Case Study Petunia Park Program Transcript

[MUSIC PLAYING]

MOORE: Hi. Good afternoon. My name is Dr. Moore. Am I understanding you’re here for a mental health assessment today?

PETUNIA PARK: That’s right.

MOORE: OK. So to make sure I have the right patient and the right chart, can you tell me your name and your date of birth?

PETUNIA PARK: Yes. I’m Petunia Park. My birthday is July 1, 1995. DR. MOORE: And can you tell me what today’s date is?

PETUNIA PARK: So it’s December 1. DR. MOORE: Do you know the year? PETUNIA PARK: 2020.

MOORE: And what day of the week is this? PETUNIA PARK: It’s Tuesday.

[CHUCKLING]

MOORE: And do you know where we are today?

PETUNIA PARK: Yes I am here in the beautiful, sunny office at the clinic.

MOORE: OK, great. Thank you. So can you tell me a little bit about why you’re here today? What brings you here today?

PETUNIA PARK: Yes. So I have a history of taking medications and then stopping them. I don’t think I need them. I really feel like the medication squashes who I am.

MOORE: OK, OK. So I’m going to be able to help you with that. But to begin, I’m going to ask you some questions about your family. I’m going to ask you some history- type questions. I’m going to ask you some symptoms that you might be having. And all of these questions are going to help me work with you on a treatment plan, OK? So I would like to begin with, when was the first time that you ever had any mental health or substance use treatment in your life?

PETUNIA PARK: OK. Well, when I was a teenager, my mom put me in the hospital after I went four or five days without sleeping. I think I may have been hearing things at that time. [CHUCKLES] I think they started me on some medication, but I’m not sure.

MOORE: Oh, OK so you were hospitalized. How many times have you been hospitalized for mental health?

PETUNIA PARK: Oh, I’ve been hospitalized about four times. The last time was this past spring. No detox or residential rehabs, though. Case Study Petunia Park Program Transcript

MOORE: OK, good. Were any of these hospitalizations due to any suicide gestures?

PETUNIA PARK: One was in 2017. I overdosed on Benadryl, but I’ve not had those thoughts since then.

MOORE: Well, I’m very glad to hear that you’ve not had any of those thoughts since then. And I’m glad that you turned out OK from that overdose. I’m glad that you’re here today. Can you tell me a little bit about what you’ve been diagnosed with during your past treatments?

PETUNIA PARK: Well, I think depression, and anxiety, had some even say maybe bipolar.

MOORE: OK, and what medications have you been tried on before for those illnesses? And if you can remember, what was your reactions to those medications?

PETUNIA PARK: Oh, let’s see. Oh, I took Zoloft, and that made me feel really high. [CHUCKLES] I couldn’t sleep. My mind was racing, and then I took risperidone. That made me gain a bunch of weight. Seroquel gave me weight, too. I took Klonopin, and that seems to slow me down some.

I really can’t remember the others. I think the one I just stopped taking was helping. It started with an L, I think. I don’t really remember the name, but it squashed me in creativity.

MOORE: OK, well, we’re going to try to help you find some medication that doesn’t make you feel squashed or have any of those negative side effects today. But in order to do that, I need some more information. And the next questions I’m going to ask you are about substances you may have used. And I want you to know that you don’t get in trouble in here if you’ve used some of these substances. It really just helps me to make sure that what’s in your system that could be impacting your neurochemistry. And when we do talk about medications, so I don’t give you something that would negatively interact with something you may be using, OK? So do you–

PETUNIA PARK: OK.

MOORE: –use any nicotine?

PETUNIA PARK: Yes. I smoke about a pack a day, and I’m not going to quit for you, either. [CHUCKLES] Oh.

MOORE: That’s OK, that’s OK. And what about alcohol? When was your last drink of alcohol?

PETUNIA PARK: When I was 19 because alcohol and me do not work well together. [CHUCKLES]

MOORE: OK, and what about any marijuana? When was your last use of any marijuana?

PETUNIA PARK: Oh no. I tried that once and got really paranoid. DR. MOORE: OK. What about any last use of cocaine?

PETUNIA PARK: Never.

MOORE: Last use of any stimulants or methamphetamines? PETUNIA PARK: Never.
MOORE: What about any huffing or inhalants? PETUNIA PARK: Never.
MOORE: OK, have you used anything like Klonopin or Xanax, any of those sedative medications?

PETUNIA PARK: Never.

MOORE: All right, good. What about any hallucinogenics like LSD, or PCP, or mushrooms?

