CASE STUDY #2

BENEFICENCE &NON-MALEFICENCE

Sandra Brownstein, PharmDMarianne McCarthy, PhD, GNP

Sue Sisley, MDLori Waldberg, LCSW

CASE #2

• CD, 76 yo widowed female with severe chronic paranoid schizophrenia along with major depression (schizoaffective disorder)

• Presents to office with son, who has concerns about treatment regimen

• Has developed several new medical conditions prompting new management options

CASE #2 (cont.)

• New conditions include:• Diabetes• Coronary artery disease• Hyperlipidemia• Essential tremor• Uterine cancer• Hypothyroidism

CASE #2 (cont.)

• Has been on lithium for decades• Primary care physician (PCP) and

consultants have recommended:– Thiazide diuretic– Anti-platelet agent– Diabetes medication– Cholesterol medication– Thyroid replacement– Anti-tremor medication (beta-blocker)– Total hysterectomy

CASE 2 – QUESTION #1

CD is incompetent1. TRUE2. FALSE

CASE 2 – QUESTION #2

Only a psychiatrist can assess CD’s capacity to make decisions regarding her medical care

1.TRUE2.FALSE

CASE 2 – QUESTION #3

Only a psychiatrist can assess CD’s capacity to make decisions regarding her psychiatric care

1.TRUE2.FALSE

CASE 2 – QUESTION #4

Goals of care questions should include:1.Adherence/compliance concerns2.Beneficial effects of

medications/surgery3.Financial cost of treatments4.Side effects of medications

CASE 2 – QUESTION #5

Potential complications of the new recommendations include:

1.Drug-disease interactions2.Drug-drug interactions3.Peri-operative complications4.All of the above

CASE 2 – QUESTION #6

The psychiatric treatment option with the smallest side effect burden is:

1.Anti-depressant medication2.Anti-psychotic medication3.Electro-convulsive therapy4.Mood stabilizer medication

CASE 2 – QUESTION #7

The medical treatment option with the smallest side effect burden is:

1.Cholesterol medication2.Diabetes medication3.Diuretic4.Surgery5.Tremor medication

CASE 2 – QUESTION #8

CD’s most likely cause of death will be:1.Cerebrovascular accident (stroke)2.Coronary artery disease (heart

attack)3.Schizophrenia

(accident/homicide/suicide)4.Uterine cancer