft, no tenderness, no Rigidity, no Rebound, negative Mcburney sign Investigations: Review of Labs: - no new labs Review of Imaging: - no new imaging Impression/Plan: 45-year-old female presented with acute psychosis: 1. Acute Psychosis - Impression: Acute Psychosis - Differential diagnosis: Schizophrenia, Bipolar Disorder - Investigations planned: MRI brain, EEG - Treatment planned: Continue Olanzapine, monitor mental status - Relevant referrals: Psychiatry follow-up 2. Hypertension - Treatment planned: Monitor blood pressure, adjust antihypertensive medication as needed 3. Type 2 Diabetes - Treatment planned: Continue Metformin, monitor blood glucose levels 4. Expected date of discharge - To be determined based on psychiatric stabilization 5. Other: - Prophylactic anti-coagulation: No - Foley catheter: No - GFR/Kidney function: GFR 85 mL/min