During this rotation’s site evaluation, I presented 2 HPIs, 5 Pharm cards and a research article. For my HPIs I chose patients with very interesting presentations, one of which was still in treatment and her diagnosis was difficult to make.
My first patient had Borderline Personality Disorder with an overlying Major Depression who came to us after a suicide attempt. She was confident she would be discharged but given her history of self-harm our team decided to admit her. Following her case was very interesting because she was prescribed Topiramate and underwent a Dialectical Behavioral therapy, which, as I learned, are the modalities used in BPD treatment.
The second patient I presented I chose because she actually had a first outbreak psychosis during applying to PA schools. Her diagnosis was difficult to make as she had no family history of mental illness and nothing like this ever happened to her before. By the time of the end of my rotation, she was still treated inpatient and, unfortunately, not getting better.
Our preceptor gave us a good constructive review that prompted critical thinking and a productive discussion. He pointed out that when a Bipolar patient has frequent mood episodes, it qualifies as Rapid Cycling which may no longer be responsive to Lithium and switching to Depakote, Tegretol or Dilantin in a combination with a low dose antipsychotic may be a next step in treatment of refractory Bipolar. Overall, using Zoom for the evaluations was very convenient and both sessions were useful and productive.