The patient was admitted to acute inpatient psychiatric services for an exacerbation of a chronic psychotic disorder best characterized as schizoaffective disorder, unspecified type. The patient had shown increasing symptoms of psychosis following discontinuation of medication, Abilify, that included bizarre and erratic behavior, disorganized and delusional thoughts with paranoid thinking together with motor agitation and increasing responses to internal stimuli. The patient was refusing food and water. The patient was brought to the emergency department and was subsequently admitted after medical clearance that included physical examination, laboratory assessment and drug screen. The assessment included no abnormal or remarkable laboratory findings including a negative drug screen consistent with the history.

The patient was psychotic and cognitively impaired with thought blocking, laconic speech, grimacing with laughter, and response to internal stimuli. The patient was guarded and only superficially cooperative with poor eye contact. The patient displayed motor agitation with irritable mood. Insight was limited and judgment impaired. The patient denied suicidal ideation or aggressive impulses and did not show evidence for overt features of mania or severe cognitive impairment (delirium or dementia) despite having poor attention and concentration due to the internal stimuli and disorganized thought patterns with tangential thought production.

The patient's treatment plan included safety monitoring and medication targeting mood disturbance and psychosis, as well as the opportunity for therapy and psycho-education provided in the therapeutic milieu. The patient was uncooperative and consistently refused her scheduled medication. The patient continued to display severe symptoms of psychosis with essentially no change in the mental status examination, and continued refusal of food. The patient had a history of adverse reaction to Haldol and to Clozapine, so resumption of Abilify was ordered. The patient remained psychotic with continued evidence for affective instability, odd behavior, and responses to internal stimuli. The patient had bouts of motor agitation and uncontrollable screaming requiring frequent as needed (prn) medications and restraint with safety emergencies; the patient received intramuscular (IM) dosing of Thorazine and Ativan during these episodes.
The health plan's determination is overturned n whole.

The patient's continued hospital stay for treatment of an exacerbation of a psychotic and mood disorder (schizoaffective disorder) associated with non-adherence and non-compliance with outpatient treatment did warrant the continued stay through discharge.