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Some 'psychiatric' patients have underlying conditions
Don't make assumptions about unusual behavior
An 8-year-old boy came into the ED Northwest Community Hospital in Arlington Heights, IL, swinging his arms at objects that were apparent only to him and saying nonsensical things. At first, nurses suspected a psychiatric disorder, but after determining that the patient had an elevated temperature, a further work-up revealed a diagnosis of encephalitis, says Barbara Weintraub, RN, MSN, MPH, APN, CEN, FAEN, manager of pediatric emergency services.
Without a complete evaluation, it would have been easy to conclude that the boy had a psychiatric disturbance, as his behavior was markedly different than baseline and he had no specific findings on physical examination, says Weintraub. "The finding of an elevated temperature is unlikely in the setting of psychiatric illness and led these care providers to seek a medical cause for his bizarre behavior," she says.
Various ingestions or overdoses, encephalitis, hypoxia, head injury, and diabetic ketoacidosis are all potentially life-threatening conditions which can masquerade as psychiatric conditions in children, says Carol A. Ziolo, RN, LCPC, a clinical educator for Northwest's mental health network. "It is so important to rule out medical conditions before you automatically go to a psychiatric diagnosis," she says.
To avoid missing life-threatening conditions, consider the following: