CLIENT DESCRIPTION
Demographics
The patient, K. R. C., is a 13 year old Caucasian female who was brought to MedStar Franklin Square Medical Center’s psychiatric emergency department on March 14, 2014 by her mother for suicidal ideation with a vague plan. She was admitted to the Children’s and Psychiatric Services (CAPS) unit on March 15, 2014 where she was diagnosed with depressive disorder not otherwise specified (DD-NOS). According to the Admission Assessment, the patient was self- injurious with superficial several cuts on her right thigh and left arm that were caused by a razor the morning of 3/14/14. Her mother was unaware of the seriousness and frequency of the patient’s self-injurious behavior until the day of admission. The patient’s parents have been divorced since she was 2 years old and have shared custody. She alternates living with her mother and father weekly. The patient is single and attends middle school in Aberdeen, Maryland. She is under her father’s HMO insurance, is non-religious, and has no known allergies. The patient has a full resuscitation order.
Chief Complaint and History of Present Illness
The patient denies medical and surgical history and her medical record confirms this. She has no previous in-patient psychiatric admissions and has never been hospitalized. However, she states she has been feeling depressed for four years now and has been cutting since she was 11 years old. Her father only became aware of her cutting last month and her mother became aware towards end of last year. Ms. K says she cuts almost every other day as a result of feeling lonely, rejected, or worthless. She has been bullied ever since elementary school over her weight.
The patient’s mother took her to counseling therapy whi...
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... life and is something that she finds difficult to change about herself because she has had negative thoughts even before she began cutting. As part of her treatment plan, Ms. K was put on sertraline (Zoloft), which is a selective serotonin reuptake inhibitor (SSRI). SSRIs are associated with suicidal ideation (SI) in adolescents as it thought they causes irritation, agitation, and impulsiveness (Stuart 699). The only SSRI that is approved for adolescents with depression is fluoxetine; signs of SI should still be monitored as antidepressants in general can increase the risk for SI. Since the patient was admitted for SI she is especially at risk for this side effect. Ms. K’s sertraline medication was discontinued and she was placed on bupropion which inhibits reuptake of the neurotransmitter dopamine. This antidepressant medication does not cause SI in adolescents.
IDENTIFYING INFORMATION: Raven Wright is a 13-year-old eighth-grader who was initially scheduled to be seen at the Psychiatric Consultation clinic at the outpatient pediatrics. The clinic staff was contacted by patient 's the therapist, who brought up a number of concerns. Per review of the chart, Dr. Sandra Shocket was concerned that the child is having thoughts of harming self and others without a plan and that child hears a voice telling her to do things. Raven was described as, anxious and depressed. At the time of appointment
A 38-year-old single woman, Gracie, was referred for treatment of depressed mood. She spoke of being stressed out due to conflicts at work, and took a bunch of unknown pills. She reported feeling a little depressed prior to this event following having ovarian surgery and other glandular medical problems. She appeared mildly anxious and agitated. She is frequently tearful, but says she does not have any significant sleep or appetite disturbance. She does, however, endorse occasional suicidal ideation, but no perceptual disturbances and her thoughts are logical and goal-directed.
Tijanee M became self injurious, without warning she went to her room and placed a blanket over the door jamming the door for entry. Staff immediately attempted to open the door and was unable. Tijanee verbalized continuously she is going to kill herself tonight. The staff was able to gain entry to the Tijanee’s room with the use of the screwdriver. Tijanee was sitting on the floor with a sock tied her neck. Staff was able to provide emotional support and retrieve the sock from Tijanee’s neck. Tijanne began to pick at her recent sores until they were bleeding. Staff used kind gestures and hurdle help to calm Tijanee down. Tijanee was able to exit her room willingly and nursing was called for assessment.
