Chief Complaint: Suicide Ideations
HPI:
45-year-old single, Hispanic female currently domiciled with a friend in Rego Park with no PMHx presents for concerns over suicidal ideations. Patient states she was at a medical appointment today and when asked about suicidal intentions, she states she had active thoughts of suicide with a plan of overdosing on pills. Patient denies any suicidal thoughts in the past. Patient also reports insomnia two weeks ago but endorses experiencing better sleep for the last two days. She states she just moved to the U.S. from the Dominican Republic seven months ago and is currently residing with her friend in Rego Park. She has two children, a son and daughter of ages 15 and 18 , who are both in the Dominican Republic with her parents. Patient states she has had a difficult time since she has come to the United States and misses her children. Patient came here in hopes to start a job and bring her children here but has yet to begin employment due to difficulty finding a job. Patient denies any use of illicit drugs or alcohol. Attempted to contact patient’s friend who she is currently residing with, however, unable to get in touch.

Past Medical History:
Denies
Past Surgical History:
Denies
Medications:
Denies
Allergies:
No Known Allergies
Family History:

Mother and Father – alive and well
Social History:
Smoking: Denies
Alcohol: Denies
Recreational Drugs: Denies
Marital Status: Single
Occupation: Unemployed
Diet: Reports a well balanced diet
Sleep: (7-8 hours a day)
ROS:
General: Denies fever, chills, diaphoresis, weakness, fatigue
Head: Denies headache, dizziness, recent trauma
Eyes: Denies blurry vision, decreased vision
Respiratory: Denies SOB, cough, or wheezing.
Cardiovascular: Denies chest pain, palpitations, feet/ankle edema
Gastrointestinal: Denies abdominal pain, nausea, vomiting, diarrhea, constipation
Nervous system: Denies seizures, LOC, weakness, loss of strength, changes in cognition, mental status
Musculoskeletal: Denies any muscle/joint pain, swelling, numbness, weakness.
Psychiatric: Admits to current suicidal ideations. Admits to decrease sleep 2 weeks ago but improved now. Denies current /homicidal ideation or auditory/visual hallucination.

Physical Exam:
BP 120/76 HR 74 RR 16 Temp 98.1F SPO2 98%
Patient is a 45 year old female who appears her stated age. Patient is alert to person, place, and time.

Mental Status Exam:

GENERAL:

1. Appearance: 45 female with brunette hair. She appears well groomed. Patient is in no apparent distress.
2. Behavior and Psychomotor Activity: Patient spoke in normal rhythm.
3. Attitude Towards Examiner: Patient was cooperative and maintained appropriate eye contact. SENSORIUM AND COGNITION:
4. Alertness and Consciousness: Pt was alert and conscious.
5. Orientation: Pt was oriented to the time of day, the place and the date.
6. Concentration and Attention: Pt demonstrated appropriate concentration and attention. She provided relevant responses to all questions.
7. Capacity to Read and Write: Pt can read and write.
8. Abstract Thinking: Pt clarified thoughts and displayed intact abstract thinking.
9. Memory: Remote and recent memory were intact. Remembered all events leading to visit.
10. Fund of Information and Knowledge: Pt’s intellectual performance was consistent with her level of education.
    MOOD AND AFFECT:
11. Mood: Patient was sad and appeared to have minimal energy and to be isolated.
12. Affect: Blunted affect
13. Appropriateness: Mood and affect consistent with topic discussed. No outburst of emotions. MOTOR:
14. Speech: Pt’s speech was in normal tone, slow speed, and clear.
15. Eye Contact: Pt had adequate eye contact.
16. Body Movements: No psychomotor abnormalities observed. Pt has no extremity tremors or facial tics. All movements were fluid.
    REASONING AND CONTROL:
17. Impulse Control: Pt has acute suicidal ideations/plan.
18. Judgment: Pt had good insight as to why she is here due her suicidal ideations.
    Differential Diagnosis:
    • Major Depressive Disorder (MDD)
      ● The patient is presenting with active suicidal ideation, which is a hallmark symptom of MDD. Additionally, her insomnia (even though improved recently) and emotional distress stemming from missing her children and difficulty finding employment strongly suggest a mood disorder. The stressors in her life (immigration, separation from family, unemployment) could have triggered a depressive episode. The patient has no prior history of depression, which might make this less likely. However, first episodes of depression can occur later in life, and recent life stressors significantly contribute to this diagnosis.
    • Adjustment Disorder
      This disorder is characterized by emotional distress or symptoms like depression, anxiety, and insomnia, triggered by significant life changes or stressors. The patient’s recent immigration, separation from her children, and struggle with employment are strong potential stressors that could lead to adjustment disorder. The patient seems overwhelmed by her life circumstances, which may have led to suicidal ideation. While adjustment disorder is common in response to life stressors, the presence of active suicidal ideation with a specific plan may indicate a more serious underlying psychiatric condition, such as MDD, rather than just an adjustment issue. The severity of her suicidal thoughts makes adjustment disorder a less likely diagnosis alone.
    • Generalized Anxiety Disorder (GAD) ● Anxiety disorders, particularly GAD, can contribute to feelings of overwhelming distress, poor sleep, and a pervasive sense of worry about one’s future. The patient is living in a foreign country, separated from her children, and experiencing financial and social stress, which could exacerbate anxiety symptoms. GAD does not typically present with suicidal ideation or specific plans, which is a more prominent feature of depression or other mood disorders. The patient’s primary concern appears to be depression, and while anxiety might be a contributing factor, it is not the primary diagnosis.
    • Post-Traumatic Stress Disorder (PTSD)
      ● PTSD could be considered due to the stress of immigration, separation from her children, and possible prior traumatic experiences. Suicidal thoughts can be associated with PTSD, particularly when there is significant distress related to past trauma or current life situations.The patient does not explicitly report symptoms of trauma or flashbacks, and there is no clear indication of past traumatic events (besides the stress of immigration). The absence of these trauma-related symptoms makes PTSD less likely.
      Assessment:
      The patient is a 45-year-old Hispanic female presenting with active suicidal ideation and a plan to overdose on pills. She reports recent insomnia, though her sleep has improved over the last two days. The patient has been living in the U.S. for seven months, separated from her children, and facing difficulties finding employment, which has caused significant emotional distress. She denies any past suicidal thoughts or substance use. The patient is struggling with adjustment to her new life circumstances, and her current emotional distress, including suicidal ideation, is likely linked to these stressors. Further psychiatric evaluation and intervention are necessary, and urgent safety planning is indicated.
      Plan:

• Patient to be admitted to CPEP for psychiatric observation and further stablization.
• Suicide risk assessment: Evaluate factors like access to means, prior attempts,
  protective factors, and family/social support.
• Develop a safety plan: Collaborate with the patient to develop a safety plan, including
  identifying triggers, coping strategies, and emergency contacts (including the hospital’s psychiatric team and a trusted family member or friend).