29th January 2024

Barry, a 54-year-old male, presents to the emergency department with his husband after falling and hurting his arm

Barry, a 54-year-old male, presents to the emergency department with his husband after falling and hurting his arm at a friend’s retirement party. He is mumbling to himself and is pacing the waiting room. When the nurse approaches him, he becomes very agitated, shouting and swearing loudly, demanding to be referred to as ‘His Majesty.’

His husband witnessed the fall and denies head trauma. He returned from a business trip 2 days ago and thinks Barry has been acting strangely since his return. He says Barry has been very loud and talkative but has not been aggressive until now.

Barry explains that he feels great, apart from his sore arm. He is offended when the doctor enquires about headaches and confusion. For the last week, his sleep has been broken, but he does not feel that this is affecting him adversely. He is dressed in bright clothing that is weather-appropriate.

He has a history of BPD and has been taking lithium for 6 years, in addition to being prescribed sertraline 2 weeks ago for a moderate depressive episode. He has no other medical history of note, does not drink alcohol, and works as an insurance broker.

Which of the following would be an appropriate next step?

Select the SINGLE most appropriate option from the list below. Select ONE option only.