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Original Question

Patient Summary: Patient Demographics: 61-year-old single white male, unemployed, on SSDI, living in a rehabilitation facility. – Substance Abuse History: Addiction to opioids (Vicodin/Percocet/Oxycodone), crystal meth, alcohol, and cannabis. Previous use includes daily consumption of 70-80 mg of Percocet, $40 worth of methamphetamine, 30 beers, and 2 joints. – Current Treatment History: Transferred to EH rehab from Valley Forge rehab for drug and alcohol treatment. Current medications include Seroquel, Prazosin, and desire to switch from Abilify to Wellbutrin. – Psychiatric History: Diagnosed with bipolar disorder, PTSD, and anxiety; five prior hospitalizations, history of suicide attempts, and substance-induced blackouts. – Symptoms: Complaints of depression (6/10), mood swings, anxiety, irritability, insomnia, and occasional flashbacks. Denies suicidal and homicidal ideation. – Mental Status Exam: Cooperative behavior; mood is sad and anxious; thought processes are goal-directed and logical; insight and judgment are intact. Plan: Discontinue Abilify, restart Wellbutrin, continue Seroquel and Prazosin, reinforce the importance of medication compliance, and explore trauma therapy. The patient is a candidate for Medication-Assisted Treatment (MAT) and is interested in it. Follow-Up: Schedule follow-up with the care team for medication management and discharge planning. I propose Naltrexone while inpatient rehab upon discharge and Vivitrol to address his alcoholism due to his noncompliant history. I also would discontinue suboxone because the Naltrexone covers

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