Pt is a 14 yo male with PPH of anxiety, OCD, and depression who presents via PC for aggression. Pt was reported to have grabbed a pair of scissors yesterday during an argument with his mother and stated “Do you wanna see what I’m gonna do?” Pt states this was to end the conversation and not actually to harm himself or his mother. Mother reports that he kicked her today as well. She reports her child has been extremely stressed getting adjusted to moving to the states , previously lived in Cuba. Of note, patient’s mother came to America 4 years ago and because of Covid, pt was only able to immigrate here 3 months ago, was staying with his grandparents previously. Pt has had some issues with sleep and defiant behavior in the past, pt was placed on risperdal due to behavioral concerns and poor sleep. (Mother adamantly denies pt ever endorsed hallucinations, delusions, or exhibited disorganized speech however reports a psychiatrist in Cuba said he was showing early signs of schizophrenia). Pt was switched to Olanzapine recently because he refused to go to school in Cuba, knowing he would be leaving for the states soon. Mother reports he was fully functional before the stress of being separated from his mother. He continues to be stressed no knowing English and mother reports he has no friends (though has always been selective socially), and has been getting detentions at school. Mother notes that her son has started exhibiting signs of OCD, where he will have to open and close doors multiple times, and worsened after tapering off the Olanzapine 1.5 weeks ago where he would take snapshots of everything, and even asked her to sift through the garbage when she threw a paper away that he wanted. Pt was started on sertraline after the taper, 25mg daily. She notes that her son has always had trouble concentrating and states that he was also started on guafenesin though mother decided not to start this medication. Pt reports that he feels safe on the unit. He admits that he has been very stressed about the move but denies depression, SI, HI. No mania or delusions elicited on interview. Pt does not appear to be RTIS. Mother states her son does not do drugs or drink alcohol and there is no history of mental illness in her family.
mpression and Plan
Diagnosis
Unspecified mood [affective] disorder (ICD10-CM F39, Discharge, Medical)
OCD (obsessive compulsive disorder) (ICD10-CM F42.9, Admitting, Medical)
sertraline 50 mg daily
abilify 10 mg
