CPAN Case of the Month – March 2025
Each month, PCPs call CPAN with a wide variety of mental health questions. Find out how CPAN helped a PCP during this consultation.
Psychiatrist: Shannon Meador, DO
Consult: “Out of Control Preschooler”
A 4-year-old patient with chronic issues related to extreme impulsivity is now experiencing more mood reactivity and dangerous behaviors since their father died 4-months prior. Running into traffic, swearing, physically hurting others, and damaging property. There is no concern for developmental delays or autism. No family history of mental health concerns. Police have been contacted to help locate the child when they impulsively run off.
Teaching point: Dangerous behavior is a serious concern for youth even when this young. Currently, there is not a defined diagnosis only a list of concerning behaviors, therefore this young person needs a more immediate evaluation to appropriately diagnose and then plan for appropriate treatment, The differential should include ADHD, ODD overlain by a more recent mood disorder such as major depression or trauma as it relates to their father’s death. Given their age, inpatient stays are rarely needed, but this concept was discussed in case the family needs to move quickly to an inpatient admission. Conduct disorder does include many of the identified concerns, but given the recent stressor coupled with a possible untreated ADHD caution is warranted in making that diagnosis. The PCP elected to treat depression first with sertraline. Discussed dosing and close follow-up necessary to determine if the medication is improving symptoms. It is expected to see improvements within 2-4 weeks at appropriate dosing. Options to address possibly ADHD or ODD were also reviewed but primarily helping this PCP with a one-time direct consultation or finding a child and adolescent psychiatrist to see in person is an important next step.