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Acute Psychosis and Mania SymptomsAPPROACH

TOXICOLOGY AND BEHAVIORAL · 19 SECTIONS

⚲

619 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Undifferentiated Overdose Opioid Toxicity Opioid Withdrawal Alcohol Intoxication Alcohol Withdrawal Stimulant Toxicity Pediatric Ingestion Carbon Monoxide Exposure Inhalational Or Chemical Exposure Suicidal Ideation And Self Harm Risk Assessment Acute Psychosis And Mania Symptoms Anxiety And Panic Symptoms Capacity Assessment And Safe Disposition Behavioral Escalation And Restraint Considerations

Pediatrics16▾

Environmental and Exposure4▾

01History/hx58

Presenting features

›Symptom characterization

›Onset pattern

›Sudden

›Subacute

›Gradual

›Time course

›Hours

›Days

›Weeks

›Primary symptoms

›Agitation

›Insomnia

›Disorganized behavior

›Hallucinations

›Delusions

›Pressured speech

›Grandiosity

›Flight of ideas

›Distractibility

›Increased goal directed activity

Associated symptoms

›Associated symptoms

›Autonomic

›Fever

›Diaphoresis

›Tremor

›Neurologic

02Alarm Features/alarm40

Immediate escalation triggers

›Resuscitation triggers

›Airway risk

›Inability to protect airway

›Recurrent emesis with reduced consciousness

›Breathing risk

›SpO2 less than 92 percent on room air

›Respiratory rate greater than 30 per minute

›Circulation risk

›Systolic BP less than 90 mmHg

›HR greater than 130 per minute with instability

›Temperature

›Temperature 38.5 C or higher with rigidity

›Temperature 40 C or higher

High risk medical causes

›Life threatening differentials

›Delirium

›Fluctuating attention

›Disorientation

›CNS infection

›Fever

›Neck stiffness

›Intracranial catastrophe

›Thunderclap headache

›New focal deficit

›Toxicologic emergency

›Severe agitation with hyperthermia

›Refractory tachycardia and hypertension

03Medications/meds45

Current medications

›Medication inventory

›Psychiatric

›Antipsychotics

›Antidepressants

›Mood stabilizers

›Medical

›Steroids

›Thyroid hormone

›Dopaminergic agents

Recent changes and adherence

›Recent medication changes

›New start

›Antidepressant start or dose increase

›Steroid start or dose increase

›Discontinuation

›Benzodiazepine stop

›Alcohol stop

›Nonadherence

›Missed antipsychotic doses

›Missed mood stabilizer doses

High risk interactions and contraindications

›Interaction traps

›QT prolonging combinations

›Antipsychotic plus macrolide

›Antipsychotic plus fluoroquinolone

›CNS depressant stacking

›Benzodiazepine plus opioid

04Diet/diet21

Intake and hydration

›Recent intake

›Poor oral intake

›Reduced food

›Reduced fluids

›Dehydration risk

›Vomiting

›Diarrhea

Caffeine and stimulants

›Stimulant exposure

›Caffeine

›Coffee

›Energy drinks

›Supplements

›Pre workout products

›Weight loss products

Alcohol

›Alcohol pattern

›Recent heavy use

›Binge drinking

›Daily use

›Cessation timing

›Last drink

›Prior withdrawal seizures

05Review of Systems/ros35

Constitutional and infection

›System review

›Constitutional

›Fever

›Weight loss

›Infection clues

›Cough

›Dysuria

Cardiopulmonary

›Cardiopulmonary

›Cardiac

›Chest pain

›Palpitations

›Respiratory

›Dyspnea

›Hypoxia symptoms

Neurologic

›Neurologic

›Seizure

›Witnessed convulsions

›Post ictal confusion

›Headache

›Sudden severe

›Progressive

Endocrine

›Endocrine

›Thyrotoxicosis symptoms

›Heat intolerance

06Collateral History and Family History/chafh23

Collateral source and reliability

›Collateral data

›Source

›Family

›EMS

›Police

›Shelter staff

›Reliability

›Direct witness

›Second hand report

Family history

›Family psychiatric history

›Bipolar disorder (F31)

›First degree relative

›Age of onset

›Schizophrenia spectrum (F20)

