ABSTRACT
Since its inception in 2012, the OpenNotes initiative has been broadly adopted by medical institutions across the nation, giving more than 40 million patients access to their medical documentation.1 The response to this access has been overwhelmingly positive, as providers and adult patients report increased trust, transparency, and collaboration.2 In contrast, the benefits of OpenNotes have yet to be realized among pediatric and adolescent patients. Since February 2018, our pediatric institution has default released medical notes to patients aged 12 years and older. Currently, 90% of medical notes are shared with adolescent and young adult (AYA) patients; however, medical documentation is withheld from those in care settings regarded as vulnerable (ie, psychiatry, child abuse) or if the provider deems the content sensitive. We previously demonstrated adequate comprehension and satisfaction with medical documentation among AYA patients seen at a pediatric gastroenterology clinic.3 However, confidentiality concerns persist among providers, especially those working within mental health settings.4.
Subject(s)
Inpatients , Psychiatry , Adolescent , Child , Documentation , Electronic Health Records , Hospitalization , Humans , Young AdultABSTRACT
BACKGROUND: Neuroleptic malignant syndrome (NMS) and serotonin syndrome (SS) are serious medical conditions associated with commonly prescribed psychiatric medications. Although the mechanisms differ, they can be clinically difficult to distinguish. We report a case of a pediatric patient with complicated psychiatric history that developed features of both syndromes in the setting of polypharmacy. CASE: A 12-year-old boy with a history of developmental delay, attention-deficit hyperactivity disorder, and posttraumatic stress disorder presented to the emergency department with behavior changes consisting of delayed reactions, gait instability, drooling, and slowed movements. Ten days before presentation, his outpatient psychiatrist had made multiple medication changes including discontinuation of cyproheptadine (an appetite stimulant) and initiation of aripiprazole. On arrival, the patient was noted to be tachycardia and hypertensive for age. He was disoriented, intermittently agitated, and tremulous with increased tonicity, clonus in the lower extremities, and mydriasis. He was supportively treated with lorazepam and intravenous fluids while discontinuing potential offending agents. His course was complicated by hypertension and agitation managed with dexmedetomidine infusion and benzodiazepines. His mental status, tremors, and laboratory values began to improve over the next 2 days, and eventually transitioned to the inpatient psychiatric unit on hospital day 7. DISCUSSION: Diagnosis of NMS or SS can be difficult when there is overlap between syndromes, particularly in the setting of multiple potential offending agents or underlying developmental delay. In addition, pediatric patients may present atypically as compared with adult patients with the same condition. CONCLUSION: The use of antipsychotic medications for young children with behavioral problems has risen dramatically in the last decade, increasing their risk for developing SS or NMS.
Subject(s)
Antipsychotic Agents/adverse effects , Neuroleptic Malignant Syndrome/diagnosis , Serotonin Syndrome/diagnosis , Child , Diagnosis, Differential , Humans , Male , PolypharmacyABSTRACT
Grieving the loss of a loved one who died from suicide can be one of the most difficult and painful experiences one ever faces. While most survivors heal their wounds without any formal treatment, a substantial minority can benefit from informed interventions. By understanding the universal themes that suicide survivors grapple with doubt, guilt/responsibility, rejection/ perceived abandonment, stigma, and trauma symptoms, and also adequately screening for Complicated Grief, major depression, and PTSD, a clinician is equipped to provide targeted and personalized care for survivors. Therefore the importance of fully screening such individuals and using treatment guidelines to create an individualized treatment plan can be paramount in helping a person cope with this devastating loss.
El duelo por la pérdida de un ser querido que falleció por suicidio puede ser una de las experiencias más difíciles y dolorosa que se deba enfrentar alguna vez. Mientras la mayoría de los sobrevivientes curan sus heridas sin ningún tipo de tratamiento formal, una minoría importante puede beneficiarse de intervenciones clínicas. Mediante la comprensión de los temas con que los sobrevivientes del suicidio deben lidiar, tales como duda, culpa/responsabilidad, rechazo/abandono percibido, estigma, síntomas de trauma, junto a una adecuada detección del duelo complicado, depresión mayor y trastorno por estrés postraumático, el médico podrá estar preparado para proporcionar atención personalizada a los sobrevivientes. Por lo tanto, la importancia de la detección de estas personas y el uso de guías de tratamiento para llevar a cabo una intervención terapéutica puede ser de utilidad para ayudar a las personas a soportar esta pérdida.
