A patient with many positive symptoms of schizophrenia, whose behavior is disorganized and who is highly anxious, tells the nurse in the psychiatric emergency department, "You have got to help me. I do not know what is going on

Question

I think someone is trying to wipe me out. I have to get a gun.". The patient, a college student, lives alone and has no family or support system in the immediate area. He has not left his room in 2 weeks, has not eaten in several days, and is unkempt. Of the available treatment settings, the nurse should recommend: a. admission to an unlocked residential crisis unit.
b. inpatient hospitalization on a locked unit.
c. attending a day treatment program for 4 weeks.
d. admission to a partial hospital program.

Answer 1

B
The patient presents with significant psychiatric symptoms that will require further assessment and intensive treatment of a type not often available outside of an inpatient mental health unit. He will also require a 24-hour locked setting until he responds to treatment; otherwise he could elope to obtain the gun and use it to protect himself against whomever he might believe is a threat to him (with potentially disastrous consequences). The patient has no support system to provide care at home, and both partial hospitalization and day treatment would leave the patient without structure and support for at least 12 hours daily; neither would provide the level of security needed to preserve the safety of the patient and others. A residential crisis center that is unlocked would not provide for safety needs, and most such facilities are designed for persons who have already been fully assessed and begun on medications.