Diagnosis: Mental Health, Alcohol Abuse/Addiction
Treatment: Mental Health: Inpatient, Substance Abuse: Inpatient

Summary: This patient was admitted to the hospital due to making a suicide attempt by taking an overdose of pills including 15 Zoloft, Gabapentin, and Naltrexone while drinking several bottles of Four Loko. He reportedly had depressive symptoms including sad mood, low energy, sleeping problems, decreased appetite, feelings of guilt, and he had 4 past reported suicide attempts prior to this one. He reported suicide intent and disappointment that he was not successful in his suicide attempt. He was drinking alcohol and had withdrawal symptoms also including tremors, elevated heart rate of 122, elevated blood pressure of 155/104, vomiting, hyperreflexia, and mild ankle myoclonus. There was suspicion of serotonin syndrome. He had diagnoses of Major Depressive Disorder, Generalized Anxiety Disorder, and Alcohol Use Disorder. He had a recent hospitalization for a suicide attempt with a medical hospitalization and also had a recent psychiatric hospitalization.

The insurer has denied coverage for the inpatient hospital admission as not medically necessary. The denial was reversed.

Suicide attempts are the single most reliable indicator for suicide and this patient had a serious suicide attempt and multiple past and recent suicide attempts. It was reported that he was disappointed that he was not successful in his suicide attempt and he stated that he knew how to be successful next time. Notes reported that he was delirious as he was not oriented to place and it was reported that he was cognitively impaired. It also was reported that psychiatry stated that he required inpatient psychiatric treatment after medically cleared so he was at risk both medically and psychiatrically and considered a high risk patient. Notes reported continued tachycardia and that he was very sad in mood as his mother was diagnosed with ovarian cancer. Notes also reported that he was lonely with no friends, felt unwanted, in addition to being delirious. Notes reported that his Librium taper was continued. Notes reported that he minimized his depression and suicidality to try to get out of the hospital. It was reported that he stated that he would return to drinking and harm himself. Notes reported that he also was taking a slow Librium taper, restarted Zoloft and started Buspirone. Notes reported that he still had withdrawal symptoms including a CIWA of 4-5 and was still taking Librium to prevent worsened withdrawal including life threatening withdrawal. Notes reported that he was at high risk due to multiple past suicide attempts and required inpatient hospital treatment until discharged to a 24 hour rehabilitation treatment for alcohol rehabilitation treatment. This patient could not safely be treated in an outpatient detoxification as he was drinking alcohol and had withdrawal symptoms requiring detoxification treatment and was high risk for suicide.