Acute change
Abrupt onset, fluctuating attention, altered consciousness, rapid decline, or a marked departure from baseline.
BH
Brooke Harbor Health System
PMHNP Clinical Learning Environment
Updated July 31, 2026
Clinical Reasoning Resource
Ruling Out Medical Causes
Psychiatric symptoms can arise from medical illness, neurologic disease, medications, substances, withdrawal, sleep disorders, and interacting physiologic factors. A focused medical assessment helps identify urgent conditions and refine the differential.
When to widen the assessment
Recognize patterns that require medical attention
Neurologic findings
New focal deficits, seizures, severe headache, gait change, abnormal movements, speech change, or recent head injury.
Systemic findings
Fever, hypoxia, autonomic instability, dehydration, severe pain, endocrine symptoms, infection risk, or pregnancy-related concerns.
Exposure or treatment change
New medication, dose change, interaction, intoxication, withdrawal, supplement exposure, or possible toxicity.
Focused workup
Connect every action to the differential
Define the purpose
Is the question diagnostic clarification, urgent exclusion, pretreatment safety, baseline monitoring, or follow-up monitoring?
Select targeted data
Choose examination, collateral, records, laboratory studies, toxicology, ECG, imaging, EEG, sleep testing, or consultation based on the suspected process.
Interpret in context
Account for pretest probability, timing, reference ranges, false positives and negatives, medications, and the patient's baseline.
Close the loop
Assign responsibility for reviewing results, informing the patient, acting on abnormalities, and documenting follow-up.