›First degree relative

›Prior hospitalizations

Social support and supervision

›Support

›Safe supervision available

›Responsible adult

›Ability to monitor meds

›Housing stability

›Stable housing

›Unhoused

07Risk Factors/rf31

Substance and withdrawal risk

›Substance risks

›Stimulants

›Cocaine

›Methamphetamine

›Hallucinogens

›LSD

›PCP

›Withdrawal

›Alcohol withdrawal risk

›Benzodiazepine withdrawal risk

Medical and neurologic risk

›Medical causes risk

›CNS disease

›Seizure disorder (G40)

›Brain tumor history (C71)

›Endocrine

›Hyperthyroidism (E05.90)

›Adrenal disease

Medication related risk

›Medication risks

›Steroid induced mood symptoms

›Prednisone equivalent high dose

›Recent burst

›Serotonergic load

›SSRI plus MAOI

›SSRI plus linezolid

08Differential Diagnosis/ddx48

Life threatening

›Life threatening

›Delirium (F05)

›Fluctuating attention

›Disorganized thinking

›Meningitis or encephalitis (G03.9)

›Fever

›Neck stiffness

›Intracranial hemorrhage (I61.9)

›Sudden severe headache

›Focal neurologic deficit

›Hypoglycemia (E16.2)

›Low bedside glucose

›Rapid symptom reversal with glucose

›Thyroid storm (E05.91)

›Hyperthermia

›Tachycardia

›Neuroleptic malignant syndrome (G21.0)

›Rigidity

›Elevated CK

›Serotonin syndrome (T43.225A)

›Clonus

›Hyperreflexia

Common

›Common

›Bipolar I disorder manic episode (F31.1)

›Decreased need for sleep

›Increased goal directed activity

09Past Medical History/pmh21

Psychiatric history

›Prior psychiatric diagnoses

›Bipolar disorder (F31)

›Prior manic episodes

›Prior mood stabilizer response

›Schizophrenia spectrum (F20)

›Baseline function

›Prior antipsychotic response

Medical history

›Medical history relevant

›Epilepsy (G40)

