Chen Eric, Passman Justin N, Yel Ilana, Chacko Mason
Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, USA.
Cureus. 2024 Dec 10;16(12):e75462. doi: 10.7759/cureus.75462. eCollection 2024 Dec.
In our report, we discuss the case of a young adult female who presented to our institution's emergency department with new-onset third-degree heart block and psychotic-like symptoms. The patient had a psychiatric history remarkable for presumed bipolar disorder, anxiety, depression, and cannabis use disorder, with no inpatient admissions or suicide attempts and not taking any psychotropic medications. While in our care, the patient expressed grandiose delusions and hallucinations. All laboratory and diagnostic testing (including tick-borne diseases) were within the normal limits. The patient did not meet strict criteria for involuntary hospitalization in New York State, but the care team faced a dilemma about the patient's safety and fitness for discharge. Here, we discuss this commonly encountered scenario and the bioethics and clinical decision-making to ensure the presenting patient's health, safety, and rights.
在我们的报告中，我们讨论了一名年轻成年女性的病例，她因新发三度心脏传导阻滞和类似精神病的症状就诊于我们机构的急诊科。该患者有精神病史，以疑似双相情感障碍、焦虑症、抑郁症和大麻使用障碍为显著特征，无住院史或自杀未遂史，且未服用任何精神药物。在我们的照料期间，患者出现了夸大妄想和幻觉。所有实验室检查和诊断测试（包括蜱传疾病）均在正常范围内。该患者不符合纽约州非自愿住院的严格标准，但护理团队在患者的安全和出院适宜性方面面临两难境地。在此，我们讨论这种常见情况以及生物伦理学和临床决策，以确保就诊患者的健康、安全和权利。
