Schizoaffective disorder presents significant diagnostic challenges due to its overlap with both bipolar disorder and schizophrenia. It's crucial to obtain as meticulous and reliable a history as possible, although this can be difficult with patients experiencing active psychosis. Ideally, you’ll establish the timing of mood and psychotic symptoms, which is essential for ensuring an accurate diagnosis.

In this fact sheet we discuss when to order and how to interpret a urinalysis in psychiatric inpatients. We won’t cover the urine tox screen (or drug screen) in this fact sheet, as it is already covered in ….

Progress notes should be succinct and readable notes that summarize the progress your patient has made over the last 24 hours (or whatever interval your hospital requires). It is likely that your hospital has adopted an electronic health record software with templates leading to bloated daily notes with reams of excessive data. This makes the progress notes unreadable and relatively useless for efficiently tracking patient progress. All hope is not lost. In this fact sheet we recommend the tried-and-true SOAP note (Subjective, Objective, Assessment, Plan) format. Alternatively, you can use the increasingly common APSO note (Assessment, Plan, Subjective, Objective) format that places the most important parts of the note at the beginning.

It’s likely you’ll sometimes encounter aggressive or violent situations in psychiatric emergency rooms and inpatient units. They’re part and parcel of the job, but that doesn’t mean you’re left without tools to handle them. Several training programs, like AVADE and Crisis Prevention Institute (CPI), are designed to teach employees how to stay safe in high-risk environments. Surprisingly, the Occupational Safety and Health Administration (OSHA) doesn’t mandate these trainings, but several states do. Regardless of the mandate, sign up for trainings if your hospital offers them and make an effort to engage in regular refresher sessions. You can learn surprisingly effective self-defense techniques in the trainings’ role-playing scenarios. Here are some key points

The use of restraints ensures a quick end to any escalation of agitated or aggressive behavior, but restraint-free approaches can also defuse the situation while safeguarding patients’ safety and dignity

In this fact sheet, we present our approach to ordering lab tests for psychiatric patients, focusing on those most relevant to those newly admitted to psychiatric units. In other fact sheets, we drill down into more detail on specific labs to help you interpret abnormalities (see, for example, …..)

Hepatitis B and C are prevalent among psychiatric inpatients, often transmitted through shared needles and sexual contact. This fact sheet serves as a concise guide on the pathophysiology, diagnosis, and treatment of these conditions, tailored for the psychiatric setting.

The psychiatric review of symptoms (PROS) is an important though often neglected part of the initial psychiatric evaluation. This fact sheet provides a framework to help you screen for the major psychiatric disorders that your client may have. It starts with a mnemonic that will help you recall all the major categories of disorders, followed by brief reminders of the diagnostic criteria. It’s helpful to have this at your side when doing your interviews, though eventually you will memorize most of the information contained herein.

Post-Traumatic Stress Disorder (PTSD) is a discrete DSM-5 disorder that can occur in people who have experienced or witnessed a traumatic event. Many of your patients in inpatient psychiatry have been exposed to significant trauma, such as adverse childhood experiences, domestic or sexual violence, and the hardships associated with homelessness or substance use. Determining whether these experiences result in PTSD or are manifestations of ongoing trauma impacts (sometimes referred to as "complex PTSD") is crucial for effective treatment. In this fact sheet we describe a practical approach to determining a diagnosis and to what extent your patient’s daily functioning is being significantly affected by past trauma.

Patients often arrive at psychiatric hospitals under involuntary commitment orders, typically initiated by police or psychiatric mobile response teams. Short holds (eg 72 hours) don’t get a judicial review, but if you extend the hold, you’ll need to provide testimony to a hearing officer or judge. Here are some strategies for providing legal testimony. Procedures vary across jurisdictions, but the overarching goal is to balance individual safety and rights with preventing undue deprivation of liberty.