›Last seizure

›Antiseizure adherence

›Thyroid disease

›Hyperthyroidism history

›Recent dose changes

Procedures and hospitalizations

›Prior hospital care

›ICU history

›Intubation for agitation

›Severe toxidrome

›Recent ED visits

›Similar presentation

›Disposition outcomes

10Physical Exam/exam52

General and vitals pattern

›General and vitals

›Appearance

›Toxic appearing

›Diaphoretic

›Vital signs

›Temperature

›HR

›BP

›RR

›SpO2

Mental status and behavior

›Mental status

›Level of consciousness

›Alert

›Somnolent

›Obtunded

›Attention

›Able to sustain attention

›Distractible

›Thought process

›Linear

›Tangential

›Disorganized

›Perception

›Auditory hallucinations

›Visual hallucinations

11Lab Studies/labs40

Core ED labs

›Initial labs

›Point of care glucose

›Immediate if altered mental status

›Repeat after sedation if concern persists

›CBC

›Leukocytosis

›Anemia

›CMP

›Sodium abnormalities

›Renal dysfunction

›CK

›Rhabdomyolysis risk with severe agitation

›Trend if elevated

Toxicology and metabolic

›Toxicology and metabolic

›Serum ethanol

›Intoxication assessment

›Withdrawal risk stratification

›Urine drug screen

›Limited specificity

›False positives possible

›Acetaminophen level

›Co ingestion screening

›Timing dependent interpretation

Infection and endocrine

›Infection and endocrine labs

›TSH

12Imaging/img44

Scoring Systems

›Scoring and monitoring tools

›Richmond Agitation Sedation Scale

›Target calm and arousable

›Trend after medication

›CIWA Ar

›Alcohol withdrawal severity

›Not validated in delirium or severe agitation

›COWS

›Opioid withdrawal severity

›Guides buprenorphine pathway local protocol dependent

›4AT

›Delirium screen

›Not a replacement for clinical assessment

›Bush Francis Catatonia Rating Scale

›Catatonia screen

›Lorazepam challenge supports diagnosis

MRI

›MRI brain

›Indications

›Suspected encephalitis with non diagnostic CT

›New focal neurologic deficit

›Contraindications

›Non MRI compatible implant

›Unstable airway or hemodynamics

›Protocol notes

›With and without contrast for encephalitis

›Consider diffusion sequences for stroke

13Special Tests/spec17

Bedside and procedural diagnostics

›Additional diagnostics

›Lumbar puncture

›If suspected meningitis or encephalitis

›CT head first if focal deficit or papilledema concern

›EEG

›Nonconvulsive status epilepticus concern

›Persistent altered mental status after sedation wears off

›Lorazepam challenge

›Catatonia suspected

›Improvement supports diagnosis

Toxicology and exposure focused

›Targeted tests

›Serum osmolality

›Toxic alcohol concern

›Osmolar gap interpretation limitations

›Carboxyhemoglobin

›CO exposure concern

›Pulse oximetry may be misleading

14ECG/ecg14

Indications and monitoring

›ECG use

›Baseline ECG

›Before QT prolonging antipsychotic when feasible

›After large cumulative doses

›QTc monitoring

›QTc 500 ms or greater high risk

›Correct electrolytes if QTc prolonged

Key patterns

›ECG patterns

›Sympathomimetic toxicity

›Sinus tachycardia

›Ischemic changes

›TCA toxicity concern

›QRS widening

›Terminal R in aVR

15Assessment/ax21

Syndrome framing

›Working problem list

›Acute psychosis

›Primary psychiatric vs secondary medical

›First episode psychosis pathway

›Manic episode

›Bipolar I manic episode (F31.1)

›Substance induced mania (F19.94)

›Delirium concern

›Fluctuating attention and awareness

›Medical trigger likely

Severity stratification

›Severity and risk

›Agitation level

›Cooperative

›Uncooperative but redirectable

›Violent or severely agitated

›Medical instability

›Hyperthermia

›Hypoxia

›Complications

›Rhabdomyolysis risk

›Aspiration risk

16Plan/plan59

Differential Management

›!Acute psychosis→›!Bipolar disorder→›Schizophrenia (acute exacerbation)→›Stimulant intoxication (cocaine, methamphetamine)→

First 5 minutes

›Immediate workflow

›Safety

›Staff safety and security presence

›De escalation attempt if safe

›Monitoring

›Cardiac monitor

›SpO2 monitoring

›Temperature trend

›Access

›IV access if cooperative

›IM plan if unsafe for IV

›Rapid reversible checks

›Bedside glucose

›SpO2 and ventilation status

Sedation strategy

›Acute agitation management

›Medication choice by suspected cause

›Sympathomimetic intoxication

›Benzodiazepine first line

›Avoid beta blocker monotherapy

›Primary psychosis or mania

›Antipsychotic or benzodiazepine

17Disposition/dispo28

ICU or monitored bed criteria

›Higher level of care

›ICU indications

›Hyperthermia with toxidrome

›Need for intubation

›Stepdown or monitored bed

›QTc 500 ms or greater with ongoing antipsychotic need

›Significant electrolyte abnormality

Medical admission criteria

›Medical admission

›Delirium

›Identified medical trigger

›Persistent inattention

›Rhabdomyolysis

›CK significantly elevated

›AKI or rising creatinine

Psychiatric admission criteria

›Psychiatric admission

›Acute psychosis or mania with impaired judgment

›Unable to care for basic needs

›Unsafe behavior

›First episode psychosis

›Need for diagnostic workup

›Need for close follow up reliability uncertain

Discharge criteria

›Discharge

›Clinical stability

›Calm and cooperative

18Discharge Instructions/di15

Copy discharge instructions

›Discharge text

›Today you were seen for changes in thinking and behavior

›Your tests did not show an emergency medical cause that needs admission today

›Avoid alcohol and recreational drugs

›Do not drive until cleared by your clinician

›Take medications exactly as prescribed

›Follow up within 24 to 72 hours with psychiatry or your primary clinician

›Return to the emergency department now for

›Fever

›Severe headache

›Seizure

›Chest pain

›Trouble breathing

›Worsening confusion

›Uncontrolled agitation

19References/r7

Guidelines and key sources

›Evidence based sources

›American Psychiatric Association practice guideline for the treatment of patients with schizophrenia 2020

