CPAN Case of the Month – September 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: 19-year-old male
Reason for CPAN Consultation: To receive support with diagnosis and medication management
Explanation of the Case and Outcome of the Call:
19-year-old partially blind male with Asthma, ASD, ADHD, Anxiety and DMDD living in a supervised dorm. They are taking Fluoxetine 40mg, Abilify 5mg, Focalin XR 30mg, Focalin 15mg on non-school days and Albuterol MDI prn. He takes his medication in his dorm under supervision. The consultation question relates to concerns related to random times that his body “freezes and he is unable to sit back up.”
The physical examination is unremarkable except for baseline nystagmus. No clonus or muscle rigidity. No vital sign abnormalities. The patient does not use nicotine, alcohol or substances. The episodes do not result in a loss of consciousness and the patient can communicate while they are occurring. They have never been witnessed by others. The PCP has ordered a CBC, CMP, CK and creatinine and is awaiting results.
A review of the presentation made a concern for panic attacks the more likely scenario. Given the patient could communicate through the episodes, their asthma did not appear to be a likely cause. As there was no postictal confusion, seizures were unlikely. But if there is a concern a referral to a neurologist may be warranted. Serotonin syndrome was also unlikely given the stability of his dosages and lack of vital sign abnormalities. Similarly, a medication side effect globally was unlikely given his overall stability. However, it may be warranted to consider a dosage decrease in Abilify given denial of concerns related to aggressive behaviors. The PCP may want to consider a referral to a therapist to address anxiety and possible panic attacks, especially if there are no further worrisome physical symptoms or laboratory abnormalities.
Finally, a global recommendation to consider measurement-based care options to follow clinical symptoms to include an anxiety scale, depression and ADHD scale to tailor treatment.