CPAN Case of the Month – September 2023

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

Patient: adolescent

Reason for CPAN consultation: completing a thorough diagnostic evaluation

Explanation of the case and outcome of the call:

A pediatrician recently wondered what they should do for a patient with numerous diagnoses and recently discharged from the hospital for the third time. The patient had been previously diagnosed with ADHD, MDD, GAD, Substance Misuse and had previous suicide attempts with Ativan and blood thinners.

The patient was taken off Vyvanse, Guanfacine and Effexor and started on Trazadone and Hydroxyzine while hospitalized and was using cannabis. At their appointment the PHQ-9 A was elevated at 13. Many trials of medications, inpatient hospitalization including substance rehabilitation had proven ineffective.

The pediatrician decided the best plan forward was to complete a thorough diagnostic evaluation. They connected with CPAN to receive a one-time direct consultation in order to clarify diagnosis and develop a clearer treatment plan. The results of the consultation will be shared with the family and with the pediatrician both in written form and through another phone consultation. While it is highly likely that this patient needs coordinated specialty services, this one-time direct consultation can provide anticipatory guidance for the pediatrician and offers the family a clearer sense of next steps.

With parental permission this patient will be seen within 1-2 weeks so that the pediatrician and family can learn together the best path forward.