Hello world!

Welcome to WordPress. This is your first post. Edit or delete it, then start writing!

Was asked to see the patient with concern for Xanax withdrawal. The patient reports she is in the hospital with concerns about her health following several episodes of severe illness related to her diabetes, including elevated blood sugars and episodes of vomiting. She has visited the emergency room multiple times for the same symptoms. The team is evaluating her due to concerns about possible withdrawal from benzodiazepines, specifically Xanax, which the patient denies regularly misusing. Sheila reports that she has taken less than half of 12 Xanax tablets, which were not prescribed but obtained off the street. She last used Xanax two days ago and is uncertain about the exact dosage, thinking they were 10 mg but later considering they might be 5 mg. She does not believe her current symptoms are related to benzodiazepine withdrawal.

Sheila reports persistent anxiety, for which she has been previously treated with BuSpar. She also admits to experiencing panic attacks. While she does not struggle significantly with depression, her overall energy level and appetite are low. She denies any suicidal ideation, homicidal thoughts, or hallucinations.

Staff reports she was positive for benzodiazepines and opiates on screening.

Past Psychiatric History:
No history of psychiatric hospitalizations or suicide attempts

Past Medical History:
Diabetes
Multiple surgeries: four surgeries on her shattered elbow (seven years ago) and surgeries on her heel following an infection that reached the bone

Current Medications:
Protonix

Medication Allergies:

Reports an unspecified allergy

Relevant Social History:

Lives with her husband and daughter
Previously cared for her mother, who passed away in January after being in and out of care facilities

Family Psychiatric History:

None reported

Habits/Substance Abuse History:
Smoking: None
Alcohol: None
Drugs: Occasional misuse of street-purchased Xanax
No other recreational drug use

Mental Status Examination:
Appearance: Poor, edentulous
Behavior: Cooperative
Speech and language: Regular rate and volume
Mood: Anxious
Affect: reactive
Thought process/content: linear
Suicidality: Denied
Homicidality: Denied
Hallucinations: Denied
Cognition: Grossly intact
Memory: Fair
Concentration: Fair
Insight: Fair
Judgment: Fair

Integrated Case Formulation/Summary: The patient presents with ongoing anxiety and recent panic attacks. While she does not believe her symptoms are related to benzodiazepine withdrawal, her history of occasional misuse of Xanax raises concerns about possible withdrawal symptoms. She has several chronic medical issues, including diabetes and a history of multiple surgeries. Her anxiety has been treated with BuSpar, but she reports ongoing panic attacks. She denies any significant depressive symptoms but does experience low energy and poor appetite.

Impression:
Generalized anxiety disorder
History of panic attacks
Benzodiazepine misuse
Diabetes, poorly controlled
Recent surgeries and complications related to diabetes

Risk Assessment:

No current suicidal ideation or homicidal thoughts
No risk of self-harm or harm to others

Recommendations:

Monitor for potential benzodiazepine withdrawal symptoms
Recommend CIWA or similar alcohol/benzodiazepine withdrawal protocol to manage any benzodiazepine withdrawal.
Recommend outpatient psychiatric follow-up once discharged from the hospital.
Recommend local resources for substance misuse.