Intermunicipal, regional, and national response, with international assistance C Note. Emergency planning is an approximate process that, in many instances, is little more than codified common sense. It also involves a collective effort and is thus a participatory process.
She was noted to be continuously crying and intermittantly yelling at her mother so the inpatient physicians were called immediately.
Upon arrival, she left the room, walked down the hallway and left the floor. The resident physician tried to convience her to return to the room but she refused and went on an elevator. The resident returned to the floor and called the security staff to help find her. Her family tried to contact her personal cellphone and went to their car without success in locating her.
After 30 minutes she came back to the floor by herself. She continued to be tearful with occasional outbursts. The nursing staff was concerned about her mental health and another episode of elopement.
The past medical history revealed depression treated by counseling. She was evaluated that evening by psychiatry staff who felt that she had some depressive features consistent with chronic illness, and she was not a risk to herself or others.
They also felt her pain was possibly due to a conversion disorder, but this could not be diagnosed until a full medical evaluation had been pursued. She was placed in a single room close to the nurses station and as far away from the outside ward doors as possible.
The patient was closely monitored by the nurses. The healthcare team made contingency plans including security and psychiatry staff in case she eloped again or became out of control. All the testing was negative and the diagnosis of conversion disorder with depressive symptoms and histrionics was made.
Discussion What often is described as adolescent out-of-control behavior can range widely. Normal disputes between adolescents and their family, friends, teachers, etc.
The differential diagnosis may include: Depression Major depression — full depressive picture without episodes of mania Bipolar disorder — full depressive picture with previous episodes of mania Dysthymic disorder — chronic, milder symptoms, often with insidious onset and constitutional factors predisposing Adjustment disorder — stress is identifiable and stopping the stress usually improves or stops the depression.
However, stress removal may not simply stop the depression Bereavement — loss is the stress. This can include death but also greiving for other losses such as physical health Suicide — attempt or ideation.1 1 Ethical Challenges and Dilemmas in Organizations A Case Study Approach The business of the modern world, for better or worse, is business.
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