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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.
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