PETUNIA PARK: No, never.

MOORE: Wonderful. OK, what about any use of pain pills or opiate medications? Anything prescribed or anything you’ve obtained from the street?

PETUNIA PARK: No, never.

MOORE: Good. And anything synthetic like Spice, or ecstasy, Bath Salts, Mollies, anything like that?

PETUNIA PARK: Never.

MOORE: Oh, wonderful. Well, I’m glad to hear that. You know those things aren’t good for your brain. So I encourage you to continue to stay away from those things.

Have you ever had any blackouts or seizures from drugs or alcohol? Or seen things that you weren’t sure were there?

PETUNIA PARK: Never.

MOORE: Good. What about any legal issues or any DUIs? PETUNIA PARK: Never.
MOORE: OK. Good, good. All right, so I’m just going to ask a little bit about your family right now. Any blood relatives have any mental health or substance abuse issues? Case Study Petunia Park Program Transcript

PETUNIA PARK: Yeah, well, well, why would you ask that? It’s not your business.

MOORE: Right. I could see where you might find that wouldn’t be any my business. But really, sometimes these issues can be genetic. They’re alarm behaviors. So my understanding of your family helps me to understand you.

PETUNIA PARK: Huh. Well, my mother was seen as crazy. I think they said she had bipolar or something. And my father went to prison for drugs. And well, we haven’t heard, or seen, or heard from him in 8 or 10 years. My brother, while I think he’s a little schizo, but he hasn’t ever went to the doctor. Nobody else with anything.

MOORE: OK. So that sounds like it must be tough growing up not seeing your father and having some of those issues in your family. But any family, blood relatives commit suicide?

PETUNIA PARK: Well, my mom tried, but nobody really did it, you know?

MOORE: OK. Have you ever done anything like that, or anything like cut on yourself, burn yourself?

PETUNIA PARK: I already told you, I tried to kill myself. Why ask me that again? No, I’m not going to kill myself or anyone else, and I don’t cut myself.

MOORE: OK. Well, I’m glad to hear that. And I want you to know that I am here for you, and we most certainly will make sure you have a crisis like number at the end of this session if you do have those thoughts in the future. So I’m glad to hear that you don’t have those thoughts today. OK. What type of medical issues do you have?

PETUNIA PARK: Oh, hoo. Let’s see. I have a thyroid issue that I take some medicine for, that hypothyroidism. And I take a birth control pill for polycystic ovaries.

MOORE: OK, when was your last menses?

PETUNIA PARK: Oh, well I have a regular one each month. So let’s see. It was last month sometime.

MOORE: OK, so any chance that you’re pregnant?

PETUNIA PARK: [LAUGHS] Lordy, no. I may have a lot of sex around, but I’m safe.

MOORE: Hm. You “have a lot of sex around.” Can you maybe tell me what that means?

PETUNIA PARK: Well, it’s exciting and thrilling to find new people to explore sex with. It helps me keep my moods high, high, high. [CHUCKLES]

MOORE: OK, so that makes you feel really high and kind of what, OK? PETUNIA PARK: Oh yeah.
MOORE: So who raised you?

Case Study Petunia Park Program Transcript

PETUNIA PARK: My mom and my older brother, mainly. DR. MOORE: And who do you live with now?

PETUNIA PARK: Well, I live with my boyfriend. And sometimes, stay with my mom when he gets mad at me for sleeping around some.

MOORE: So that’s created some issues in your relationship, I see. OK. Are you single, married, widowed, or divorced?

PETUNIA PARK: I’ve never been married. DR. MOORE: OK. Do you have any children? PETUNIA PARK: No.

MOORE: All right. Are you working?

PETUNIA PARK: Yes, I work part time at my aunt’s bookstore. She’s more tolerant of the days I don’t come in from feeling too depressed.

MOORE: OK, so I hear some, maybe, feelings of depressed. OK. What is your level of education?

PETUNIA PARK: Oh, I’m in vo-tech school right now for cosmetology. I’m going to do makeup for movie stars. [CHUCKLES]

MOORE: Oh, that sounds really wonderful. OK, so but what about now? What do you do for fun now?

PETUNIA PARK: Well, I am writing my life story, and it’s going to be published. I also paint like Picasso. I’m going to sell those paintings to movie stars, too. Case Study Petunia Park Program Transcript

MOORE: Well, that’s wonderful. Maybe someday you can show me your paintings as well. OK, have you ever been arrested or convicted for anything?

