Caroline Onischak, MSN, APRN, PMHNP-BC will share her expertise on medical mimics at the APNA 35th Annual Conference. We spoke with Caroline about her work, what nurses need to know about the topic, and best practices for identifying them.
Q: What do nurses need to know about medical mimics?

A: Nurses should be aware of medical mimics (medical conditions that may be mistaken for psychiatric illness) because mistaking a medical condition for a psychiatric one can delay treatment and even be life threatening.  And, of course, if you are not treating the root of a problem, you will not be able to help the patient overcome it. Mental health disorders may not have a psychiatric cause, so we need to look beyond the surface when presented with a patient with mental health symptoms.

Q: What prompted you to take a closer look at this topic?

A: While working as an inpatient psychiatric-mental health nurse, I was concerned that some of the patients might have had medical conditions that were contributing to their mental health symptoms. During clinical training for my PMHNP degree, I worked with a psychiatric consultation liaison team. We provided care for patients who are in the hospital for medical conditions, which means it was crucial for us to understand which medical conditions had impact on a patient’s cognition and mood.

Q: Can you share any tips for spotting medical mimics?

A: I’ll be sharing a diagnostic and information gathering rubric in my session. This is a helpful tool to keep in mind when working with patients.  I work with young adults now who are basically healthy, but I always want to think critically and be mindful of medical conditions that might be contributing to my patients’ mental health symptoms. I look at their medical histories carefully, consider what conditions they might be at risk for, and always order an EKG and routine labs (CBC, CMP, TSH, lipids, HgA1C, B12, folate and Vitamin D). If a head injury or seizure activity is suspected, the patients are sent for further testing.

Learn more at Caroline’s APNA 35th Annual Conference presentation, Medical Mimics: Medical Conditions That Masquerade As Psychiatric Disorders, on Saturday, October 16.