A Case of Clinical Scholarship

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A 32-year-old child and adolescent psychiatry resident with a history of presenting an abstract at a local psychiatric conference during residency and fourth authorship on an immunotherapy paper from a summer internship during medical school presents with a new-onset desire to write a case report. She has just come off her consultation liaison rotation, during which she consulted on a 12-year-old boy with attention-deficit/hyperactivity disorder, oppositional defiant disorder, disruptive mood dysregulation disorder, and low depressive state hospitalized for pseudoseizures, a new-onset inability to walk, and aggressive outbursts. He had a negative magnetic resonance imaging scan, negative computed tomography scan, negative laboratory test results, and an unremarkable lumbar puncture. Based on an equivocal electroencephalogram, a neurology resident decided to prescribe a mood stabilizer, obtained it himself from the pharmacy, and administered it to the patient intravenously, only then realizing that it was six times the intended loading dose. Before anybody could stop him, the resident erased all documentation about the medication and fled the city. Nevertheless, that afternoon, before the error and fraud were caught by a pharmacist and before the child and his family were notified, the child’s symptoms appeared to resolve and the child walked comfortably for the first time in months. The child and adolescent psychiatry resident is tentatively titling the case report, “Resolution of Conversion Disorder With a Megadose of Unknown Mood Stabilizer.”

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