Palpitations Case 3

A 22-year-old women from a mental health inpatient unit has been referred to the ED because of recent episodes of palpitations (several per day) since admission to the psychiatric intensive care unit with acute psychosis. Staff described her as sweaty during the episodes but she denies any other symptoms during the episodes.

She admits to feeling very uncomfortable and anxious as an inpatient, and that everyone there is trying to kill her. She is a smoker and drinks alcohol when it is available. She takes olanzapine and nitrazepam.

Physical examination is normal.

Haematological and biochemical profiles are also normal but she is refusing to have an ECG because she doesnt want to undress.