The LPN-Team Lead contacted the social worker about Dr. Sundaram’s patient. The patient is a single, Caucasian grandmother and mother of two; she is alert and orientated to person, place and time. The patient reports that she lives with her 16 year old daughter and 3 month old granddaughter. The patient states that she works two jobs, one full-time and one part-time job and she assist with the care of her new granddaughter while her daughter is a work. The patient report that she is feeling (angry) and hurt because her boyfriend of 11 years cheated on her when she was in the hospital and left her a month ago; this and the loss of her child last year at 6 months gestation in addition to her CHF, COPD and influenza appears to have left the patient feeling of depression and hopelessness. The social worker noted that the patient scored a 19 on her PHQ-9, although she denies thoughts of suicide at this time. The patient states that she suffers from insomnia and gets approximately 2-3 hours of non-continuous sleep a night.
While taking data, I have worked with this child to increase behaviors with reinforcement, teach new skills, and to reduce interfering behaviors, which can include self-injury. During the past year, I completed an online suicide talk session, which explores suicide prevention as well as becoming a Certified Mental Health First Aider. I also became a suicide and crisis line volunteer, giving emotional support for individuals experiencing emotional or situational distress, various forms of mental illness and in need of general information or referrals. The callers varied from transgender individuals to youth to other ethnic minority groups. I learned to not minimize grief or experiences because everyone is entitled to their feelings and every individual grieves and experiences trauma in various
There is an escalating problem that is becoming more prominent among adolescent society involving the use of anti-depressant medication and its increased risk of suicidal tendencies. Studies show that more Americans are turning to antidepressants and are not informed of the irreversible dangers that are associated with taking them. Antidepressants possess a variety of different side effects just like other medications, however, there is a growing concern regarding the increasing rate of suicides among adolescent teens. Especially in today’s society, there is an alarming increase in influences that the media places upon the younger generations living in America. Antidepressant use in this age group should include high monitoring of suicidal thoughts and tendencies, and should include an increased effort to raising awareness of this issue.
My client is a 16 year old Caucasian female, was admitted into Children Medical Services on July 28, 2015. She lives with her mother in a mobile home. Mother and father are divorced because her father was abusive. Since mother is now a single parent finances are a struggle. Mother also has depression and is receiving counseling. My client has Dysthmia, a chronic type of depression in which a person's moods are regularly low (cite). She was diagnosed with Obsessive Compulsive disorder is an anxiety disorder in which people have unwanted and repeated thoughts, feelings, ideas, sensations, or behaviors that make them feel driven to do something (cite). My client has a problem with inattentiveness, over-activity, impulsivity, which was diagnosed as Attention Deficit Hyperactivity Disorder. She also suffers from Posttraumatic Stress from observing father abuse towards mother when she was a child. Her previous medical history includes ADHD, Asthma, Vaginitis, Urinary Tract Infection, Sinusitis, and Otitis Media. My client is physically in normal range for her age. Based on the growth chart in the ped’s book for her weight she falls in the 75th percentile and her height she is in the 25thpercentile. She had a slim physique and no appearance of nutritional deficiencies. Skin appeared smooth, hair looks lustrous and strong, and mucous membranes appeared pick and moist. She was casually groomed in school clothing.
Approximately 24% of 12-17 year olds have considered suicide and up to 10% have attempted suicide.” (Suicide Intervention Training PG 3). Teens today are very likely to commit suicide for various reasons. In today’s society there are a lot of judging and bullying cases around the world. No matter how much we promote a bully free zone there will always be a couple of cliques, or individuals, who want to bring others down and who do not know the seriousness of bullying. Although bullying is a big cause of suicide, the leading cause is a mental illness that many people are familiar with called depression. “Psychiatric disorders can affect diverse aspects of an individual’s life.”( Dispelling Myth Surrounding Teen Suicide, PG 1). If you or someone you know seems down most of the time, the best thing to do is to go see someone about your despair. If you are diagnosed with depression, prescribed depression medicine can help and can be one way to prevent suicidal thoughts or actions. “There is a lot of evidence that suicide is preventable.”(Cont. Principles of Suicide Prevention, PG
“Suicide is the third leading cause of death for 15- to 19-year-olds. In any given year, about 20% of all high school students think of committing suicide; almost 10% try” (Cropper 112). This shocking statistic shows the high risk of suicide among teens, but what some might not know is that the most common form of treatment used to help teens suffering with depression is one that might also increase the risk of suicide and/or harmful actions to oneself. Tricyclic antidepressants such as Zoloft, Paxil, Celexa, and Lexapro are commonly prescribed to adolescents and young adults to relieve symptoms of depression, and they work by either releasing more of the brain’s “happy chemical,” serotonin, in those with clinical depression, or by stopping the release of the brain’s emotional chemicals in those with manic depression (or other diseases such as bipolar disorder) (Silverstein 61). Although antidepressants can have a positive effect on the symptoms of depression, the risk of suicide among those who take it is too high to use as a first option. Suicidal behavior is a serious side effect in teens that are prescribed tricyclic antidepressants; depression should be treated with safer alternatives, such as behavioral treatment or other forms of therapy as opposed to such a “trial and error” approach.
