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CPAN Case of the Month – November 2024

Each month, PCPs call CPAN with a wide variety of mental health questions. Find out how CPAN helped a PCP during this consultation.

Patient: 9-year-old female

Reason for CPAN Consultation: Support with medication management

Explanation of the Case and Outcome of the Call:

A 9-year-old female with ADHD, ODD, Asthma and Constipation was not responding to various psychotropic medications. The family had seen another PCP during the summer and in the course of 12 months had been to the emergency room three times for physical aggression and suicidal thoughts and taken several different psychotropic medications with unclear benefit. While the PCP was working to have the youth be seen by a psychiatrist, they hoped that our consultation might provide some near-term guidance. During the consultation, the following educational points were discussed: 

  1. CPAN could provide a focused one-time direct patient consultation to clarify diagnosis and treatment plans. This may be especially helpful if the referral to psychiatry is estimated to take 8 weeks or more and the current treatment regimen is not effective. 
  1. It was emphasized that many psychiatric conditions could manifest as behavioral disturbances in school-age children. While obtaining a complete psychiatric assessment may be challenging during PCP visits, it’s crucial to gather more information about the nature of these disturbances. Questions should explore whether the patient experiences difficulties in multiple settings and what associated symptoms accompany meltdowns or behavioral disturbances. For example, if these disturbances are linked to hyperactivity or impulsivity, prioritizing treatment for ADHD may be necessary. If symptoms are related to depressive thoughts and suicidality, prioritizing depression treatment is important.  Furthermore, psychotropic medications are only one aspect that is needed to provide appropriate care. Ensuring that her physical ailments were well managed (asthma and constipation) is critical. Additionally, treatment of ODD or a possible mood disorder typically requires an evidence based psychosocial intervention. Clarifying the diagnosis(es) is critical as it would assist the PCP in guiding the appropriate care recommendations. Changing psychotropic medications without a clear diagnosis or symptom profile can lead to poly-pharmacy, side effects and ultimately care that is not effective.