›American Psychiatric Association practice guideline for the treatment of patients with bipolar disorder update 2023 local protocol dependent

›ACEP clinical policy on the adult psychiatric patient in the emergency department 2017

›Project instructions file

›/mnt/data/approach_chatgpt_instructions.rtf

›Internal formatting and safety rules

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Acute Psychosis and Mania SymptomsAPPROACH

TOXICOLOGY AND BEHAVIORAL · 19 SECTIONS

⚲

619 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx58

Presenting features

›Symptom characterization

›Onset pattern

›Sudden

›Subacute

›Gradual

›Time course

›Hours

›Days

›Weeks

›Primary symptoms

›Agitation

›Insomnia

›Disorganized behavior

›Hallucinations

›Delusions

›Pressured speech

›Grandiosity

›Flight of ideas

›Distractibility

›Increased goal directed activity

Associated symptoms

›Associated symptoms

›Autonomic

›Fever

›Diaphoresis

›Tremor

›Neurologic

02Alarm Features/alarm40

Immediate escalation triggers

›Resuscitation triggers

›Airway risk

›Inability to protect airway

›Recurrent emesis with reduced consciousness

›Breathing risk

›SpO2 less than 92 percent on room air

›Respiratory rate greater than 30 per minute

›Circulation risk

›Systolic BP less than 90 mmHg

›HR greater than 130 per minute with instability

›Temperature

›Temperature 38.5 C or higher with rigidity

›Temperature 40 C or higher

High risk medical causes

›Life threatening differentials

›Delirium

›Fluctuating attention

›Disorientation

›CNS infection

›Fever

›Neck stiffness

›Intracranial catastrophe

›Thunderclap headache

›New focal deficit

›Toxicologic emergency

›Severe agitation with hyperthermia

›Refractory tachycardia and hypertension

03Medications/meds45

Current medications

›Medication inventory

›Psychiatric

›Antipsychotics

›Antidepressants

›Mood stabilizers

›Medical

›Steroids

›Thyroid hormone

›Dopaminergic agents

Recent changes and adherence

›Recent medication changes

›New start

›Antidepressant start or dose increase

›Steroid start or dose increase

›Discontinuation

›Benzodiazepine stop

›Alcohol stop

›Nonadherence

›Missed antipsychotic doses

›Missed mood stabilizer doses

High risk interactions and contraindications

›Interaction traps

›QT prolonging combinations

›Antipsychotic plus macrolide

›Antipsychotic plus fluoroquinolone

›CNS depressant stacking

›Benzodiazepine plus opioid

04Diet/diet21

Intake and hydration

›Recent intake

›Poor oral intake

›Reduced food

›Reduced fluids

›Dehydration risk

›Vomiting

›Diarrhea

Caffeine and stimulants

›Stimulant exposure

›Caffeine

›Coffee

›Energy drinks

›Supplements

›Pre workout products

›Weight loss products

Alcohol

›Alcohol pattern

›Recent heavy use

›Binge drinking

›Daily use

›Cessation timing

›Last drink

›Prior withdrawal seizures

05Review of Systems/ros35

Constitutional and infection

›System review

›Constitutional

›Fever

›Weight loss

›Infection clues

›Cough

›Dysuria

Cardiopulmonary

›Cardiopulmonary

›Cardiac

›Chest pain

›Palpitations

›Respiratory

›Dyspnea

›Hypoxia symptoms

Neurologic

›Neurologic

›Seizure

›Witnessed convulsions

›Post ictal confusion

›Headache

›Sudden severe

›Progressive

Endocrine

›Endocrine

›Thyrotoxicosis symptoms

›Heat intolerance

06Collateral History and Family History/chafh23

Collateral source and reliability

›Collateral data

›Source

›Family

›EMS

›Police

›Shelter staff

›Reliability

›Direct witness

›Second hand report

Family history

›Family psychiatric history

›Bipolar disorder (F31)

›First degree relative

›Age of onset

›Schizophrenia spectrum (F20)

