Put your knowledge and skills to the test with the case of a 13 year old girl who presents to the ED with an acute onset of amnesia, confusion, and slurred speech. Her vitals are stable, bloodwork is normal, and examination only reveals some muscle soreness and gait instability.
With regards to her past medical history, she was diagnosed with PANDAS and was treated for tics with some psychotropic medications as a young child. She has a previous history of viral meningitis, MRSA abscesses, and an unusual seizure history for which she was treated with antiepileptic drugs. She also has a history of sexual abuse dating back 6 years ago, around the same time that her sister tried to suffocate her brother and social services became involved. She has experienced bullying at school, and 6 months ago she had been engaging in cutting behaviours, for which she received counselling. In the last 3-4 months her mother reports that she has displayed disturbing writings, drawings, and conversations with others. She has no psychiatric diagnoses, nor does she have a history of suicide attempts or psychiatric hospitalizations.
Can you come up with a diagnosis or treatment plan?
"A teen with seizures, amnesia, and troubled family dynamics" by Shephali Sharma and Julie Alonso-Katzowitz (Current Psychiatry)
With regards to her past medical history, she was diagnosed with PANDAS and was treated for tics with some psychotropic medications as a young child. She has a previous history of viral meningitis, MRSA abscesses, and an unusual seizure history for which she was treated with antiepileptic drugs. She also has a history of sexual abuse dating back 6 years ago, around the same time that her sister tried to suffocate her brother and social services became involved. She has experienced bullying at school, and 6 months ago she had been engaging in cutting behaviours, for which she received counselling. In the last 3-4 months her mother reports that she has displayed disturbing writings, drawings, and conversations with others. She has no psychiatric diagnoses, nor does she have a history of suicide attempts or psychiatric hospitalizations.
Can you come up with a diagnosis or treatment plan?
"A teen with seizures, amnesia, and troubled family dynamics" by Shephali Sharma and Julie Alonso-Katzowitz (Current Psychiatry)
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