PETUNIA PARK: No. The police did pick me up and take me to the hospital once. I didn’t have much sleep that week. And they said I was dancing around in my nightgown in a field with my guitar. I really don’t remember much of that, though. I think maybe my mom made up that story against me because she wanted me to go back to my boyfriend’s house.

MOORE: OK, so that was one of your hospitalizations that we talked about earlier. OK, what about any history of trauma with childhood or adult? Any kind of physical, sexual, emotional abuse?

PETUNIA PARK: Well, my dad was pretty hard on us when he was around. But he didn’t really touch us or anything. More just yelled at us a lot.

MOORE: OK. All right, so I’ve gathered some history here. Now, I want to get into more of some of the symptoms that brought you in to see me today. So you mentioned before that sometimes your depression keeps you from working at your aunt’s bookstore. Can you tell me a little bit more about what that looks like for you?

PETUNIA PARK: Well, about four or five times a year, I have these times when I just don’t want to get out of bed. I have no energy, no motivation to do anything. I just can’t feel any interest in my creativity. I feel like I’m not worth anything because I feel that creativity slipping away.

So this is usually happening after I’ve been up for five days working hard on my works with my writing, painting, and music. Everyone says I’m depressed, but I’m not sure. It could be that I’m just exhausted from working so hard.

MOORE: OK, so I hear you talking about these creativity episodes right before you crash. Per se, this depression. Tell me a little bit more about those episodes. What do those look like for you?

PETUNIA PARK: Oh, I love those times. Those are the reasons I don’t always take my medication because I feel like I’m squashed. I have lots of energy to do a lot of things. I can go four or five days with very little sleep. I get lots of things done, but my friends tell me I talk too much and appear scattered.

[SIGHS] They’re just jealous of all the accomplishments I’m getting done. These are the times I look to explore my mind and body with feeling good through sex with other people.

MOORE: OK, how long do those episodes last typically when you have them? PETUNIA PARK: About a week.
MOORE: About a week. OK. So I want to ask a little bit more about some other symptoms that maybe we haven’t talked about. Do you feel like you worry a lot or have any kind of anxiety and panic symptoms?

PETUNIA PARK: No, no no. I’m not a worry.

MOORE: OK, do you do anything that you feel like you have to do repetitively over and over? And if you can’t do them, you feel like the end of the world is coming?

Something like maybe count on threes or wash your hands 20 times? Anything like that?

PETUNIA PARK: [LAUGHS] No, no. I don’t have OCD, if that’s what you’re asking.

MOORE: OK, what about hearing or seeing things you’re not sure others see or hear? Anything like that?

PETUNIA PARK: Not right now. It’s been a couple of months since that happened. Sometimes when I’m not sleeping good, I hear voices telling me how great and wonderfully talented I am.

MOORE: OK. So, but no voices right now? PETUNIA PARK: No.
MOORE: OK, good. What about your appetite? How’s your appetite?

PETUNIA PARK: Well, when I’m really creative, I’m too busy to eat. And when I’m crashing and resting, I eat everything in sight.

MOORE: OK, so what about your sleep? On average, how much time do you think you sleep in a whole 24-hour period? And do you have any bad dreams? Case Study Petunia Park Program Transcript

PETUNIA PARK: No bad dreams. Most of the time, I get about five or six hours. When I’m creative, I’m lucky to get three hours and a whole week. Ugh. And when I’m crashed, I sleep about 12 or 16 hours a day.

MOORE: OK, wonderful. So this is great. I have a lot of information from you that I think we will be able to come up with a treatment plan and maybe find some medication that’s going to help you feel better without you feeling so squashed and having negative side effects, but really help you be able to function through the day.

[MUSIC PLAYING]

Week (#4): (Petunia Park)

College of Nursing-PMHNP, Walden Nursing

NRNP6665: PMHNP Across the Lifespan 1

Dr. VS

Petunia Park

Subjective:

Chief Complaint: Mental Health Assessment

History of Present Illness (HPI.): Ms. P.P appears to be a young Mexican woman, age

19, present for mental health assessment. Ms. Park stated her birth date is July 1, 1995. She has no current medication presently. She has a history of taking drugs and then stopping them. Ms. Park stated, “I

don’t think I need them. I feel like the medication squash who I am”. The patient continues to have anxiety, depression, and manic episodes, with possible OCD and schizophrenia due to hearing voices and hospitalization. P.P. works at aunt bookstore once in a while. The patient stated she is in Voc-tech school for cosmetology. “I am going to do make-up for movie stars.