›First degree relative

›Prior hospitalizations

Social support and supervision

›Support

›Safe supervision available

›Responsible adult

›Ability to monitor meds

›Housing stability

›Stable housing

›Unhoused

07Risk Factors/rf31

Substance and withdrawal risk

›Substance risks

›Stimulants

›Cocaine

›Methamphetamine

›Hallucinogens

›LSD

›PCP

›Withdrawal

›Alcohol withdrawal risk

›Benzodiazepine withdrawal risk

Medical and neurologic risk

›Medical causes risk

›CNS disease

›Seizure disorder (G40)

›Brain tumor history (C71)

›Endocrine

›Hyperthyroidism (E05.90)

›Adrenal disease

Medication related risk

›Medication risks

›Steroid induced mood symptoms

›Prednisone equivalent high dose

›Recent burst

›Serotonergic load

›SSRI plus MAOI

›SSRI plus linezolid

08Differential Diagnosis/ddx48

Life threatening

›Life threatening

›Delirium (F05)

›Fluctuating attention

›Disorganized thinking

›Meningitis or encephalitis (G03.9)

›Fever

›Neck stiffness

›Intracranial hemorrhage (I61.9)

›Sudden severe headache

›Focal neurologic deficit

›Hypoglycemia (E16.2)

›Low bedside glucose

›Rapid symptom reversal with glucose

›Thyroid storm (E05.91)

›Hyperthermia

›Tachycardia

›Neuroleptic malignant syndrome (G21.0)

›Rigidity

›Elevated CK

›Serotonin syndrome (T43.225A)

›Clonus

›Hyperreflexia

Common

›Common

›Bipolar I disorder manic episode (F31.1)

›Decreased need for sleep

›Increased goal directed activity

09Past Medical History/pmh21

Psychiatric history

›Prior psychiatric diagnoses

›Bipolar disorder (F31)

›Prior manic episodes

›Prior mood stabilizer response

›Schizophrenia spectrum (F20)

›Baseline function

›Prior antipsychotic response

Medical history

›Medical history relevant

›Epilepsy (G40)

