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Brooke Harbor Health System

PMHNP Clinical Learning Environment

TRAINING ENVIRONMENTFictional educational health system · No real patient data

Grand Rounds · 12:00 · Brooke Auditorium

Grand RoundsCase-based clinical reasoning within the BHHS training environment.

Delirium or primary psychosis?

A five-minute guided case built around one decision point. Work through each step in order, commit to an answer, and then compare your reasoning with what the case turns on.

Step 1 of 6Presentation
  1. 1Presentation
  2. 2Decision
  3. 3Reasoning
  4. 4Comparison
  5. 5Management
  6. 6Resources

The presentation

Consultation-Liaison Psychiatry, 14:40

You are asked to see a 71-year-old admitted two days ago after a mechanical fall at home. There was no head injury and imaging was unremarkable. The chart notes no psychiatric history. Overnight nursing staff documented that the patient was pulling at lines, insisted there were people in the room, and did not recognize the unit. This afternoon they are pleasant, oriented to place, and describe the night as a bad dream.

The referring team asks whether this is a first presentation of a psychotic disorder and whether an antipsychotic should be started.

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