Acute Management of the Psychotic Term Paper

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Medically, certain conditions must be ruled out before Linda is
transported for psychiatric admission. High on the list of differential
diagnosis is head injury, electrolyte imbalance, thyroid disorder,
metabolic disturbance, nutritional issues, and toxic substance ingestion.
If the history appears clear that Linda has not experience psychosis,
hallucination or delusion before, these and other conditions must be ruled
out before a psychiatric diagnosis is given.
Of primary concern is the safety for Linda and the staff. One person
should be encouraged to establish a relationship with Linda in the medical
setting, communicating with her but allowing adequate escape distance
should her demeanor or threat level change. Linda should be spoken to in a
soft, quiet voice in a secure setting. She should be provided choices
regarding voluntarily taking medications.

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Conversation with Linda should
be simple and to the point, avoiding prolonged or argumentative
conversations. It may require limit setting to get a good history, since
Linda may be tangential in her history.
Physical restraint should be used as a last resort, and only in
accordance with local protocol.
The caretaker must also consider themselves in this setting. Linda is
fearful and anxious, and a challenging patient. She may become hostile if
she perceives danger or disbelief. It will be important to maintain a calm
and non-judgmental relationship with Linda.
Consideration should be given to using benzodiazepines to calm her.
Primarily, the provider must ensure he or she is safe and providing
adequate evaluation for the patient to….....

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