Ethical and Clinical Challenges in Involuntary Hospitalization for First-Break Psychosis

In our report, we discuss the case of a young adult female who presented to our institution's emergency department with new-onset third-degree heart block and psychotic-like symptoms. The patient had a psychiatric history remarkable for presumed bipolar disorder, anxiety, depression, and cannabis use disorder, with no inpatient admissions or suicide attempts and not taking any psychotropic medications. While in our care, the patient expressed grandiose delusions and hallucinations. All laboratory and diagnostic testing (including tick-borne diseases) were within the normal limits. The patient did not meet strict criteria for involuntary hospitalization in New York State, but the care team faced a dilemma about the patient's safety and fitness for discharge. Here, we discuss this commonly encountered scenario and the bioethics and clinical decision-making to ensure the presenting patient's health, safety, and rights.