The University of Texas System

CPAN Case of the Month

Dr. Edore Onigu-Otite is a child and adolescent psychiatrist with Baylor College of Medicine’s CPAN hub. She spoke to us about a recent consultation she provided to a pediatrician.

Presenting Problem:

The patient’s grandmother contacted the pediatrician’s office requesting refills for Fluoxetine and Seroquel. This was a patient of the pediatric clinic, but she had not been seen in more than six months.

Background History:

The patient was a 16 year-old female who lived with her legal guardian. Over the past year, she had been seen in clinic. She was depressed, and was prescribed Fluoxetine. She skipped many of her appointments and was inconsistent on her meds.

Interim History:

The patient had recently had a suicide attempt, for which she was admitted to the inpatient psychiatry hospital. She was hospitalized, prescribed Fluoxetine, and started on Trazodone (as needed for sleep) and Seroquel. Because drugs were involved in her suicide attempt, she was transferred from the psych hospital to a drug rehab facility. At the time of discharge, the psych hospital provided 30 days worth of meds. The first available appointment with a psychiatrist was not until three weeks after the end of rehab. The pediatrician was contacted by the patient’s grandmother to see if she could prescribe meds, but the pediatrician was unsure which meds to prescribe.

The present dilemma:

The pediatrician’s challenges were that the patient had not seen a psychiatrist in the past month, the inpatient psychiatry hospital could not provide refills, and the patient could not obtain an appointment with a psychiatrist until three weeks after discharge from the drug rehab program. Given this, the only physician who knew the longitudinal history of the patient would be the pediatrician. The pediatrician wanted to know if the meds were okay to prescribe.

The consultation question:

  1. Was it okay to provide medications until the patient could see the psychiatrist?
  2. Would that be for all three meds, or only one or two of them?

CPAN support provided:

  1. The pediatrician was validated for the care and attention provided to the patient and for for taking the time to double-check on the clinical situation.
  2. Further information revealed that the patient had a history of trauma.
  3. Recommendations were as follows:
    a. Advised to continue Fluoxetine for depression
    b. Advised they could continue Seroquel to provide mood stabilization until reviewed by a psychiatrist
    c. Advised that if uncomfortable prescribing Trazodone, the pediatrician could recommend OTC medication such as melatonin for sleep.
    d. Advised to start therapy – CPAN also provided resources.
  4. The pediatrician was encouraged to call back if there were any other/further problems or questions they might have.