Clinical judgment/clinical reasoning

You are working on an inpatient psychiatric unit and need to do an initial assessment of R.B, who has just been admitted. He is 22 years old and has been attending the local university and living at home with his parents. R.B. has always been a good student and has been socially active. Last semester his grades began declining. He became very withdrawn and spent most of his time alone in his room. His personal self-care has deteriorated as he can go days without bathing. Before admission, R.B. spent several weeks in seclusion. He refused to join family gatherings, isolated himself, and closed the blinds. Within the past 2 days, he refused to eat, stating, “They have contaminated the food.” As you approach R. B., you note that he appears to be talking to himself. When you talk to him, he looks around and answers in a whisper but gives you little information. He states, “They are watching me and told me not to cooperate.”

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