1. CASE STUDY #2 BENEFICENCE & NON-MALEFICENCE Sandra Brownstein, PharmD Marianne McCarthy, PhD, GNP Sue Sisley, MD Lori Waldberg, LCSW

2. CASE #2 CD, 76 yo widowed female with severe chronic paranoid schizophrenia along with major depression (schizoaffective disorder) Presents to office with son, who has concerns about treatment regimen Has developed several new medical conditions prompting new management options

3. CASE #2 (cont.) New conditions include: Diabetes Coronary artery disease Hyperlipidemia Essential tremor Uterine cancer Hypothyroidism

4. CASE #2 (cont.) Has been on lithium for decades Primary care physician (PCP) and consultants have recommended: –Thiazide diuretic –Anti-platelet agent –Diabetes medication –Cholesterol medication –Thyroid replacement –Anti-tremor medication (beta-blocker) –Total hysterectomy

5. CASE 2 – QUESTION #1 CD is incompetent 1.TRUE 2.FALSE

6. CASE 2 – QUESTION #2 Only a psychiatrist can assess CD’s capacity to make decisions regarding her medical care 1.TRUE 2.FALSE

7. CASE 2 – QUESTION #3 Only a psychiatrist can assess CD’s capacity to make decisions regarding her psychiatric care 1.TRUE 2.FALSE

8. CASE 2 – QUESTION #4 Goals of care questions should include: 1.Adherence/compliance concerns 2.Beneficial effects of medications/surgery 3.Financial cost of treatments 4.Side effects of medications

9. CASE 2 – QUESTION #5 Potential complications of the new recommendations include: 1.Drug-disease interactions 2.Drug-drug interactions 3.Peri-operative complications 4.All of the above

10. CASE 2 – QUESTION #6 The psychiatric treatment option with the smallest side effect burden is: 1.Anti-depressant medication 2.Anti-psychotic medication 3.Electro-convulsive therapy 4.Mood stabilizer medication

11. CASE 2 – QUESTION #7 The medical treatment option with the smallest side effect burden is: 1.Cholesterol medication 2.Diabetes medication 3.Diuretic 4.Surgery 5.Tremor medication

12. CASE 2 – QUESTION #8 CD’s most likely cause of death will be: 1.Cerebrovascular accident (stroke) 2.Coronary artery disease (heart attack) 3.Schizophrenia (accident/homicide/suicide) 4.Uterine cancer