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Employing the patient-centered collaborative care approach: a case study of complex geriatric patient with psychopathalogy of treatment resistant depression and primary hyperparathyroidism.

Joel R Saul, Sharon M Holder, Jonathan S Lokey

Introduction: Primary hyperparathyroidism is a relatively common endocrine disease with many nonspecific physical symptoms as well as potentially serious psychiatric effects. The incidence of the illness, severity of symptoms, and poorer outcomes are all positively correlated with increasing patient age. The Patient Centered Collaborative Care Approach is a demonstrable method of coordinating patient care, reducing the burden on patient advocates, and improving patient outcomes. The use of the Patient Centered Collaborative Care Approach has not previously been well described in treatment of psychiatric manifestations of primary hyperparathyroidism. Methods: Using the example of an elderly woman admitted with complex psychopathology and a diagnosis of primary hyperparathyroidism, this case will illustrate the value of the Patient-Centered Collaborative Care Approach in (1) establishing accurate diagnoses, (2) reducing harm from comorbidities, (3) improving patient outcomes, (4) potentially reducing overall hospital costs. Results: The case exemplifies the potential benefits of implementing the Patient-Centered Collaborative Care Approach in the treatment of a medically complex patient hospitalized for psychiatric complaints. Conclusion: A diagnosis of Primary hyperparathyroidism (PHPT) was not immediately made due to variables confounding initial lab values to include significant dehydration and malnourishment prior to admission. A multidisciplinary team was employed in the treatment for this patient utilizing the Patient centered Collaborative Care Approach. This included the psychiatric treatment team, internal medicine, endocrine surgery, as well as significant family involvement. Parathyroid adenoma was confirmed mass was successfully removed surgically. The patient made a rapid and dramatic improvement and her depressive symptoms remitted. The critical importance of clinical flexibility, questioning available data, and a collaborative team approach to the evolution of a diagnosis is discussed.