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.

PH-F17-3791

5/20/24: Patient discharged from inpatient and admitted to PCR.

5/8 update: Patient scheduled for admission to PrairieCare Residential on 5/20/24 at 10:00am.
5/6 update: Patient is currently awaiting an RTC bed through PrairieCare Residential in Maple Grove. Patient has been approved for 3rd pathway funding through Hennepin County. Due to patient behaviors seeming to increase, other options are being explored for aftercare as denials are a possibility. Parents do not feel safe with the patient coming home.

Discharge Plan:
Residential Treatment:
-PrairieCare Residential; intake 5/20/24 at 1000

Other RTC Referrals:
-Nexus Gerard; referral made
-North Homes; referral made, declined due to FAS and IQ
-Avanti Center for Girls; referral made, declined due to aggression and peer conflict

Outpatient Providers:
Establish CMHCM; opened with Soreya Jama through Hennepin County, 3rd pathway funding approved

Establish/Continue CTSS with Samira through Nexus FACTS
Continue Therapy with Mary Midler at Great Lakes Neurobehavioral Center in Edina (weekly)
Continue PCP with Dr. Megan Reilly at Partners in Pediatrics in Plymouth
Continue Psychiatry with Gerard Balan at Plymouth Psych Group
Continue IEP Case Management with Yvette Zeese at Wayzata High School
Continue Neurological Services with Dr. Catalfamo at Noral Neurological Clinic in Bloomington

ADMISSION NOTE: Patient was admitted due to acute safety concern and was unable to contract for safety at home. Pt was in PHP in the past and family was monitoring her 24/7 at home as instructed. Pt became irritated that she is constantly being watched and ended up having altercation with her mother because she was instructed by her mother to change outside of her bedroom because the mother was unable to see her. Pt ended up leaving and went to her grandmother’s house which is next door while mom followed her, pt went straight to the kitchen grabbed a knife and start threatening to stab herself. Mother was able to wrestle the knife out of her hands and called EMS. Pt has a history of depression, anxiety, epilepsy, and fetal alcohol syndrome.

HCMCH-F14-3794

Update 5/15: Referral madeEmbark (out of state PRTF) and other 2 PRTF out-of-state referrals, as well as Bar None Haven.
The patient is 14 y/o female with a PMH dx to include DMDD,, ADHD, PTSD, and FASD. The patient has presented to ED for SI, attempts elopement and aggression. The patient has significant hx of MH IP hospital admissions. She was recently d/c Dungarvan after 2.5 years.

Hx of sexual abuse and neglect. She ward of the state. Her extensive trauma history and attachment issues, which hinder her ability to form relationships.

CH-F16-3722

Patient has a history of DMDD, PTSD, ADHD, intellectual disability with FSIQ of 50, TBI, as well as seizures and psychogenic non epileptiform seizures who presents from group home where she has been aggressive and threatening to staff and other house mates. She attacked another resident there. This resident is pursuing legal charges. The patient continues to describe intent to harm other residents and staff if she goes back there, as she wants a different group home. The group home has given letter of termination and suspension. Hennepin County is patient’s guardian. County is looking into previous respite home she was at as an option, as she did really well there prior to coming to this group home 1 month ago. This same situation occurred with the same group home last fall where they terminated her and brought her to the ER.

PH-F12-3422

Update 4/15/24: Patient discharged from inpatient on 4/15/24 to home with outpatient services while awaiting level 6 RTC/PRTF placement.

Update 4/3/24: Bar None Haven (Referral submitted, Denied 3.22.24), Northwood Children’s (Referral submitted, On waitlist), Grafton (Referral submitted), Nexus East Bethel (Referral submitted). County also working on referral for MITH program (MN Intensive Therapeutic Homes). MN Choice Assessment done.

12-year-old female with DMDD and RAD presenting to PrairieCare Inpatient Hospital. Patient has had multiple psychiatric hospitalizations, 2 RTC placements and 2 JDC placements.

Discharge Plan:
Locked Level 6 RTC – Bar None Haven (Referral submitted)

Current Providers:
CMCHM at Beltrami County
Individual Therapy
Medication Management
Wavier Case Management Services through Beltrami County (In process)

PH-F14-3375

Update 4/12/24: Patient discharged from inpatient to home, while waiting for RTC admission.

Update 4/11/24: Patient scheduled to discharge from inpatient on 4/12/24, stepping down to outpatient supports, while waiting for RTC. Intake process is moving forward at North Homes RTC, with potential admission on 4/18 or 4/19.

Update 4/4/24: Patient has been accepted at North Homes RTC with a potential admission mid-April. Patient has now been assigned a CMHCM, waiting on screening for county funding.

Update 3/21/4: Pt is under review for acceptance at North Homes pending county funding, Waiting assigned CMHCM, parent is currently doing the intake process at the county to get a CMHCM for the Juvenile Screening.

Patient is a 14-year-old transgender male presenting at PrairieCare’s inpatient hospital. Patient presented to Sanford Bemidji Medical Center on 3/4 when parents brought them. That night while parents were away from home patient was aggressive toward sister. Family called crisis and were directed to bring to ED for evaluation. This is after a similar event last week where patient attempted to stab sister with a knife and father had to intervene.

CH-F16-3629

Patient presented to the ER via law enforcement for aggressive behaviors at shelter care resulting in property destruction. Patient is not able to return to the shelter and does not have any safe disposition options.

CH-M13-3592

The patient is a 13 Y year-old male with a history of autism spectrum disorder, disruptive mood dysregulation disorder, ADHD, and depression who presented to the ER on 4/5/24 via EMS from his residential facility for assessment of aggression and suicidal ideation. He has a long history of aggressive behaviors that per chart review worsened around October, 2023 and he has not been able to be safely maintained in his home since that time. He has had several extended hospitalizations and since he was admitted to residential on 2/5 has had 41 incident reports related to attempts to harm himself and aggression when staff attempt to intervene. He has had increasing dysregulation resulting in an increase in restraints, length of time in restraints, and the amount of staff it requires to calm him resulting in the inability to return to residential. Home is not an option at this time.

MHF-M17-3467

Pt came to ED 3/25 after being on the run for a few weeks. Was previously at hotel crisis respite prior to being on the run, damaged property there and can not return. County is current guardian, though patient turns 18 very shortly and will be his own guardian at that time. History of behaviors, verbal and physical aggression and property destruction. Has been denied from shelters due to behaviors and previously denied from RTCs in and out of state, though due to age would no longer be an option. Refuses all mental health services and has not had a DA since 2020. Is on CADI waiver. Recommendation on weekly call to discuss benefits of IRTS program/treatment with him.

NMH8R0MGH-F14-3413

Presents from home after altercation with mother and sister. Family does not feel safe with patient returning home.

MHF-M17-3392

Patient presented with police after being found as a runaway from parents home, staying at friends house. Patient reportedly having increased aggressive episodes at home towards parents and property destruction. Parents unwilling to have patient in the home at this time. Working with family and case manager on shelter or alternative placement need.