During my first site evaluation for this rotation, I presented a patient that presented in acute psychosis. The patient had no prior psychiatric history. While taking a history from the patient, she stated that she was a colonel in the army and needed to leave the ER because she was running the presidential campaign for Kamala Harris. During the site evaluation, we discussed the possible reasons for admitting this patient compared to monitoring her in the ER. We reviewed the benefits of asking providers about their thought process and how they developed the treatment regimen for each patient. We also discussed the differential diagnoses for this patient. This patient did not have a previous psychiatric history and therefore it is important to differentiate whether this is the first presentation of a late-onset psychiatric disorder or if there is an underlying physiological process that is causing these symptoms. We also reviewed five drug cards that I prepared that were based on medications I saw prescribed in the psychiatric ER.

For my second site evaluation, I prepared two patients to present, along with a corresponding research article. The first patient that I prepared was a patient that presented with exacerbation of Schizoaffective disorder, Bipolar type secondary to medication noncompliance. This patient has multiple visits in the ER due to the same complaint. The patient currently resides in a group home. She was brought in by EMS after her home initiated the call due to agitated and aggressive behavior. In the ER, the patient continued to act internally preoccupied and agitated. I included an article I found which evaluated the benefits of long-acting Paliperidone injection. I thought that this may be a good alternative treatment for this patient as it may increase her medication compliance and reduce the incidence of ER visits. I also prepared an additional five drugs to review. These drugs were all relevant to my experiences in the Psych ER.