According to the FDA, about 2.5% of children and around 8% of adolescents are affected by depression (Temple). A common way to treat depression is by taking antidepressants. Children and teens have also been prescribed antidepressants for various reasons other than depression such as OCD and anxiety disorders. While it is legal for teenagers and children to take antidepressants, many people are concerned with the issues that taking antidepressants have. Children and teens should be allowed to take antidepressants only when other forms of therapy don’t work. Antidepressants are serious drugs that have severe warnings when children and teens use them. There is also an increased risk of worsening depression and suicide in children and teens, especially in the when they begin to take it. Even the less severe side effects can make quite a negative impact on life.
As the EAI team was discussing Molly’s case, one of the ED Residents made a few telephone calls. Molly’s PCP reported that during her last visit about 2 weeks ago, Mollie was alert and able to respond to questions appropriately. He confirmed that Mollie’s daughter and son in law have experienced psychiatric problems, adding that the son in law has expressed anger regarding Mollie’s living arrangements. The home health care agency was contacted. The RN and aide both report they have never met the son in law and have had very limited contact with Mollie’s daughter. When contacted by telephone, the daughter provided no explanation for Mollie’s extensive bruises noted on admission to the hospital. The daughter stated that Mollie did not fall, but in fact lowered herself to the floor in an effort to draw
An inpatient psychiatric hospitalization may come as a bump in the road to some, but may be routine procedure for others. At Chicago Lakeshore Hospital, adolescent females are hospitalized for many reasons ranging from suicidal ideations to eating disorders. From the observations since starting an internship at Chicago Lakeshore Hospital, suicidal ideation and self-injury behavior occur in most of the patients. Borderline personality disorder and major depressive disorder are the two leading diagnoses on the unit.
Nicole Dagan, age 19, has recently attempted to commit suicide. She was bullied at work and at home. The people she worked with would make fun of her because she was a teen mom of two kids and they believed she made a mistake by marrying her husband. Her family told her that her husband and children were a mistake and that her husband was cheating on her. She felt oppressive and snapped. She decided that ending her life would be easier than having to live with all the stress and bullying. Nicole attempted to commit suicide by cutting her throat from ear to ear; she failed at ending her life, but she is now in the hospital getting mental help.
One consequence of untreated mental illness could be suicide, often a constant struggle for people who battle with a mental health problem. According a study, “In 2004, the FDA looked at published and unpublished data trials of antidepressants that involved nearly 4,400 children and adolescents...four percent of those thought or tried suicide (“Mental Health Medications”). In otherwards antidepressant are usually prescribed to overcome depression however, for others it can increase the thoughts of suicide greatly. Suicide is number 10 for the leading cause of
...ontrol emotional pain. Self-injury, is an unhealthy way to deal with emotional distress. About one-half to two-thirds of people who cut also have an eating disorder. “Girls and guys who self-injure are often dealing with some heavy troubles. Many work hard to overcome difficult problems. So they find it hard to believe that some kids cut just because they think it's a way to seem tough and rebellious...You can't force someone who self-injures to stop. It doesn't help to get mad at a friend who cuts, reject that person, lecture her, or beg him to stop. Instead, let your friend know that you care, that he or she deserves to be healthy and happy, and that no one needs to bear their troubles alone.” -(kidshealth.org) on “How does cutting start”. Need someone to talk to you about your cutting? Call 1-800-DONT CUT (1-800-366-8288) National Adolescent Suicide Hotline.