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- Aug 9, 2012
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I recently took a new position in outpatient CAP, something I had very little intention of doing being an inpatient/emergency/c&l psychiatrist at heart (I'm a rare breed in the CAP world), but needed to make the geographical switch for my significant other. I used to see SDN posts on cool cases and just wanted to share a few from my practice.
I've had two (entirely separate) young girls (<12) sexually assaulted by their father's relatively recently. Both have had pretty extreme post-traumatic reactions (as one might expect) in addition to coping with the chaos this brings to their whole life (child welfare, divorce, etc as one can imagine). Both had made serious suicide attempts (again both under 12 years of age) before seeing me. They both struggled heavily for the first few months and there was a lot of mom tears during my first few visits. Between prazosin (shockingly effective for both), SSRI, TF-CBT and educating/empathizing with the mothers both have gone from abject trainwrecks failing their elementary school years to do really well in the span of 6 months of treatment. Smiles from ear to ear, sleeping well, doing great in school. The resiliency of children is and always will be the reason pediatric fields pay less than adult medicine (except CAP 😉).
Also have a young teenager who struggled with lots of affective instability, violent fights including use of weapons and frequent AH. He actually thanked me for his Abilify prescription and looks like a different kid over the span of a few months. His school grades are the best they have been in years.
There are some days outpatient gets a bit emotionally draining as it is intimate in a way that my inpatient work was not but reminding myself of days like above make it a job I am thrilled to have.
I've had two (entirely separate) young girls (<12) sexually assaulted by their father's relatively recently. Both have had pretty extreme post-traumatic reactions (as one might expect) in addition to coping with the chaos this brings to their whole life (child welfare, divorce, etc as one can imagine). Both had made serious suicide attempts (again both under 12 years of age) before seeing me. They both struggled heavily for the first few months and there was a lot of mom tears during my first few visits. Between prazosin (shockingly effective for both), SSRI, TF-CBT and educating/empathizing with the mothers both have gone from abject trainwrecks failing their elementary school years to do really well in the span of 6 months of treatment. Smiles from ear to ear, sleeping well, doing great in school. The resiliency of children is and always will be the reason pediatric fields pay less than adult medicine (except CAP 😉).
Also have a young teenager who struggled with lots of affective instability, violent fights including use of weapons and frequent AH. He actually thanked me for his Abilify prescription and looks like a different kid over the span of a few months. His school grades are the best they have been in years.
There are some days outpatient gets a bit emotionally draining as it is intimate in a way that my inpatient work was not but reminding myself of days like above make it a job I am thrilled to have.
