Emergency Scenario 600_f3_17

Location Information

Hafnarstræti 91, 600 Akureyri, third floor apartment 3B. Four-story concrete building, constructed in 1965. Main entrance has a coded lock, code is 1972. Elevator and stairwell access. Street parking available. Building has a basic fire alarm system. Weather: 7°C, overcast, light wind, good visibility. GPS: 65.6821° N, 18.0898° W. Nearest landmark: Hof Cultural and Conference Center.

Emergency Details

34-year-old male, exhibiting acute psychotic symptoms. Primary symptoms: Agitation, disorganized speech, paranoid ideation, visual hallucinations (reports seeing 'shadows' and 'hearing voices'). Secondary symptoms: Restlessness, pacing, mild sweating. Patient is non-compliant with medication regimen. No known history of violence. Caller is patient's brother, reports patient has not slept for 3 days. Patient is currently in his apartment, alone with his brother.

History of Events

Timeline:
18:00 hours: Patient began exhibiting increased restlessness and agitation.
19:00 hours: Patient's speech became increasingly disorganized and nonsensical.
20:00 hours: Patient began reporting visual and auditory hallucinations, expressing paranoid beliefs.
20:30 hours: Brother arrived at the apartment, found patient in an agitated state. Patient refused to take medication.
20:45 hours: Brother called emergency services.
20:48 hours: Current time, patient is pacing in the apartment, still hallucinating. 

Prior Events: Patient has a history of schizoaffective disorder, diagnosed 5 years ago. He has had several hospitalizations for acute psychotic episodes. Last mental health appointment was 2 weeks ago, where he was stable. Medications include: Risperidone 4mg daily, Lithium 900mg daily, and Lorazepam 1mg as needed (patient reports not taking it). No known allergies. Last meal was a sandwich at 12:00 hours. Patient has a history of non-compliance with medication.

Diagnostics

Initial Assessment

Initial Impression: Acute Psychotic Episode, likely Schizoaffective Disorder Exacerbation.
Justification for F3 Classification:
- Patient is experiencing significant psychiatric symptoms, but is not an immediate threat to self or others based on caller report.
- Condition requires timely intervention to prevent escalation and ensure patient safety.
- No immediate life-threatening symptoms reported, allowing for a standard response time.

Differential Diagnoses:
1. Schizoaffective Disorder Exacerbation (high probability)
2. Substance-Induced Psychosis (less likely, no reported substance use)
3. Bipolar Disorder with Psychotic Features (possible, but less likely given history)
4. Acute Stress Reaction (less likely, given duration of symptoms)

Required Actions:
- Dispatch of ground EMS with psychiatric training.
- Assessment of patient's mental status and risk of harm to self or others.
- Consideration of pharmacological intervention if patient is cooperative.
- Preparation for transport to psychiatric unit at the Akureyri Hospital.

Final Diagnosis

Final Diagnosis: Acute Exacerbation of Schizoaffective Disorder, with medication non-compliance as a contributing factor.
Key Findings:
- Patient's symptoms aligned with a known history of schizoaffective disorder.
- Patient admitted to not taking his medications for the past 3 days.
- No evidence of substance use or other medical causes for the psychotic episode.
- Patient responded well to intramuscular antipsychotic medication in the emergency department.

Outcome validated F3 priority assignment. Timely intervention prevented further escalation of symptoms. Patient was admitted to the psychiatric unit for stabilization.

Learning Points:
1. F3 classification was appropriate due to the absence of immediate life-threatening risks.
2. Medication non-compliance is a significant factor in psychiatric exacerbations.
3. Dispatch should emphasize the importance of inquiring about medication adherence in similar cases.

Emergency Call Transcript