{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T06:21:06Z","timestamp":1783059666271,"version":"3.54.6"},"reference-count":12,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":182,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Psychiatry"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>We discuss a case of a 54\u2010year\u2010old woman with a history of schizoaffective disorder and Parkinson\u2019s disease who presented with altered mental status, including weakness, falls, medication refusal, and paranoia, heralding medical deterioration. The treating teams initially suspected that this presentation was medically driven, and she had multiple admissions to general medicine to look for an \u201corganic\u201d explanation of her clinical status. Despite this, no medical driver was identified, and she was diagnosed with progression of her primary psychiatric disease. After she was \u201cmedically cleared\u201d and was admitted to the inpatient psychiatry unit for 10 days, she was found to be medically unstable, with progressive dysphagia and decreased responsiveness. She was then admitted to the intensive care unit (ICU), where was found to have dysphagia, aspiration pneumonia, lung abscess, severe hypernatremia, and associated diabetes insipidus, and ultimately died of her medical illness. This case illustrates important limitations of the \u201cmedical clearance\u201d of patients with psychiatric presentations, including limited literature and clinical guidance in this area, and risks of the term \u201cmedical clearance\u201d itself, which may inappropriately discourage medical reassessments when indicated. We review practices that can help reduce these risks.<\/jats:p>","DOI":"10.1155\/crps\/7070787","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T05:48:25Z","timestamp":1783057705000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Limits to the \u201cMedical Clearance\u201d of Patients Presenting With Psychiatric Changes: A Case Report and Review of the Literature"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2522-9132","authenticated-orcid":false,"given":"Jordan","family":"Pelc","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0846-8008","authenticated-orcid":false,"given":"Gregory","family":"Chandler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4353-5758","authenticated-orcid":false,"given":"Riley","family":"Rose","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"e_1_2_8_1_2","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.138.5.629"},{"key":"e_1_2_8_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11126-012-9251-1"},{"key":"e_1_2_8_3_2","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2016.10.32258"},{"key":"e_1_2_8_4_2","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.psc.2017.04.001","article-title":"Emergency Department Medical Clearance of Patients With Psychiatric or Behavioral Emergencies, Part 1","volume":"40","author":"Tucci V. T.","year":"2017","journal-title":"Psychiatric Clinics of North America"},{"key":"e_1_2_8_5_2","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2017.3.32259"},{"key":"e_1_2_8_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13368"},{"key":"e_1_2_8_7_2","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2023.1209450","article-title":"Refining Medical Clearance Protocol for Patients With Primary Psychiatric Complaints in the Emergency Department","volume":"14","author":"Casey C. A.","year":"2023","journal-title":"Frontiers in Psychiatry"},{"key":"e_1_2_8_8_2","first-page":"156","article-title":"Medical Clearance\u2019 of Patients With Acute Mental Health Needs in the Emergency Department: A Literature Review and Practice Recommendations","volume":"118","author":"Thrasher T. W.","year":"2019","journal-title":"WMJ: Official Publication of the State Medical Society of Wisconsin"},{"key":"e_1_2_8_9_2","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.202000858"},{"key":"e_1_2_8_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/0163-8343(84)90066-5"},{"key":"e_1_2_8_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00391-007-0432-8"},{"key":"e_1_2_8_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2009.04.010"}],"container-title":["Case Reports in Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crps\/7070787","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/crps\/7070787","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crps\/7070787","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T05:48:27Z","timestamp":1783057707000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/crps\/7070787"}},"subtitle":[],"editor":[{"given":"Edo S.","family":"Jaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":12,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/crps\/7070787"],"URL":"https:\/\/doi.org\/10.1155\/crps\/7070787","archive":["Portico"],"relation":{},"ISSN":["2090-682X","2090-6838"],"issn-type":[{"value":"2090-682X","type":"print"},{"value":"2090-6838","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-10-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"7070787"}}