Browsing by Author "Sivamohan, Anjali"

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    Postpartum Hepatic Infarction in Antiphospholipid Syndrome Patients
    (2021-03) Joseph, Sophia; Hardman, Sara; Zeh, Janie; Sivamohan, Anjali; Mehta, Rakesh
    CASE: Our patient is a 31-year-old woman with a complicated past medical history of Systemic Lupus Erythematosus (SLE) and Antiphospholipid Ayndrome (APS). She originally presented several years ago when she was found to have Libman-Sacks endocarditis. She was diagnosed with SLE and APS at the time and was subsequently anticoagulated with warfarin. When she became pregnant, warfarin was discontinued and she was managed with a low molecular weight heparin (LMWH). She was continued on LMWH post-partum, but was noncompliant. For a few weeks following delivery, she presented to the hospital on several occasions with acute right upper quadrant pain. CT imaging confirmed several hepatic infarcts and she was treated with steroids, fondaparinux, and plaquenil. CONCLUSIONS: APS poses several risks during and after pregnancy due to susceptibility to venous and arterial thrombosis1. There is an increased risk of thrombosis up to 12 weeks postpartum. Continuation of anticoagulation following delivery is essential in APS women who have a high baseline risk of thrombosis2. Non-compliance with medications may have contributed to this presentation. This case is unique in that hepatic infarcts rarely occur due to the dual blood supply of the liver. Moreover, the diagnosis of hepatic infarction can be difficult as it may present similarly to HELLP, possibly contributing to her multiple admissions with RUQ pain3,4. CLINICAL SIGNIFICANCE: This case is significant because it demonstrates the rare, but life-threatening risk of postpartum hepatic infarction in APS patients. Proper postpartum management and compliance with anticoagulation medications are essential to mitigating risk. Furthermore, providers may face challenges in diagnosing hepatic infarction as it could mimic other diseases.
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    The Use of Dialectical Behavior Therapy in Patients with Suicidal Ideation
    (2023) Gallagher, Clare; Sivamohan, Anjali; Andrews, Madeline; Coffey, Gillian; Raza, Mubashra
    Background: Dialectical behavior therapy (DBT) is a psychotherapeutic approach that aims to reduce incidences of self-harm and suicidal ideations through use of skills-based training and individualized psychotherapy. While DBT has been applied to patients with borderline personality disorder (BPD), it can potentially be used in anyone with a history of self-harm or attempted suicide. We investigated whether DBT is an effective therapy in the treatment of patients with repeat suicidal ideation regardless of a BPD diagnosis. Case Description: A 31-year-old female veteran with a history of substance use disorders, post-traumatic stress disorder, BPD, and multiple suicide attempts presented to the emergency department (ED) for suicidal ideation (SI). She has had at least 7 hospitalizations in the past year for SI. While inpatient, the patient had daily therapy, motivational interview, and pharmacological management. She denied SI upon discharge and was sent home on her previous medication regimen and follow-up with substance use recovery and DBT. Conclusion: Few studies have looked at the effectiveness of DBT in treating SI or self-harm without exclusively looking at BPD. However, the studies that have evaluated DBT for suicidal ideation, it was seen to be effective in reducing incidence of self-harm and suicidal attempts including a meta-analysis of 18 clinical trials found DBT reduced self-directed violence and frequency of psychiatric crisis. One point found during our literature search worth exploring further is whether DBT is offered more to female patients compared to male patients due to the association of BPD as every study reviewed had a female majority. Clinical significance: Per CDC, suicide is the 12th leading cause of death. In 2020, there were an estimated 1.20M suicide attempts and 45,979 Americans died by suicide. DBT therapy should be considered as a standard of care in patients with suicidal ideation as current literature suggests it can be beneficial in reducing suicidal attempts and incidence of self-harm.