introduction: The terms “confusion,” “delirium,” “encephalopathy” and “altered mental status (AMS)” are often used interchangeably when describing a patient who has undergone a rapid cognitive change and is unable to think and concentrate normally. Psychiatrists are often asked to evaluate and treat acute confusion in patients who are medically ill. This fact sheet outlines a quick and systematic approach to assessment. For information focused specifically on the elderly, see our fact sheet, “How to Evaluate Confusion in the Elderly.”

Self-injurious behaviors (SIB) are among the most pressing concerns you might face on an inpatient psychiatric unit. They require a balance of swift medical intervention, empathy, and stringent safety measures. Here we review practical tips for preventing and managing SIB.

Diagnostic criteria ● Restriction of caloric intake relative to requirements, leading to a significantly low body weight for age and sex. While there is no specific weight cut off, a BMI < 18.5 kg/m2 is often used. ● Intense fear of gaining weight or becoming fat. ● Disturbance in the way one's body weight or shape is experienced. ● Specify one of the following subtypes: Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior. Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior. (Seen in up to 50% of anorexia patients).

What is QT Prolongation?: The QT interval on an electrocardiogram (EKG) represents the time it takes for the heart's ventricles to depolarize (contract) and repolarize (relax). These interval times are corrected to account for variations in heart rate and are specified as “QTc”. QT prolongation can lead to serious arrhythmias, including torsades de pointes (TdP), and sudden death. While the link between QT and TdP is not clear, QTc above 500 msec is a significant risk factor for TdP.

Ask questions 1 and 2 YES NO 1) Have you wished you were dead or wished you could go to sleep and not wake up? ___ ___ 2) Have you actually had any thoughts of killing yourself? I

Many psychiatric units require that you add suicide risk factors vs protective factors to your progress notes or treatment plans. This is usually dictated by Joint Commission site surveys. Here we provide a handy list of risk and protective factors to help in your assessment and documentation of a patient’s level of suicide risk. You can use this determination to recommend the appropriate level of nursing observation.

Introduction: The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is a tool that allows you to gauge the intensity of OCD symptoms and track treatment progress. We recommend that you administer the scale to any inpatient whose reason for admission is related to OCD symptoms. It's readily accessible online, such as here:

Psychiatric patients often have comorbid alcohol use disorders. While mild to moderate alcohol withdrawal can be managed on the psychiatric unit, cases with severe autonomic instability, seizure history, or significant medical issues require transfer to the medical floor. This article provides practical guidance on the management of mild to moderate alcohol withdrawal on psych units.

Diagnosis ● DSM-5: o At least two weeks of unipolar major depression (eg., 5/9 SIGECAPS symptoms) o Plus hallucinations or delusions o Suicide attempts common—30% ● Prevalence: Much more common than you might think: 28% of people with depression have psychotic symptoms; 42% of patients hospitalized for depression have psychotic features

Syphilis, often termed the "great imitator," is a sexually transmitted infection (STI) that can present symptoms similar to many other conditions, including psychotic and mood disorders. Here we review its stages, diagnosis, and treatment.