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Discussion 3

A PMHNP resource hub for ER psychosis assessments, featuring case dialogues, schizophrenia evaluation tools, de‑escalation strategies, involuntary hold protocols, and acute medication management guidance.

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    Discussion 3.1: Assessing a Person in Psychosis ** Margaret has presented to the ER due to fear that she is being poisoned. A full medical work-up has been completed by ER physician and there is no evidence of poisoning. The ER doctor consults me to come and complete a psychiatric assessment as it appears this patient has a pre-existing diagnosis of schizophrenia in her chart. ER physician reports that Margaret lives in a supported community with staff on-site due to her history with noncompliance and difficulty managing her schizophrenia. It is also reported that Margaret stopped taking her antipsychotic medications 2 weeks ago when she initially had concerns of poisoning and her paranoia has continued to escalate. She is currently on 1:1 supervision in the ER as an elopement risk and a danger to herself and others. **MEETING WITH MARGARET** Hi Margaret, my name is Ashley. I am a psychiatric mental health nurse practitioner, and I have been asked to come meet with you. Can you tell me what is going on and what brings you to the emergency room today? Margaret: I really don't know what is going on, the staff where I stay just dropped me off here and left me. PMHNP: Do you know what would have caused them to feel the need to bring you in? Margaret: I know they are the ones trying to poison me, I am sure this is just their next step to getting rid of me.

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