USMLE Forum Archives - USMLE Step 2 CK - Psychaitry & Ethics 7
Psychaitry & Ethics 7
TheOne - 04-27-07 11:56
A 34-year-old woman with schizophrenia is brought to the emergency department by the police because she was found in a park, actively hallucinating and talking to herself. She is cooperative but irritable. She denies command hallucinations and is not violent or suicidal. She admits that she ran out of her medication several days ago and was unable to get in touch with her case manager. She has been living in a personal care home for the past 3 months and was stable on her medication, but says she left the personal care home yesterday and never returned. Which of the following is the most appropriate next step in management?
A. Admit her to the psychiatry inpatient service for further treatment
B. Contact her case manager to ensure support and followup
C. Convince her to take a haloperidol decanoate shot and stay "medicated" for a month
D. Give her a new prescription and discharge her to the personal care home
E. Send her back to the personal care home and let the owner handle her
TheOne - 04-27-07 11:56
A 34-year-old woman with schizophrenia is brought to the emergency department by the police because she was found in a park, actively hallucinating and talking to herself. She is cooperative but irritable. She denies command hallucinations and is not violent or suicidal. She admits that she ran out of her medication several days ago and was unable to get in touch with her case manager. She has been living in a personal care home for the past 3 months and was stable on her medication, but says she left the personal care home yesterday and never returned. Which of the following is the most appropriate next step in management?
A. Admit her to the psychiatry inpatient service for further treatment
B. Contact her case manager to ensure support and followup
C. Convince her to take a haloperidol decanoate shot and stay "medicated" for a month
D. Give her a new prescription and discharge her to the personal care home
E. Send her back to the personal care home and let the owner handle her
Page 1
#1
Re: Psychaitry & Ethics 7 Sarahhh - 04-28-07 01:40 C.. she isnt a reliable patient.. she most probably wont come back for followups.. so its better to give her a long acting depot form of haloperidol
#2
Re: Psychaitry & Ethics 7
TheOne - 05-03-07 14:17 The correct answer is B. The most appropriate step is to contact the case manager to verify the information and to ensure that she gets the care and the medication she needs. She may be medicated in the emergency department and then sent to the personal care home with the case manager or the personal care homeowner.
Admitting her to psychiatry (choice A) is not justified because she has a case manager, a place to go, and is no threat to herself or others. Giving her haloperidol decanoate (choice C) is not appropriate because she has been on peroral atypical medication before and has been doing well. She is compliant with medication, and giving a decanoate shot would only increase the risk for tardive dyskinesia.
Giving a patient a prescription (choice D) while she is actively hallucinating is not a good choice. The chances of her picking it up at the pharmacy are minimal. Sending her back to the personal care home (choice E) without any intervention is not appropriate care.
#4
Re: Psychaitry & Ethics 7 babbu5508 - 07-07-10 00:11 B. Contact her case manager to ensure support and followup...to know the reliability of info and see what treatment she has been on so as to continue it or not
Page 1