A 24-year-old woman is brought to the emergency department by her older sister due to increasingly erratic behavior. The patient has a history of major depressive disorder, for which she currently takes no medications. For the past two weeks, she has been sleeping only 2 hours a night, exhibiting pressured speech, and endorsing grand delusions that she is a highly-trained secret agent. Today, she told her sister, "I have to jump off the hospital roof tonight to prove my immortality to the agency." In the emergency department, the patient is highly agitated, pacing the room, and attempting to elope. She adamantly refuses voluntary admission and any medical treatment. The patient has a valid advance directive from a previous depressive episode that explicitly names her sister as her healthcare proxy. However, the patient's father arrives at the emergency department, states that psychiatric care is a "hoax," and demands to take his daughter home immediately. Which of the following is the most appropriate next step in management?
- Place the patient on an involuntary psychiatric holdCevap
- BDischarge the patient to the custody of her father
- CInitiate escitalopram monotherapy to treat the underlying depression
- DNotify local authorities to warn the patient's employer about her delusions
- EDiagnose schizophreniform disorder and coordinate intensive outpatient therapy