Psychiatric Diagnosis: Disruptive Mood Dysregulation Disorder (DMDD)

DMDD is a psychiatric diagnosis that applies to children and adolescents who exhibit severe temper outbursts and persistent irritability. It is often associated with difficulties in regulating emotions.

EHS-F16-4792

Patient is a 16-year-old girl with history of mental illness who was brought to the emergency department from port group home where she has been residing for about 5 days. Patient states that she was in juvenile detention immediately prior to going to the group home. Patient has been prescribed psychotropic medicines in the past, but is not currently using any medications. Recommendation from probation officer and county social worker is juvenile detention center or psychiatric inpatient hospitalization pending long term psych placement. However, LE states they can’t bring her to JDC as she has no charges that would make that appropriate at this time without order from probation. Pt has been aggressive, verbally and physically while in the ED. She has eloped on multiple occasions and has attempted to harm herself.

PH-F8-4701

Recommendation is for QRTP or PRTF – either could potentially meet the needs of this patient and limited treatment centers available due to patient’s age. Patient is currently in psychiatric inpatient hospitalization.
Patient is an 8-year-old female. Patient presented to inpatient from the ED due to increase in unsafe and risk-taking behaviors. This is her fourth inpatient hospitalization; one in 2022 and three in 2024. Patient has attended day treatment twice and participated in outpatient psychotherapy and medication management.

Discharge Plan:
PRTF/QRTP: (county funding approved for QRTP)
– Grafton (declined due to not meeting criteria)
– Northwood (referrals submitted 9/9, on waitlist 9/23 – awaiting update on admission timelines)
– Gerard (unable to accept due to age)
– Avanti (unable to accept due to age)
– Bar None Haven (unable to accept due to age)
– North Homes (unable to accept due to age)
– Heartland Girls Ranch (unable to accept due to age

Continue with following outside providers:
– Therapy/Therapist: Solutions Behavioral Healthcare Professionals
– Primary Care Provider: Sanford Health
– Medication Management: Solutions Behavioral Healthcare Professionals
– Case Management: Solutions Behavioral Healthcare Professionals
– Occupational Therapy: Beyond Boundaries Therapy and Wellness

CH-F14-4759

Patient presented to the ER following an intentional overdose to end her life and had just started PHP the week of admission. She had an additional overdose of the same medications in March 2023 and has had reported several other suicide attempts. Patient is on probation for assaulting her mother and has a history of running away, physical & verbal aggression, sexual misconduct (sending nude photos of herself to adult males for money), alcohol/chemical use, school difficulties, and parent/child conflict.

HCMCH-M12-4692

12 year old male with ADHD, unspecified mood disorder with recent suicide attempt, T1DM, hypothyroidism, asthma who is in the ED after intentionally setting fire and burning house down. Has an IEP for speech therapy.

MHF-F12-4640

Came to our ED 9/22 from home due to aggressive threats. Previously was IP with our hospital 9/3-9/12. Mom does not feel she can take kiddo home at this time. Is in process of obtaining Childrens Mental Health CM and CADI waiver, but has neither as of now (did request these to be expedited.) Mom is also working on referrals to Residentials (has private insurance) but has not been placed on any lists yet.

PH-F10-4549

Recommendation for level 5 QRTP or level 6 PRTF. Patient is currently in psychiatric inpatient hospitalization.
Ten-year-old female patient with a history of in utero exposure and early childhood trauma and attachment concerns, with a historical diagnosis of FASD-Alcohol-Related Neurodevelopment Disorder (ARND). Patient presents with emotional dysregulation, violent threats and aggression, as well as passive suicidal ideation. Patient has been hospitalized multiple times and participated in several outpatient services.

Discharge Plan:
RTC (recommendation letter sent to CMHCM who is requesting county screening meeting)
-Nexus Gerard (referral sent, reviewing, will hear back week of 9/2)
-Northwood (referral submitted, next opening end of year, will review for acceptance at that time)
-North Homes (declined due not have staffing to meet needs related to aggression, SW requested reconsideration; declined 8/21)

PRTF (PRTF eligibility form sent to DHS 8/16)
-Nexus East Bethel (referral submitted w/PRTF eligibility approval 9/4)
-Grafton (referral submitted w/PRTF eligibility approval 9/4)
Bridging with Day tx
-Catholic Charities (referral pending although may not consider d/t RTC rec, IEP sent, 8 person WL)

Current Providers:
Med Management- Mayo Clinic
CM- Dakota County
CADI waiver- Dakota County contracted provider
CTSS

MHF-M12-4485

Pt came to our ED on 8/10 from Grandparents home who were providing foster care and there was an altercation. Grandparents are refusing to take pt back. Hennepin County CPS/ICWA have temp custody. Pt not appropriate for IP due to fecal incontinence and struggles with communication. County is looking for DD waiver CRS and doing a MNchoices assessment on 8/16.

CH-M11-4450

Patient presented to the ER via law enforcement for homicidal ideation towards his foster family (maternal aunt) and biological brother and had threatened them with a knife. Was removed from his biological home in June due to neglect, abuse, domestic abuse, substance use in the home. Patient with dissociative episodes and resorting back to small child like behaviors.

CH-F12-4277

Patient presents to the ER from PRTF twice in the same day after boarding for an extended period of time due to aggression towards staff. She has since been discharged from the PRTF as they felt a higher level of care was indicated. She is currently doing well here with intermittent verbal escalations though does struggle with peer relationships. She does express visual and auditory hallucinations though these do appear to be related to trauma.

CH-M10-4290

Patient presented via law enforcement to the St. Cloud ETC after eloping from mother’s home and found wandering on Highway 10. Initially aggressive/combative with law enforcement. Patient was cleared for discharge but refused to go with mom, because combative and required PRN to calm down. Was kept overnight. Patient’s mom refused to pick patient up once cleared for discharge due to his ongoing aggressive behaviors. CPS is involved and a new report was filed.

Police hold initiated 7/9/24 and CHIPs petition is being pursued. County CPS worker is seeking foster care placement.

Update (7/18)- Court hearing for CHIPs petition. County CPS case worker is continuing to look for foster care placement. Patient will have twice weekly phone calls with his mother.