Clinical Log

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Clinical log: South Oaks Hospital, Amityville.

College
March 2019

Clinical log: South Oaks Hospital, Amityville

I go to south oaks hospital in Amityville every Thursdays as part of my course requirements and clinic rotation. South Oaks hospital offers various programs for children and adolescents, both as inpatient and outpatient. My preceptor John Prato NP works in an inpatient children’s unit taking care of children and adolescent aging from 5 -18. I spent my day with John Prato taking care of the children, doing mental health assessments, follow up of labs, medication adjustments and discharge planning. I follow John with his assigned patients, participate in interdisciplinary meetings, and family meetings. We conduct psycho education to both family and patients, perform initial evaluation for new admissions, and obtain collateral information from school, outpatient psychiatrist and patient family. Upon admission, an individualized treatment plan and goals for discharge are developed based upon the children’s unique needs, situation and assessment. We provide behavioral support, facilitate therapeutic rehabilitation, one to one and family sessions and psycho education. I watched the partial program for half a day on one day and I was amazed to see the follow up in there. Written below is an initial evaluation of a client that I did on March 22 nd along with my preceptor.

Patient is a 13 year old male who is admitted due to suicidal statement and huffing dust cleaner which mother believes was in an attempt to hurt himself. Patient had also been caught Thursday 1/17/19 stole mothers credit card to purchase 80 dollars of Amazon gift certificates sent to his IPhone. On interview, patient presents tense, somewhat irritable. Pt is guarded, making attempts to minimize behaviors PTA. When asked about breathing in can of computer duster, pt denies that this was a suicide attempt or an attempt to get high. Pt does endorse feeling sad, angry irritable at times and reports poor frustration tolerance. Patient admits to punching walls, destruction of property, and physical aggression towards others. Patient denies feeling depressed, hopeless. He denies HI/SI/I/P/impulses for SIB and reports that text to friend of suicidal nature was in an effort to relate to this boy as he has had suicidal ideation before. No AVH. No delusions elicited. Pt reports that he as gone 24-48 hours without sleep, however no clear identifiable history of hypomanic/manic episode.

Collateral from Outpatient MD stated that patient has a diagnoses of ADHD, depression.
Collateral information from patient’s mother who reports that patient has been having explosive outbursts/behavioral disturbance since age 3 (running out of school, biting teacher). When patient has an episode he is unable to de-escalate, rocks back and forth, hitting self in head out of frustration. Episodes can be in response to smallest of triggers. Patient is very impulsive, often acting without thinking, engaging in bizarre behavior at times. Patient noted to have impulsively eaten chopsticks and Vaseline before. Pt initially saw neurologist, diagnosed with ADHD and had trials of Adderall, Ritalin Vyvanse (agitation), and Concerta. Patient was once again started on Adderall XR and seemed to reduce level of agitation and helped with concentration. Patient was started most recently on Zoloft for mood, depression, anxiety and mother reports feeling as if it has helped somewhat. Discussed recommendation to start trial of Seroquel in place of Risperdal (which was started prior to admission) and pts mother consents to trial of Seroquel up to and including 300 mg daily.
There are several children admitted to South oaks hospital with similar problems and most of it is from poor family upbringings. Many of them struggle with difficult family dynamics. In this case patient has a great deal of anger, frustration in the context of feeling abandoned by father (no contact in 9 years). Patients father with history of mood disorder, inpatient hospitalization, suicide attempt via overdose, substance abuse, incarceration. Patient’s maternal aunt with history of Bipolar disorder, SIB/cutting, suicide attempts.