RT Book, Section
A1 Smith, Mindy A.
A1 Usatine, Richard P.
A2 Usatine, Richard P.
A2 Smith, Mindy A.
A2 Mayeaux, Jr., E.J.
A2 Chumley, Heidi S.
SR Print(0)
ID 1164350344
T1 Mental Health
T2 The Color Atlas and Synopsis of Family Medicine, 3e
YR 2019
FD 2019
PB McGraw-Hill Education
PP New York, NY
SN 9781259862045
LK dermatology.mhmedical.com/content.aspx?aid=1164350344
RD 2024/04/24
AB A  21-year-old  woman  is  seen  by  a  family  physician  in  a  student-run  free  clinic  within  a  residential  chemical  dependency  program  for  women.  She  has  just  finished  withdrawing  from  intravenous  heroin.  She  is  experiencing  anxiety  and  insomnia  and  is  asking  for  medications  to  help  her  sleep  at  night  and  function  during  the  day.  The  young  woman  has  a  10-month-old  baby.  She  had  been  on  a  methadone  program  during  her  pregnancy.  The  patient  states  that  her  mother  is  bipolar  and  often  uses  various  drugs  including  heroin.  Her  brother  sells  heroin  but  claims  to  not  use  it  anymore.  He  does  sell  heroin  to  her  and  her  mother  at  a  discount.  The  patient  admits  to  having  been  sexually  abused  as  a  child  and  states  that  the  heroin  numbs  some  of  the  pain  from  her  childhood.  Unfortunately,  she  has  bad  nightmares  (related  to  posttraumatic  stress  disorder  [PTSD])  that  make  sleeping  difficult.  She  did  return  to  injecting  heroin  after  the  baby  was  born  and  lost  custody  of  her  child.  She  is  motivated  to  maintain  sobriety  so  she  can  be  with  her  baby  again.  The  family  physician  listens  with  compassion  and  empathy  and  prescribes  some  non-addicting  medications  to  help  her  with  the  anxiety,  insomnia,  and  nightmares.  A  follow-up  appointment  is  set  for  the  following  week,  as  it  is  clear  that  this  young  woman  needs  a  lot  of  support  in  addition  to  close  management  of  pharmacologic  therapy.