Читать книгу Dynamic Consultations with Psychiatrists - Jason Maratos - Страница 74

The onset of her mental illness was shortly after her father's death in January 2010; her father died of a chest infection. Miss C was then in Form 2. She experienced low mood and weeping spells for 1 to 2 months after that. Her mental condition deteriorated in June 2011, when she was in Form 3; she presented with social withdrawal, frequently blaming her family for not offering her good food. She attempted suicide in September 2011 by burning charcoal in her room; she had even written a final note. Miss C was saved by her mother 1 hour later and was sent to the hospital accident and emergency department. She was stabilized and seen by a psychiatrist who diagnosed depression and discharged her on fluoxetine. A child psychiatric outpatient clinic followed up with Miss C. She could not tolerate fluoxetine; as her mood continued being labile, her medication was changed to venlafaxine 225 mg daily. Miss C showed partial improvement in December 2011.

Miss C had a manic relapse in February 2012 again with irritable mood, pressure of speech, and social withdrawal. She blamed her family for giving her poor food and would go out to buy snacks at night. She was overspending (in excess of US$2,000) for accessories and stamps for collections. She had grandiose ideas, including that she looked like a celebrity and that she might have been some prominent figure in her past life, such as Jesus, Buddha, or President Mao. She was finally admitted to hospital in March 2012 because of violent behavior against her aunt and because she was breaking objects at home. She was first tried on risperidone 6 mg nightly + sodium valproate CR 400 mg, and clonazepam 2 mg daily with suboptimal control. She developed a depressive swing during her inpatient stay with crying spells, rumination about her deceased father, paranoid ideation toward others, fleeting suicidal ideas, with persistent thoughts racing and multiple plans. Her medication was changed to olanzapine 20 mg N, sodium valproate 600 mg, and Clonazepam. Her depressive symptoms improved but manic symptoms persisted; she developed akathisia, which was partly controlled by benzodiazepines, Artane, and propranolol. Lithium was started, and manic symptoms significantly improved. Miss C discharged herself against medical advice in July 2012 and was readmitted 1 week later with manic symptoms. She was stabilized and discharged on lithium, sodium valproate, and venlafaxine.

The Child Psychiatric Clinic had followed up with Miss C and doubted drug compliance. Mirtazapine was used briefly in October 2013 for depressive symptoms and lithium was tailed off in June 2013 because “she did not like” that medication.

She was admitted to hospital in October 2014 and stayed until December 2014 for manic relapse with irritable mood, grandiose delusions, poor sleep with increase energy, and (over)spending US$100 to buy stamps. She was stabilized and discharged on lithium 800 mg, sodium valproate CR 400 mg, and Quetiapine 600 mg.

Miss C was then followed up in general adult psychiatric outpatient clinic. Escitalopram was started in October 2016 for low mood. Quetiapine was tailed off gradually due to sedation. Buspirone was added in February 2017 for anxiety. Patient was last seen in the outpatient clinic and was stable on quetiapine 150 mg nightly, lithium 600 mg nightly, sodium valproate CR 400 mg nightly, and buspirone 10 mg twice a day. A clinical psychiatric nurse and a clinical psychologist have followed up with her since March 2017 as requested.