General Statement: I will get enough information to come up with a treatment plan and maybe find some medications that will make you feel better without you feeling so squashed and having negative side- effects, but help you able to function through the day.

Caregiver: Ms. P is her caretaker but lives with her boyfriend; but sometimes stays with mom and brother when he gets mad for becoming and being promiscuous.

Hospitalization: Ms. Park stated: “When I was a teenager, my mother put me in the hospital after I went four or five days without sleeping. I think I may have been hearing things at that time”. [Chuckles]. Ms. Park stated she had been confined to hospitalization about four times. The last time was this past spring. No detox or residual rehab, though. One was in 2017. I overdosed on Benadryl, but I have not had those thoughts. Police picked her up and took her to the hospital once.

Medication trials: Ms. Park has taken Zoloft, which made her feel high and could not sleep, Risperidone, which made were mind race and gained a bunch of weight, Seroquel has increased importance as well, and Klonopin, which seemed to slow her down. I really cannot remember the others. “I think the one I just stopped helping.” It started with an “L,” I think. I do not reflect the name, but it squashed me in creativity.

Psychotherapy or Previous Psychiatric Diagnosis: Ms. Park stated depression, anxiety, and some bipolar and denies OCD. Not hearing or seeing thing right now (schizophrenia). Sometimes when I am not sleeping well, I listen to the voices telling me how great and wonderfully talented I am. It has been a couple of months since that happen.

Substance Current Use and History: Smokes about a pack a day, not going to quit for you either. Ms. P. drank alcohol at age 19, but it did not work well with me. Ms. Park denies using marijuana, cocaine, stimulants or methamphetamines, or any huffing or inhalant. Dismiss any sedative mediations such as Klonopin or Xanax, hallucinogenics like LSD, PCP, or mushrooms. Ms. P. does not

use pain pills, or opiate medications, or anything prescribed or from the streets. Dismiss any synthetic like spice, ecstasy, Bath Salts, Mollies. Ms. Park denies any seizures or blackouts from drugs or alcohol use.

Family Psychiatric/Substance Use History: The mother perceives to be crazy. I think she had bipolar or something? My father went to prison for drugs, and I have not heard or seen from him since in eight or ten years. My brother, I think, is a little “schizo,” but he has never seen a doctor. My mother attempted to commit suicide. Ms. Park tried to cut herself and kill herself. There was abuse by their father, and him being hard on her, yelling a lot. Ms Park denied any sexual abuse or physical abuse.

There was emotional and possible mental abuse in the yelling and her behavior.

Medical History: Ms. Park states she has thyroid issues and polycystic ovaries, loves sex, and loves to explore sex with different men.

Current Medications: None. Ms. P had tried several medications; her recent history of taking and then stopping them is a reliving problem. Ms. P. is on birth control pills for polycystic ovaries. Her medications were Zoloft, which made her feel high, she could not sleep, and her mind was racing; Risperidone, gained much weight; Seroquel gained weight also. Klonopin: that seems to slow me down. The last one begins with an “L.” I do not remember, but that squashes me in creativity.

Allergies: No allergies stated to medication, food, or pollen.

Reproductive History: On birth control pills, denies being pregnant. Have regular menus. Being promiscuous, but declares being safe. Menses was last month sometime and would not give a specific date. Ms. P.P. identifies herself as a woman. Ms. P. states she has polycystic ovaries.

R.O.S.

General: The patient appears in good health, is height/ weight proportionate, she appears slightly older than she stated. Vital signs typical, no fever. No malaise or weight

HEENT: No blurred vision, visual loss, or yellow sclera. Ears, Nose, Throat: No hearing loss, nasal drainage/congestions, headaches, or sore throat.

SKIN: No wounds, flushing, rashes, redness, or itching.

CARDIOVASCULAR: No chest pain, chest pressure, or discomfort. No palpitations or edema. RESPIRATORY: No shortness of breath, difficulty breathing, cough, sputum, or cyanosis GASTROINTESTINAL: No anorexia, nausea, vomiting, diarrhea, or constipation. No abdominal pain or discomfort. No blood.

GENITOURINARY: No burning on urination, urgency, hesitancy, pain, or discomfort. Denies any odor or odd color in urine. No alteration in the bladder.

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control. The gate appears even and smooth.

MUSCULOSKELETAL: No muscle or joint pain, weakness, back pain, stiffness, or reduction of range of motion.

HEMATOLOGIC: No excessive bleeding, anemia, clotting, or bruising. LYMPHATICS: No enlarged painful nodes. No history of splenectomy ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance, hair loss, excess urination, fatigue, or polydipsia. She has thyroid issues.

