Robin is a 41-year-old married, cisgender woman, mother of 3 children, who is brought to the emergency room (ER) by the police because of extremely dangerous behavior. She was pulled over by a pond where she had a plan to drive herself and her 3 small children into the water. When lifeguards called the police, she was on her way driving her car into the water. According to police, she said was trying to do a â€œfinal baptismâ€ with her children so they would be rid of â€œtheir demons.â€ Recently, she was seen by a psychiatric mental health provider who discontinued olanzapine, which she had been on for several years, because she had gained 50lbs after the birth of her 3rd child one year ago.
When Robin arrived at the ER, she refused to communicate, was sprinkling water on the evaluation room table, and chanting nonsensically. Per previous medical records, she gave birth at the hospital to a healthy daughter one year ago and may have been experiencing post partem depression at discharge. She was referred to a visiting home health RN who had her last meeting with Robin 2 weeks ago. Robin is disheveled, wearing a torn blue dress and is barefoot. She displays no eye contact and is pacing from wall to wall. When given water to drink, she poured it on the floor. She is refusing to have any labs drawn.
Husband reports that she has a history of one psychiatric inpatient admission before they were married and he has little details on any course of treatment, other than her PCP was treating her symptoms until she began having odd thoughts that her PCP was the â€œMessiah.â€ Her PCP subsequently referred her to a psychiatric mental health provider who discontinued the olanzapine and started her on paroxetine for complaints of increasing anxiety. Husband also says that she has been getting little sleep and has been â€œtalking to herself.â€ Prior to this episode, mother-in-law was making plans to fly out and help with the children because Husband felt that Robin was neglecting the children who were appearing unkempt. The kindergarten teacher of the oldest son had recently called the parents voicing concern about his appearance and school performance.
Currently, Robin is in a room in the psych ER with a one-to-one staff member sitting outside the door.
1. What are the nonpharmacologic interventions that would help?
2. What are the psychopharmacological interventions that would help?
3. Identify safety risks and how they should be dealt with in the treatment plan.
Include current supportive evidence in your responses to the questions above using two required resources from this weekâ€™s materials and one new resource. National guidelines should also be considered with treatment plans.