| | Location | Treatment Day | Symptoms | Labs/Images | Treatment |
| | Urgent care | 1 | Shortness of breath and cough | COVID-19 PCR | | | Outpatient pediatrics | 24 | Shortness of breath, nasal congestion, and anxiety | | Prednisone 60 mg × 5 days | | Outpatient pediatrics | 37 | Worsening anxiety, hopelessness, inattention, poor sleep, and tearfulness | | Escitalopram 10 mg daily | | Outpatient pediatrics | 50 | Worsening anxiety, distorted thoughts, fear of being alone, fear of taking showers, racing thoughts, confusion, intrusive thoughts | CBC, CMP, TSH, CRP | Referral to counseling | | Emergency department | 152 | Worsening depressive thoughts, suicidal ideation, and thoughts of hurting others | CBC, CMP, ethanol, UDS | | | Outpatient pediatrics | 177 | Daily headaches, “brain fog,” difficult sleep onset, waking up during night, auditory hallucinations, tearfulness | CBC, CMP, TSH, LDH, uric acid, troponin, CT head | | | Outpatient pediatrics | 233 | Difficulty with thought organization, “brain fog,” derealization | | | | Emergency department | 285 | Punching the ground with his fist, confusion, rapid speech, visual hallucinations | CBC, CMP, ethanol, UDS | | | Emergency department | 292–297 | Rage, punching walls and doors, rapid speech, auditory hallucination, sadness, and hopelessness, feeling “messed up,” lack of control of thoughts, transient SI | CBC, CMP, ethanol, UDS, COVID-19 | Tele-psych inpatient observation for 5 days | | Outpatient pediatrics | 298 | Sore throat, nasal congestion, and shortness of breath | COVID-19 PCR | | | Pediatric emergency department | 319 | Increasingly severe intrusive thoughts, homicidal ideation, “brain fog,” visual hallucinations, delusions, inability to control his thoughts | CBC, CMP, CRP, UDS, Marijuana metabolites | Admitted to inpatient pediatric hospitalist service | | Pediatric inpatient hospitalization | 319–326 | Marked anger, aggressive behavior, obsessions, intrusive homicidal and homosexual thoughts, nonspecific auditory and visual perceptual anomalies, depersonalization, depression, anxiety, and sleep onset difficulty | See Table 3 | Sertraline 25 mg daily, Olanzapine 5 mg daily, Hydroxyzine 25 mg PRN | | Inpatient psychiatric hospitalization | 326–336 | Moderate improvement of symptoms | Psychological testing: PHQ-9, R-CMAS, Y-BOCS, SRS-2, CARS-2 | Sertraline 200 mg daily, Olanzapine 10 mg daily, Hydroxyzine 25 mg PRN | | Emergency department | 351–365 | Rage, aggressive behavior, intrusive homicidal and homosexual thoughts, passive SI, apathy, anhedonia, depression | CBC, CMP, ethanol, UDS, U/A | Tele-psych inpatient observation for 15 days | | Emergency department | 391–394 | Rage, anxiousness, hopelessness, flattened affect, auditory and visual hallucinations, cognitive slowing | CBC, CMP, ethanol, UDS | Tele-psych inpatient observation for 3 days | | Outpatient child and adolescent psychiatry | Days 395–605 includes 13 follow-up appointments | Moderate improvement of symptoms
-Psychotic features improved (no AVH, ideas of reference, delusions, or disorganized thoughts)
-Has ongoing anxiety and worries that “something bad will happen,” in the context of not being able to defend family
-Intrusive thoughts are constant, and urges wax and wane with decreases in divalproex sodium and risperidone
-Thoughts are primarily homicidal, which are completely ego-dystonic
-Higher doses of risperidone and valproic acid were too sedating
-Persistent cognitive difficulties with math and attention | CMP and liver enzymes normalized. Lipid panel, hemoglobin A1C WNL.
AIMS-0 had increased tardive/tremor of the tongue at risperidone 5 mg and improved at 3 mg. | Fluvoxamine 250 mg QHS,
divalproex sodium ER 500 mg QHS, Risperidone 3 mg QHS
Hydroxyzine 75 mg QHS for anxiety and sleep.
Mother gives turmeric OTC and ibuprofen 400 mg OTC when urges worsen, with a notable “calming” effect |
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