OBJECTIVE:

Diagnostic results: Vital signs are within normal range: Temp: 98.2; Pulse: 90: Respiration: 18: Blood Pressure: 138/88. Laboratory Test: Urine drug and alcohol screen negative. CBC within normal ranges, CMP within normal ranges. Lipid panels are within normal ranges. Prolactin Levels 8; TSH 6.3 (H). The CMP and CBC can help determine the general health of the patient.

Still, TSH and PRL are necessary due to the relationship between reproductive hormones, thyroid disease, and depression in women. The prolactin is normal but on the low side. Hypothyroidism and medication can create Hypo- prolactinoma levels (Jacobson, 2012; Petruzzelli et al., 2020). TSH levels can cause an increased risk for readmission secondary to exacerbated depressive symptoms when thyroid disease is untreated (Yang et al., 2021).

Assessment:

Mental Status Examination:

The patient appears alert but not orientated. Ms. P. stated her birthday is July 1, 1995, and today’s date patient said December 1^st, 2020, which makes her only five years old. Ms. P’s developmental age appears a lot older than that. She seems to be about 19 years of age, a Mexican American young woman who looks much older than her age. She is semi-cooperative. She is neatly groomed and clean and dressed appropriately. There is no evidence of any abnormal motor activity. Her speech is clear, presently coherent during the interview, and standard in volume and tone.

The thought process is incongruent with her goals directed and logic. Her logic was fair to poor, and insight was noted. Documented delusional thought process and pattern, but no AVH during the time of interview. Her mood is euphoric, and her affect appropriate to her spirit. There is some evidence of loss of association or flight of ideas. The patient’s eye contact is good; the patient’s body position is closed, with legs crossed in the chair.

Presently patient denies thoughts of suicide/self s harming but had thought in the past. She was chucking at inappropriate times. She denies any auditory or visual hallucinations at this time. Cognitively, she is alert and oriented. Her recent and remote memory is semi-intact all the way. She could not remember the drugs, dosage, and last time taken. Her hospitalization was unknown dates, where, and when or durations. Her concentration appears fair. Her insight is acceptable to the poor. She smokes and drinks, and she is highly promiscuous.

Diagnostic Impression:

The patient has multiple diagnoses. She does not meet all the criteria for Schizoaffective. According to American Psychiatric Association (2013), schizoaffective disorder is based on assessing an uninterrupted period of illness during which the individual continues to display active or residual symptoms of psychotic illness such as schizophrenia.

She hears the voices when she is manic, and lacks sleep. There are some overlapping symptoms, but she does not meet all criteria (Baryshnikov et al., 2020). She may meet the criteria for Bipolar Disorder with a introductory presentation of mania and depression (American Psychiatric Association, 2013). Manic has inflated self-esteem, decreased need for sleep, and flights of the idea. MDD is depression most of the day, insomnia, fatigue, feeling of worthlessness, or excessive or inappropriate guilt (Chen et al., 2021; Sadock et al., 2015).

The third possible diagnosis is a personality disorder. Diagnosis of borderline personality. It is a pattern of instability in interpersonal relationships, self-image and affects, and marked impulsivity (American Psychiatric Association, 2013; Bateman et al., 2015). She does meet these criteria because of the sexual risky behavior, instability interpersonal relationships, unstable self-image, self-cutting, and suicide attempts. This diagnosis will be deferred until it is collected and until other diagnoses are explored (Choukas-Bradley et al., 2020; Bateman et al., 2015).

Reflection:

In reflection on this case in question, questions regarding the extent, nature and frequency of her sexual risky behavior, suicide attempts, mania and depression . The trauma that occurred during her childhood needs to be further study and how it affected her. The information must differentiate between bipolar and personality disorder fully. Currently the behavior could point to personality disorder, specifically borderline personality, with a possible dual diagnosis of bipolar.

The hearing of voices comes when she’s manic and lack of sleep, which fits the diagnosis of bipolar. I do not think the schizoaffective disorder is the appropriate diagnosis. Medication is not first-line treatment, if she has borderline personality disorder. Psychosocial intervention is the primary treatment (Bateman et al., 2015). With comorbidity as in this case, Bipolar, medication would help and could be treated .

Case Formation and Treatment Plan

This Ms. P. tried so many medications and she has as a history of taking drugs and then stopping them; also, she has thyroid disease. My most significant concern is her risky behavior, mania, suicide attempts, and depression. Order labs and EKG to monitor the OT intervals, daily weight, Rapid plasma regains (RPR) and genetic marker for the family.