›Last seizure

›Antiseizure adherence

›Thyroid disease

›Hyperthyroidism history

›Recent dose changes

Procedures and hospitalizations

›Prior hospital care

›ICU history

›Intubation for agitation

›Severe toxidrome

›Recent ED visits

›Similar presentation

›Disposition outcomes

10Physical Exam/exam52

General and vitals pattern

›General and vitals

›Appearance

›Toxic appearing

›Diaphoretic

›Vital signs

›Temperature

›HR

›BP

›RR

›SpO2

Mental status and behavior

›Mental status

›Level of consciousness

›Alert

›Somnolent

›Obtunded

›Attention

›Able to sustain attention

›Distractible

›Thought process

›Linear

›Tangential

›Disorganized

›Perception

›Auditory hallucinations

›Visual hallucinations

11Lab Studies/labs40

Core ED labs

›Initial labs

›Point of care glucose

›Immediate if altered mental status

›Repeat after sedation if concern persists

›CBC

›Leukocytosis

›Anemia

›CMP

›Sodium abnormalities

›Renal dysfunction

›CK

›Rhabdomyolysis risk with severe agitation

›Trend if elevated

Toxicology and metabolic

›Toxicology and metabolic

›Serum ethanol

›Intoxication assessment

›Withdrawal risk stratification

›Urine drug screen

›Limited specificity

›False positives possible

›Acetaminophen level

›Co ingestion screening

›Timing dependent interpretation

Infection and endocrine

›Infection and endocrine labs

›TSH

12Imaging/img44

Scoring Systems

›Scoring and monitoring tools

›Richmond Agitation Sedation Scale

›Target calm and arousable

›Trend after medication

›CIWA Ar

›Alcohol withdrawal severity

›Not validated in delirium or severe agitation

›COWS

›Opioid withdrawal severity

›Guides buprenorphine pathway local protocol dependent

›4AT

›Delirium screen

›Not a replacement for clinical assessment

›Bush Francis Catatonia Rating Scale

›Catatonia screen

›Lorazepam challenge supports diagnosis

MRI

›MRI brain

›Indications

›Suspected encephalitis with non diagnostic CT

›New focal neurologic deficit

›Contraindications

›Non MRI compatible implant

›Unstable airway or hemodynamics

›Protocol notes

›With and without contrast for encephalitis

›Consider diffusion sequences for stroke

13Special Tests/spec17

Bedside and procedural diagnostics

›Additional diagnostics

›Lumbar puncture

›If suspected meningitis or encephalitis

›CT head first if focal deficit or papilledema concern

›EEG

›Nonconvulsive status epilepticus concern

›Persistent altered mental status after sedation wears off

›Lorazepam challenge

›Catatonia suspected

›Improvement supports diagnosis

Toxicology and exposure focused

›Targeted tests

›Serum osmolality

›Toxic alcohol concern

›Osmolar gap interpretation limitations

›Carboxyhemoglobin

›CO exposure concern

›Pulse oximetry may be misleading

14ECG/ecg14

Indications and monitoring

›ECG use

›Baseline ECG

›Before QT prolonging antipsychotic when feasible

›After large cumulative doses

›QTc monitoring

›QTc 500 ms or greater high risk

›Correct electrolytes if QTc prolonged

Key patterns

›ECG patterns

›Sympathomimetic toxicity

›Sinus tachycardia

›Ischemic changes

›TCA toxicity concern

›QRS widening

›Terminal R in aVR

15Assessment/ax21

Syndrome framing

›Working problem list

›Acute psychosis

›Primary psychiatric vs secondary medical

›First episode psychosis pathway

›Manic episode

›Bipolar I manic episode (F31.1)

›Substance induced mania (F19.94)

›Delirium concern

›Fluctuating attention and awareness

›Medical trigger likely

Severity stratification

›Severity and risk

›Agitation level

›Cooperative

›Uncooperative but redirectable

›Violent or severely agitated

›Medical instability

›Hyperthermia

›Hypoxia

›Complications

›Rhabdomyolysis risk

›Aspiration risk

16Plan/plan59

Differential Management

›!Acute psychosis→›!Bipolar disorder→›Schizophrenia (acute exacerbation)→›Stimulant intoxication (cocaine, methamphetamine)→

First 5 minutes

›Immediate workflow

›Safety

›Staff safety and security presence

›De escalation attempt if safe

›Monitoring

›Cardiac monitor

›SpO2 monitoring

›Temperature trend

›Access

›IV access if cooperative

›IM plan if unsafe for IV

›Rapid reversible checks

›Bedside glucose

›SpO2 and ventilation status

Sedation strategy

›Acute agitation management

›Medication choice by suspected cause

›Sympathomimetic intoxication

›Benzodiazepine first line

›Avoid beta blocker monotherapy

›Primary psychosis or mania

›Antipsychotic or benzodiazepine

17Disposition/dispo28

ICU or monitored bed criteria

›Higher level of care

›ICU indications

›Hyperthermia with toxidrome

›Need for intubation

›Stepdown or monitored bed

›QTc 500 ms or greater with ongoing antipsychotic need

›Significant electrolyte abnormality

Medical admission criteria

›Medical admission

›Delirium

›Identified medical trigger

›Persistent inattention

›Rhabdomyolysis

›CK significantly elevated

›AKI or rising creatinine

Psychiatric admission criteria

›Psychiatric admission

›Acute psychosis or mania with impaired judgment

›Unable to care for basic needs

›Unsafe behavior

›First episode psychosis

›Need for diagnostic workup

›Need for close follow up reliability uncertain

Discharge criteria

›Discharge

›Clinical stability

›Calm and cooperative

18Discharge Instructions/di15

Copy discharge instructions

›Discharge text

›Today you were seen for changes in thinking and behavior

›Your tests did not show an emergency medical cause that needs admission today

›Avoid alcohol and recreational drugs

›Do not drive until cleared by your clinician

›Take medications exactly as prescribed

›Follow up within 24 to 72 hours with psychiatry or your primary clinician

›Return to the emergency department now for

›Fever

›Severe headache

›Seizure

›Chest pain

›Trouble breathing

›Worsening confusion

›Uncontrolled agitation

19References/r7

Guidelines and key sources

›Evidence based sources

›American Psychiatric Association practice guideline for the treatment of patients with schizophrenia 2020

›American Psychiatric Association practice guideline for the treatment of patients with bipolar disorder update 2023 local protocol dependent

›ACEP clinical policy on the adult psychiatric patient in the emergency department 2017

›Project instructions file

›/mnt/data/approach_chatgpt_instructions.rtf

›Internal formatting and safety rules

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.