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Gray skies are gonna clear up, put on a happy face


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2019 Aug 23, 3:59am   483 views  0 comments

by Al_Sharpton_for_President   ➕follow (5)   💰tip   ignore  

Case 26-2019: A 27-Year-Old Woman with Opioid Use Disorder and Suicidal Ideation

Approximately 3 months before admission, the patient became homeless and was staying intermittently with friends. Two months before admission, she began to ingest clonazepam daily, and 3 weeks before admission, she began to use intranasal heroin daily. She had depression and anxiety, and 2 days before admission, she expressed that she felt “tired of living this life” and wanted “to end it all.”

On the evening of presentation, the patient reportedly smashed her cell phone on the ground and ate the glass shards as a suicide attempt. Nausea and diffuse abdominal discomfort developed, and she reportedly had an episode vomiting, with the vomit containing 2 teaspoons (10 ml) of blood. Three hours after the ingestion, she presented to the emergency department of this hospital with throat, chest, and abdominal pain. She reported that she had “regret” about the ingestion and wanted “help” with her substance use and suicidality.

The patient reported past sexual trauma but did not provide details; she did not report any previous suicide attempts, homicidal ideation, or hallucinations. A limited review of systems was notable for anorexia, diaphoresis, diarrhea, impaired sleep, fatigue, mood lability, nightmares, and flashbacks. Her psychiatric history included polysubstance use disorder (with the use of intravenous heroin, fentanyl, benzodiazepines, and cocaine), cutting behavior during adolescence, and anxiety and depression. She had never undergone psychiatric treatment or hospitalization. Her medical history included hepatitis C virus infection, obesity, genital herpes simplex virus infection, and a low-grade squamous intraepithelial lesion of the cervix; in addition, a motor vehicle collision had led to open reduction and internal fixation involving the left arm. She took no medications and had no known adverse reactions to medications. She worked in a local store and had a small child. She had smoked one and a half packs of cigarettes daily for the past 10 years and was a current smoker. She drank 1 pint of vodka daily and reported no history of withdrawals or blackouts. Multiple relatives, including both of her parents, had a history of substance use disorder.

https://www.nejm.org/doi/full/10.1056/NEJMcpc1904043

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