Respond to both students with at least 1.5 Paragraph.
Student #1 FABIOLA
My most interesting patient this week is J.M., a 38-year-old homeless female with a history of major depressive disorder (MDD), post-traumatic stress disorder (PTSD), uncontrolled diabetes, diabetic neuropathy, hypothyroid, hyperlipidemia, restless leg syndrome, morbid obesity, polysubstance abuse on Suboxone, who is being admitted to WT9 from Greenwich Hospital after swallowing razor blades in a suicide attempt. An esophagogastroduodenoscopy (EGD) was performed at Greenwich emergency room (ER), and two razor blades were retrieved from her stomach. Also, while at Greenwich ER, the patient made superficial scratches on her left forearm. She reports she used a razor blade to do this.
I encountered the patient in her room, lying in bed. She is easily engaged, pleasant, cooperative, and maintains good eye contact. She reports chronic anxiety and depression. She states she had been in treatment for substance abuse at Rescue Mission in Bridgeport for three months and had been successful in the program. She states her drugs of choice are opiates, cocaine, and alcohol. She states to have experienced a seizure, for which she was hospitalized. Upon being released from the hospital, she was not accepted back at the Mission. She reports she was told that she needed a higher level of care. She reports she has been homeless for several months. She states she felt helpless and hopeless, leading her to swallow four razor blades and a bottle cap in a suicide attempt. She states, “I thought it would be painless.” She reports having four suicide attempts in the past by cutting, with three previous hospitalizations. She reports the last admission was at Danbury Hospital in February of this year. She reports a history of multiple sexual assaults and a 3-year domestic violence relationship. She states she has no supportive friends or family in the area. She states she moved here from Florida to live with a cousin almost 20 years ago. She states she has two daughters, ages 18 and 14. She reports that one is in Florida with the rest of her family, and the other lives with her father. She states she hopes to control her anxiety and become productive again. Per chart review, she has a history of medication and treatment non-compliance.
Her habitus is heavy, and her height is short. She looks disheveled and her stated age. She has a normal gait and posture. Her speech is spontaneous, and she has normal psychomotor behavior. Her mood is depressed with a constricted and subdued affect. Her thought process is coherent and logical. She is goal-oriented. She has limited insight and judgment. She denies delusion, visual and auditory hallucinations, and violent and homicidal thoughts. She endorses suicidal ideations.
Given the patient’s risk factors, including multiple previous suicidal attempts, self-harm, lack of support system, substance abuse, and homelessness, the patient is at moderate to higher risk of suicide in the community. Therefore, the patient will benefit from inpatient treatment for safety to self by being placed on a one-to-one (1:1) suicidal wash with security, medication management to stabilize mood, and individual and group therapy, and safe discharge planning with placement. Student #2 JENNIFER This week’s most interesting patient was a 17-year-old female who presented for a follow-up. She was diagnosed with reactive attachment disorder and post-traumatic stress disorder. Although she has improved immensely, she is still experiencing angry outbursts, irritability, and actions of self-harm including cutting herself and choking herself with a towel wrapped around her neck. She is currently at a residential treatment facility. Her medications include aripiprazole, amantadine, and clonidine. I find this patient very interesting because she has been prescribed amantadine. According to my preceptor, she uses this medication as a last resort for extreme irritability and anger because it is not a medication recommended by American Child & Adolescent Psychiatry. My preceptor states that the medication works well, but if she used it, then you know she was desperate.
Amantadine is used off-label in childhood psychiatry with effectiveness for ADHD, unipolar depression, autism spectrum disorder, and obsessive-compulsive disorder (Morrow et al., 2021). Comparatively, it has fewer side effects than the medications more frequently used for the aforementioned disorders as stimulants and atypical antipsychotics have a larger profile of side effects (Morrow et al., 2021). In the study by Morrow et al. (2021), the children who were taking amantadine had very high success rates, especially for impulsivity symptoms with over 70% of patients reporting symptom improvement and irritability/anger symptoms with over 50% of patients reporting symptom improvement. Furthermore, 114 of the 297 patients in the amantadine study either completely discontinued or decreased their current psychotropic medication dosage by greater than 50% (Morrow et al., 2021). Unfortunately, amantadine is not well discussed in many medication reference materials for mental health. Stahl (2021) briefly discusses that amantadine lacks anticholinergic properties and is thought that its mechanism of action is weak antagonism of the N-methyl-D-aspartate glutamate receptors. It is thought that amantadine leads to downstream changes in dopamine activity (Stahl, 2021). Regardless of how amantadine works, it does help with drug-induced parkinsonism and possibly helps with tardive dyskinesia (Stahl, 2021) and it is effective for several childhood disorders (Morrow et al., 2021).
References
Morrow, K., Choi, S., Young, K., Haidar, M., Boduch, C., & Bourgeois, J. A. (2021). Amantadine for the treatment of childhood and adolescent psychiatric symptoms. Baylor University Medical Center Proceedings, 34(5), 566–570. https://doi.org/10.1080/08998280.2021.1925827Links to an external site.
Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press.