Grand Rounds Discussion: Complex Case Study Presentation

Case Study

The patient is a 25-year-old African American female who was seen today via telehealth with her consent obtained with diagnosis of Chronic Bipolar disorder, Schizoaffective disorder, Autistic disorder, and depressive disorder. The patient stated, “I’m concerned about my outburst of rage, I’m having random rage daily”. She reported that she is taking her medications and she does not think they are working for me. The patient is on ability 5mg. Mom reported that the patient gets into outbursts of rage and breaks TV and other things in the house. She goes to neighbors’ houses and knocks at their doors. Mom reported that the patient was taken to Southern Maryland hospital yesterday and was given Xanax injection and she was told that there was no bed available for the patient. The patient visited Innova hospital in Virginia as well and she was told that the patient does not have the criteria for inpatient, and she was sent back home. The patient reported auditory hallucinations and feelings of irritability and outburst. The patient reported good appetite and good sleep. The patient's mom reported that police came to the house during one of the patient’s outbursts but refused to take her to be committed to a psychiatric hospital.

The patient is alert and oriented to person, place, time, and situation. The patient has very slow speech. Her mood is euthymic, and her affect is congruent to her mood. Her thought process is linear, and goal directed. Her insight and judgment are good. She denies suicidal or homicidal ideation, intent, or plans presently. She denies visual hallucinations, delusions, and or paranoia presently. But she reported auditory hallucination and occasionally feels depressed and outburst.

The patient remains a 25-year-old African American female who was seen today via telehealth with consent obtained with diagnosis of Chronic Bipolar disorder, Schizoaffective disorder, Autistic disorder, and diagnosis of depression. The patient stated that she is taking her medications and that she does not think they are working for her. The patient repeatedly stated that her concern presently is how to deal with her outburst. The provider increased the Abilify to 10mg, and Depakote is prescribed 250mg three times daily for mood stabilization. The patient remains on Zoloft 100mg to help her with her depressive mood. The patient denies any visual hallucination but stated that she occasionally feeling depressed and outburst. She reported auditory hallucination. She reported good appetite, and good sleep.

Plan of care:

The patient will have a decreased depression within the next 90 days.

The patient is educated on the medications side effects and the interactions, and verbalized understanding.

The patient will be referred to a psychotherapist.

The patient is educated on positive coping mechanisms to improve mood.

Follow up in 4 weeks.

Call 911 for suicidal or homicidal ideations.

VITAL SIGNS REPORTED: Temp.97.4, Pulse-72, Respiration-18, B/P-129/77, oxygen level-97%.