I would like to see a PCP to start her on Synthroid, plus considered Topiramate 50 mg B.I.D for mood and sleep (Stahl, 2017; Kantojarvi et al., 2020). Will slowly titrated medication up while assessing for side effects and efficacy over the next several months in an outpatient setting. The following medication would be Citalopram 20mg daily, which is a SSRI and S- RI, would use this for mood stabilization (Stahl, 2017; Onishi et al., 202; Kantojarvi et al., 2020). Will be slowly titrated up medication while assessing for side effects and efficacy over the next several months.

I would start therapy to explore the nature of her risky sexual behavior, her ineffective coping mechanism, and her instability interpersonal relationships. She will need support in identifying cognitive distortions, addressing stuck points in her trauma, creating a safety plan, and identifying positive coping skills. Ms. P. will have appointments for therapy and psychiatry services.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.
Baryshnikov, I., Sund, R., Marttunen, M., Svirskis, T., Partonen, T., Pirkola, S., & Isometsä, E. T. (2020). Diagnostic conversion from unipolar depression to bipolar disorder, schizophrenia, or schizoaffective disorder: A nationwide prospective 15‐year register study on 43 495 inpatients. Bipolar Disorders. https://doi.org/10.1111/bdi.12929
Bateman, A. W., Gunderson, J., & Mulder, R. (2015). Treatment of personality disorder. The Lancet, 385(9969), 735–743. https://doi.org/10.1016/s0140-6736(14)61394-5
Case Study: Petunia Park. (2021). https://class.waldenu.edu. Walden University Blackboard:
Chen, H., Li, W., Cao, X., Liu, P., Liu, J., Chen, X., Luo, C., Liang, X., Guo, H., Zhong, S., Wang, X., & Zhou, J. (2021). The Association Between Suicide Attempts, Anxiety, and Childhood Maltreatment Among Adolescents and Young Adults With First Depressive Episodes. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.745470
Choukas-Bradley, S., Hipwell, A. E., Roberts, S. R., Maheux, A. J., & Stepp, S. D. (2020). Developmental Trajectories of Adolescent Girls’ Borderline Personality Symptoms and Sexual Risk Behaviors. Journal of Abnormal Child Psychology, 48(12), 1649–1658. https://doi.org/10.1007/s10802-020-00699-4
CrashCourse. (2014). Depressive and Bipolar Disorders: Crash Course Psychology #30. On YouTube. https://www.youtube.com/watch?v=ZwMlHkWKDwM
Jacobson, S. A., & American Psychiatric Publishing. (2012). Laboratory medicine in psychiatry and behavioral science. American Psychiatric Pub.
Kantojärvi, L., Hakko, H., Mukka, M., Käyhkö, A., Riipinen, P., & Riala, K. (2020). Psychotropic medication use among personality disordered young adults. A follow-up study among former adolescent psychiatric inpatients. Psychiatry Research, 293, 113449. https://doi.org/10.1016/j.psychres.2020.113449
Onishi, Y., Mikami, K., Kimoto, K., Watanabe, N., Takahashi, Y., Akama, F., Yamamoto, K., & Matsumoto, H. (2021).
Second-Generation Antipsychotic Drugs for Children and Adolescents. Journal of Nippon Medical School, 88(1), 10–16. https://doi.org/10.1272/jnms.jnms.2021_88-108
Petruzzelli, M. G., Marzulli, L., Giannico, O. V., Furente, F., Margari, M., Matera, E., & Margari, F. (2020). Glucose Metabolism, Thyroid Function, and Prolactin Level in Adolescent Patients With First Episode of Schizophrenia and Affective Disorders. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00775
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry: behavioral sciences/clinical psychiatry (11th ed.). Wolters Kluwer.
Stahl, S.M. (2017). Essential Psychopharmacology: Prescriber’s Guide (6^th.). University Printing House
Yang, L., Yang, X., Yang, T., Wu, X., Sun, P., Zhu, Y., Su, Y., Gu, W., Qiu, H., Wang, J., Chen, J., & Fang, Y. (2021). The effect of thyroid function on the risk of psychiatric readmission after hospitalization for major depressive disorder. Psychiatry Research, 305, 114205. https://doi.org/10.1016/j.psychres.2021.114205
Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing. Walden University.(2022). Minneapolis, Minnesota

Case Study Petunia Park Program Transcript