For my final site evaluation, I presented on a pediatrics case of a 13-year-old boy who had history of bipolar I disorder and ADHD. He was not adhering to his medications (Resperidone and Depakote) since they made him feel anxious. As such, he presented in a manic episode, throwing plates and apples at his mother that resulted in an altercation between the two and his mother called EMS and NYPD. The patient also has a history of Xanax abuse as given by his older brother but his parents are now divorced and he no longer lives with his brother.

The ROS and PE exams were pretty much unremarkable. I think that I gave a good list of differentials, including bipolar I disorder, oppositional defiant disorder, conduct disorder, childhood-onset schizophrenia, and substance-induced psychotic disorder. I was able to list reasons why I believed that the patient was in a manic episode of bipolar I disorder and the process I took to rule out the other differentials. Dr. Saint Martin agreed with my differentials and thought process. In addition, I had an elaborate plan for my patient, including restarting Risperidone and Depakote, obtaining vitals, routine labs, and a utox, check Depakote levels, making sure the patient follows up with outpatient psychiatry, and educating the patient about psychotherapy like behavioral therapy, cognitive therapy, interpersonal therapy, and social rhythm therapy to better control and respond to his manic or depressive symptoms when they occur. During the mid-site evaluation, Dr. Saint Martin asked me to include more about patient education so I was able to elaborate further on that during the final site evaluation.

While I was presenting my case, Dr. Saint Martin brought up some points that I did not focus on. For example, he asked me why the patient’s older brother was giving him Xanax. He also asked me whether the patient was larger in size and build than his mother. In future H&Ps for my improvement, I will make sure to consider these factors and think a little outside the box to see if any other information is pertinent. Overall, I believe that I am capable of writing an H&P that encompasses the psychiatric patient, coming up with the appropriate differentials, and formulating a plan that pertains to each patient.

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