Case Presentation

07-09-2015

Wake Forest School of Medicine

Past Psychiatric / Medical History

Always quiet and
reserved
3 months ago - sister
found pictures on her
phone
Began to see a
therapist
Shared decision to
come to ED

Wake Forest School of Medicine

Family History

Father passed away when she was

in 3rd grade
Mother has unstable relationships
Constant fighting at home

Wake Forest School of Medicine

History of Present Illness

16 yo female
Past Medical History
ADHD
Major Depression
Anxiety

Cutting Behavior
Would be easy to
kill myself

Wake Forest School of Medicine

Medications
Prozac for 12 weeks

Wake Forest School of Medicine

Social History
I hate school
Reclusive at school with few friends
Most friends have perfect lives
1 friend who is also suicidal
Im not good at anything. My grades are
terrible.

Wake Forest School of Medicine

Physical Exam - continued

Laceration on her right ankle

Wake Forest School of Medicine

Mental Status Exam

General Alert and oriented to person, place and time.
Appearance normal body habitus, normal posture
Attitude/behavior cooperative but with poor eye contact
Psychomotor - normoactive
Speech fluent, normal volume, normal tone, normal rate, normal prosody and normal
amount good vocabulary
Mood slightly depressed
Affect blunted, restricted
Thought process linear, coherent, goal directed
Thought Content positive for suicidal thoughts. Denies homicidal ideation, paranoia,
delusions, grandiosity.
Cognition memory intact, attention intact, language normal and fund of knowledge
intact.
Insight good
Judgment she cuts herself
Wake Forest School of Medicine

Assessment and Plan

Voluntary commitment
Referred to inpatient pediatric psychiatry unit

Wake Forest School of Medicine

Learning Issue
Risk factors for youth suicide:
History of previous suicide attempts
Family history of suicide
History of depression or other mental illness
Alcohol or drug abuse
Stressful life event or loss
Easy access to lethal methods
Exposure to the suicidal behavior of others
Incarceration

Studies also showed that being adopted increased risk for adolescent
suicide.
Wake Forest School of Medicine

Learning Issue
Physical Examination:
Within normal limits
Psychomotor retardation
Stooped posture
Slow movements
Slow speech
Cognitive Impairment
Decreased concentration
Forgetfulness
Wake Forest School of Medicine

Learning Issue
Differential:
Hypothyroidism
Parkinsons
Dementia
Medications
Tumors
CVA
Grief

Wake Forest School of Medicine