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.

CH-M14-3045

The patient is a 14 Y year-old male with a history of mild intellectual disability, reactive attachment disorder, disruptive mood dysregulation disorder, ADHD, and anxiety who presented to the ER on 2/1/24 via law enforcement for assessment of aggressive behaviors at his group home. Group home staff report he has caused $10,000 in damage since his admission to the group home on 1/8 which included damaging house property and 3 staff members vehicles. He received a letter of suspension from the group home effective 2/1/24 due to his behaviors.

He has had extensive MH services including foster home placements, temporary placements with his grandmother and biological father, multiple ER assessments for aggressive behavior with suicidal & homicidal statements, residential at Gerard Academy, residential at Northwoods in 2017 for 6 months, partial hospitalizations in 2015, 2016, and 2023, inpatient hospitalizations at Children’s, Miller Dwan, Prairie Care x2, Prairie St. John’s, day treatment, group home placement, level 4 schooling, in home skills, case management, PCA services, psychological testing, speech therapy, OT, and individual therapy. He is currently on a CADI waiver.

He has a long history of behavioral dysregulation including: fire setting (set a blanket on fire at age 7, burned the trim on the bathroom door at age 7), sexualized behaviors (including anally penetrating a younger male step cousin when the patient was 6 along with engaging in oral sex), aggression towards animals (broke dogs hip, hit/kicked/choked, killed family cat & dog), physical aggression (including slamming staff fingers in the door, giving 2 staff concussions, kicked staff in the chest, hitting, kicking, biting, squeezing, grabbing, has thrown his younger sister), property destruction, self injurious behavior (head banging, wrapping shirts around his neck, picking at his skin), elopement from classrooms and his home, stealing, and hoarding food. He was in detention at Lino Lakes a few months ago for assaulting his mom.

It is not felt that inpatient psychiatric hospitalization is indicated at this time due to the chronicity of his behaviors though he is not able to return to his group home at this time.

MHF-F16-2943

Patient presents from a family friend’s home where she was living however due to ongoing dysregulation and threats to harm the family, patient can no longer stay there. Mother does not feel safe with patient at home due to homicidal threats to family. Patient has no current options and needs long term placement.

HCMCH-M15-2928

1/19/24 he’s slated to discharge to Bar None on 1/22/24.
15 y/o male whose ward of the state presented to ED after an episode of emotional dysregulation which led to destroying property.

MHF-M14-2604

1/18/24. No placement at this time. Waiting for a waiver to open up more funding sources. Denied at respite/shelter due to behaviors

Patient presented from Aspen House shelter due to aggressive behavior and property destruction. Patient is unable to return to shelter. Mother refusing to discharge home. County looking into shelter options and foster care placement

CH-F16-2246

Update: 1/15/24- Patient has been accepted by Nexus with an admission date of 1/16/24!!

Patient presented to the ER from out of state due to being kicked out of residential treatment for elopements and aggression towards staff and peers. She was boarded in the ER for a significant amount of time before being admitted to the mental health unit for boarding. Patient has CHIPS case though parents are actively involved in her care. Patient has an extremely high risk of elopement and has a history of being sexually trafficked while on elopement. Patient struggles with conduct, low academic performance, and history of aggression. She has had 2 rule 20 assessments and was found incompetent. Patient has been declined from PRTF’s from over 25 states.

MHF-M14-2692

1.4.24 – Nexus YCT doing an intake next week.
Presented to ED after altercation with Mom resulted in property destruction and pushing her. Behavior concerns specifically aggression in home towards mother, siblings; patient is in a level 4 special-education program due to ongoing challenging behavior at school often leading to multiple suspensions, needing higher level of intervention. The police have been called to the home multiple times due to patient’s increasingly violent and aggressive behavior, poor impulse control, low frustration tolerance, agitation and oppositional behavior.

MHF-F14-2598

Patient presented to the ED from Prairie Care residential due to aggressive behaviors. Patient is at baseline and not recommended for IP MH admission. Prairie Care will not accept back, CPS has custody and reports patient needs RTC. County working on referrals, has been declined from most shelters and RTC in MN.

PH-F10-2551

Discharge Plan:
-Gerard (PT denied d/t documented IQ, requested reconsideration as new testing shows IQ as 78, pending)
-Northwoods (Waitlist is 1+ years long)
-North Homes (Pt denied d/t age)
-Acadia Out of State RTC network (Referral sent, pending)
-CABHH (Referral sent, pending)

10 yr old female admitting from Windom Area Health emergency department for suicidal ideation and homicidal ideation. Pt eloped from school and attempted to run into traffic and was brought to the ED via the police. Nobles County is Legal Guardian.

Existing services:
-Psychiatry through Southwest Mental Health Center
-New therapist starting in December through Healing Path in Levurne
-Previous therapist through Greater MN Family Services
-Neuropsych done with Surdy Psychological Mankato
-Nobles County guardian and CMHCM
-Nobles County guardian and CPS

CH-M11-1984

Patient presents from PHP where he was discharged due to ongoing aggression and attempts to urinate on staff and floor. Patient currently struggling with family dynamics, limit setting, gender identity, disrobing, property destruction, and aggression.

CH-M13-2506

The patient is a 13 Y year-old male with a history of fetal alcohol syndrome, separation anxiety, ADHD, RAD, sensory processing difficulty, DMDD, conduct disorder, and ODD who presents to the ER on 12/2 via law enforcement for assessment of aggression, suicidal, and homicidal ideation after physically assaulting his adoptive mom and brother and threatening to use a knife or gun to hurt the family when they weren’t looking. The patient made threats to kill himself with a colored pencil. The patient has aggressive outbursts several times per day when he is told no.

The patient has a long history of psychiatric services including residential at Northwoods x3, inpatient hospitalization x1, group home placement, PHP and further outpatient services. The county is currently in the process of developing an individual home for him which is thought to be completed in January though still requires licensing.

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