Lamm Kevin M, Stone Cooper L, Rebon Genevieve
Department of Psychiatry, Cape Fear Valley Medical Center, Fayetteville, United States.
Associate Program Director for the Cape Fear Valley Psychiatric Residency Program with Campbell University, Fayetteville, United States.
J Family Med Prim Care. 2020 Aug 25;9(8):4412-4414. doi: 10.4103/jfmpc.jfmpc_180_20. eCollection 2020 Aug.
Primary-care providers are most often the first point of contact for patients presenting with mental illness. Highly stigmatized and with a litany of other medical issues requiring redress by providers, it may receive inadequate attention, despite its unintuitive consequences. Therefore, the purpose of this case is to demonstrate the potential catastrophic consequences of untreated mental illness by providers. As a result of a serious suicide attempt by a patient afflicted with bipolar disorder, this patient presented with significant blood loss secondary to multiple self-inflicted lacerations to the wrist, parasternal stab wounds, and a resultant hemopneumothorax. By juxtaposing this patient's mental illness with his other traditionally "more" concerning medical history (i.e., multiple myeloma, Factor V Leiden, and recurrent DVTs), we are forced to reexamine where mental illness resides in the hierarchy of treatment.
初级保健提供者通常是患有精神疾病患者的首要接触点。精神疾病受到高度污名化，且存在一系列其他需要提供者解决的医疗问题，尽管其后果不直观，但可能未得到充分关注。因此，本病例的目的是展示提供者对未治疗的精神疾病可能造成的灾难性后果。一名患有双相情感障碍的患者企图自杀，导致严重后果，该患者因多次手腕自残割伤、胸骨旁刺伤以及由此导致的血气胸而出现大量失血。通过将该患者的精神疾病与其其他传统上“更”令人担忧的病史（即多发性骨髓瘤、凝血因子V莱顿突变和复发性深静脉血栓形成）并列，我们不得不重新审视精神疾病在治疗优先级中的位置。
