Patient was seen via telehealth/videoconference Patient would

Patient was seen via telehealth/videoconference Patient would like to be called: “Kelson” Pronouns: He / Him Mikayla is a 14 year old female admitted to Partial Hospitalization Program referred from In Patient. Patient admitted for homicidal ideations. Patient reports that they have been having intrusive thoughts about wanting to kill someone. Per intake note patient has been mutilating animals and mother found a decapitated mouse in a jar. Mother has also found chicken bones in his drawer. Mother has found drawings of mutilated people and reports that patient has been obsessed with Jeffrey Dahmer. He reports that he found a mouse that was dead and he mutilated. He reports that it was his first time. He has thought about mutilating an animal for a while. He reports also having thoughts to hurt any person, no attempt. Mikayla was diagnosed with MDD severe with Psychosis and GAD. He is currently on Abilify 5 mg and Vistaril 50 mg. He reports having these thoughts 1 year ago. He reports that it started little by little. He denies any history of being abused and trauma. He is curious about what it will look like inside. He has thoughts of both killing and finding out what is inside. He reports feeling depressed. He reports depression started 2 years ago when parents got divorced. He reports feeling upset, out of his control, he reports low motivation and isolation, he has experienced suicide thoughts, no previous attempts. No self harming behaviors. He reports some anxiety, he overthinks and worries. He reports history of panic attacks. Not recent. He reports mood swings, he gets overwhelmed. He reports happy to sad and sad to mad. He reports feeling interested in the mutilation and “joyful in a way” and he does not feel angry about it. He is aware that it is not a normal feeling. He knows that it is wrong. He knows that he can go to jail if he hurts someone. He would like help and like to get better. He is aware it is wrong. He denies anger and aggression. He has been eating and sleeping okay. Psychiatric History / Onset of Illness: Hospitalization 1 time Outside psychiatrist: none Outside therapist: Has not seen a therapist for 2 years He is not currently taking any medications. History of Suicidal ideations: Yes History of Suicide attempts: None History of homicidal ideation: Yes History of Homicidal attempts: None but has mutilated a dead mouse History of physical aggression: None History of property destruction: None History of aggression towards animals: Yes Legal History: None Last psychiatrist: Last therapist: Substance Use / Abuse History: He has experimented with alcohol. None current Trauma / Abuse History: No history of abuse Medical Health History: Denies Developmental / Educational / Vocational History: No known in utero exposure to drugs or alcohol Normal child milestones Has IEP, Currently in the 8th grade, History of being bullied Grades: good, No suspensions Questions: As a PMHNP for a Partial Hospitalization Program, what is your role in the program? What discharge instructions you should expect from the hospital? As a PMHNP, do you feel that the medication is appropriate? What type of medication is Abilify, what are the indication and side effects to be noted? What recommendations and treatment plan would you recommend for the patient and family? What are the goals for treatment.

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