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neelamrana

Child PMPS,Plz comment.

6 posts in this topic

1.U r cald by peadiatric SHO for a 16 yr old girl who was admitted 2 days ago with an overdose of 15 tablets of valium and history of DSH by cutting her wrists in the past.Her parents are splitup and her mother is responsible for her care.However she has been kicked out of her house by her mother and also her father has refused to take her in once she is discharged.she has a history of taking drugs including alcohol,cocaine and cannabis.

How wud u assess and mange the girl.

the father is however also concerned abt her future care and wants treatment for her drugs problem.

the girl has dropped out of school seven months ago.

2.A 14yr old boy from zimbabwe brought by his mother with history of behaving strangely and hearing voices.Boy has recently come to UK along with his father and other 3 siblings to join his mother who has sought asylum 3 yrs ago.After the initial assessment the mother doesnt want him to be admitted and wants to take home.

How wud u assess him and manage this situation.

the mother in the past has been on olanzapine.

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First one, lots of questions:

generally usual assessment of patient due to overdose, low mood, suicide etc

additional factors: drugs misuse, hx of self-harm, rejection from parents, marital family problems in the past, possible family violence

Dilemma: as she is 16 her mother can legally kick her out; the girl is now homeless;

if you don't think that she need hospital admission where would she be discharged?

Social Services need to be involved early.

Difficult situation if you need to admitt the girl and she doesn't agree;

if you can't find a bed on an adolescent unit and have to admit on a adult ward.

Also from the MHA point of view I assume that her parents are still her nearest relative?

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this is a complicated situation with issues of consent to treatment, establishing the underlying diagnosis of the boy presentation, risk assessment he poses to himself and others and advicing on management.

as the child is 14teen his mother has the right to decide for him. but this could be overriden by the court which I will approach to admitt the child for assessment.

after this hurdle I think the pmp should be straight with the importance of involving the team in the management looking at the circumstances around the family.

wat do people think :-/

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second PMP

from the hx it appears that the boy might be experiencing psychotic symtoms; also that his mother had been treated with antipsychotic medication

this would raise suspicion for first on-set psychosis; obviously we need to exclude other conditions (drug misuse, anxiety disorders including PTSD, cultural issues etc)

we need to do a thorough risk assessment and decide wether the boy can be treated in the community or he needs hospital treatment; of course he might be perfectly healthy but there might be some risk issues from his mother's illness.

this family are asylum seekers/refugees; I would discuss any concerns with a senior collegue and social services

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for 16-17 yr old, do we involve the parent even if the teenager disagrees to such an involvement e.g. AN?

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