Abnormal narrative bank — focused / at-risk
Each shows the specific finding with severity and measurement, the baseline comparison, related risk, the intervention, provider notification and orders, the patient response, and the reassessment plan — edit to the actual visit.
A1 Positive depression screen with passive ideation | Skilled psychiatric assessment found a positive depression screen — the PHQ-9 elevated from baseline with low mood, anhedonia, and poor sleep — and on a direct, compassionate risk screen the patient expressed passive thoughts of being better off not here, without a plan or intent on structured assessment. Per protocol, the patient was not left alone during the assessment, a safety plan was collaboratively completed, and the 988 Suicide and Crisis Lifeline was provided and reviewed along with reducing access to means per protocol. Provider notified at 11:00 with the screen result and the risk findings; order received to arrange an urgent mental-health evaluation and adjust treatment. The patient agreed to the plan and crisis resources; teach-back accurate. Urgent follow-up coordinated and reassessment planned. |
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A2 Active suicidal ideation — emergency response | Skilled psychiatric assessment identified active suicidal ideation with intent on a direct risk screen, representing an acute safety emergency. The patient was not left alone, and per protocol emergency services (911) and crisis services were activated immediately, the provider was notified, and the 988 Suicide and Crisis Lifeline was engaged; the environment was made safe and the patient was supported and kept under continuous observation pending the emergency response. Family present were informed and involved in safety as appropriate. The risk, the immediate safety measures, and all communications were documented, with follow-up coordinated to ensure continuity of care and a safety plan after the emergency evaluation. |
A3 Worsening anxiety with panic | Skilled psychiatric assessment found worsening anxiety — the GAD-7 elevated from baseline with new panic episodes affecting sleep and function — without risk to self or others on screen. Findings indicate worsening anxiety with panic. Provider notified at 12:10 with the screen result and the panic symptoms; order received to adjust treatment and arrange a mental-health evaluation. Coping and grounding strategies were taught, treatment adherence reviewed, and crisis resources provided; teach-back accurate. Reassessment of anxiety and function planned next visit. |
A4 New psychotic symptoms | Skilled psychiatric assessment found new psychotic symptoms — the patient described responding to internal stimuli and expressed paranoid beliefs — a change from baseline, with the possibility of a medical or delirium cause to be excluded. Findings indicate new psychosis requiring urgent evaluation. Provider notified at 10:40 with the symptoms and the change from baseline; order received to evaluate urgently, including for a medical or delirium cause, with instruction to activate emergency response for danger to self or others or severe agitation. Safety was assessed and the caregiver supported; the situation was documented. Urgent evaluation coordinated. (Delirium evaluation in the Cognitive / Mental Status reference.) |
A5 Psychiatric-medication nonadherence | Skilled psychiatric assessment found psychiatric-medication nonadherence — the patient had stopped the prescribed medication because of a side effect — with early re-emergence of symptoms on the validated screen but no risk on screen. Findings indicate nonadherence with early symptom recurrence. Provider notified at 11:30 with the nonadherence, the side effect, and the screen; order received to address the side effect and resume or adjust treatment. Skilled teaching provided on the importance of adherence, the side effect, and not stopping treatment abruptly, with crisis resources reviewed; teach-back accurate. Reassessment of adherence and symptoms planned next visit. |
A6 Substance-use concern | Skilled psychiatric assessment found a substance-use concern on screening, affecting mood, safety, and medication adherence, without an acute intoxication or withdrawal emergency at the visit. Findings indicate a substance-use concern requiring coordination. Provider notified at 12:00 with the screening result and the impact; order received to coordinate a substance-use evaluation and resources. The patient was engaged supportively and provided with resources and crisis contacts, with instruction to seek emergency care for signs of overdose or severe withdrawal; teach-back accurate. Reassessment and resource coordination planned. |
Linked disease-specific scenarios Disease-specific and overlapping mental-health content is authored elsewhere and is not duplicated here. Cognition and delirium route to the Cognitive / Mental Status reference; psychosocial stressors, supports, and caregiver strain to the Psychosocial / Caregiver reference; the medical contributors to mood and behavior are reviewed with General / Constitutional and Vital Signs; and pain as a contributor to mood routes to the Pain reference. Any identified risk to self or others is met with the immediate safety response and crisis resources, including the 988 Suicide and Crisis Lifeline and emergency services. |
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