MA v Lindsay Clancy - Rebecca Jollotta - Psychiatric Nurse Practitioner

Testimony of Rebecca Jollotta, a board-certified psychiatric mental health nurse practitioner, who treated Lindsay Clancy: Professional Background and Care Transition • Role & Specialty: Rebecca Jollotta is a psychiatric nurse practitioner certified in perinatal mental health, treating women up to two years postpartum. • Transition of Care: On November 29, 2022, she took over Lindsay Clancy's psychiatric care at South Shore Health. Initial Assessments & Worsening Symptoms (Late Nov – Early Dec) • Nov 29 Virtual Visit: Lindsay reported persistent insomnia (sleeping ~2 hours), weight loss, and severe anxiety. She was collaborative but expressed deep fears of becoming dependent on Ativan. • Objective Screenings: Scores indicated moderate-to-severe depression (EPDS of 17) and moderately severe anxiety (GAD-7 of 14). Her thinking was linear and goal-directed; she exhibited no signs of psychosis, mania, or active suicidal/homicidal ideation. • Nov 30 – Dec 3 MyChart Exchanges: Lindsay stopped Remeron due to worsening depression and new "intrusive thoughts of wanting it to be all over". Jollotta recommended restarting Prozac and adding low-dose Seroquel (25mg, then 50mg) for sleep. She explained the physical difference between medication dependence and addiction. The December 6 In-Person Visit & Bipolar Suspicion • Deteriorating Scores: Accompanied by her husband, Patrick, Lindsay's scores worsened to severe levels (EPDS: 21, GAD-7: 19). • Zoloft Activating Response: The couple described a September episode where increasing Zoloft caused Lindsay to go 48 hours without sleep while remaining completely alert and un-fatigued. • Differential Diagnosis: This reaction raised clinical suspicions of an underlying bipolar spectrum/mixed manic state. Patrick rejected the suggestion. • Taper Plan: To ease benzodiazepine withdrawal fears, Jollotta performed a CIWA assessment (minimal score of 1) and switched Ativan to Valium due to its longer half-life. At their preference, Remeron/Seroquel were stopped to focus on Prozac. Titration, Phone Crisis, and PHP Recommendation (Dec 7 – 13) • Treatment Shift (Dec 7): Lindsay reported sleeping poorly on Valium but not feeling tired the next day. Jollotta held the Prozac and ordered a rapid titration of Seroquel up to 400mg to target the suspected manic symptoms and restore sleep. • Dec 9 Crisis Call: Patrick and Lindsay called reporting acute panic, numbness, and thoughts of suicide. Jollotta contracted for safety over the phone (no active plan or intent), paused the Valium taper, and strongly recommended a specialized perinatal Partial Hospitalization Program (PHP) at Women and Infants Hospital in Rhode Island. • Dec 12 – 13 Follow-Ups: Lindsay slept 7-8 hours on Seroquel 200mg and Valium 2.5mg but felt "incredibly depressed and unmotivated" during the day. At her virtual follow-up (EPDS was 20), she denied active suicidal ideation, plan, or intent, and expressly denied thoughts of harming her children. Acute Escalation & Medication Pairing (Dec 15 – 16) • Dec 15 Emergency Call: Lindsay reported her "worst day" with persistent intrusive thoughts of suicide. Jollotta advised them to go directly to an ER with specialized perinatal psychiatry, specifically recommending MGH or McLean Hospital. • Dec 16 Adjustments: Lindsay visited the MGH ER but chose to remain outpatient to pursue the Women and Infants PHP. Her original psychiatrist, Dr. Tufts, recommended adding 25mg of Lamictal to stabilize her mood. Jollotta agreed Lamictal was an excellent mood stabilizer for depression, outlined the slow titration required to avoid Stevens-Johnson syndrome (a severe rash), and increased Seroquel to 300mg. PHP Intake, Seroquel Taper, and Last Contact (Dec 19 – 30) • PHP Intake & Discharge (Dec 20): Lindsay attended her Women and Infants intake but was discharged the same day. • Holiday Taper: Though initially hesitant to manage a taper while going on vacation, Jollotta sent in a structured 12-night Seroquel taper at Lindsay's strong insistence. • Final Contact (Dec 30): Patrick called stating Lindsay was safe but wanted to be admitted to McLean under the Dec 15 bed offer. 00:00:00 - MA v Lindsay Clancy - Rebecca Jollotta - Psychiatric Nurse 00:08:15 - First contact Nov 29 2022 00:11:12 - Prior meds and Nov 16 ER visit 00:12:19 - Nov 29 visit Remeron and sleep 00:18:43 - Hydroxyzine Ativan Preference 00:35:13 - Starts Seroquel 25 mg 01:06:26 - Dec 6 visit with Patrick 01:12:00 - Bipolar Possibility 01:34:34 - Women and Infants PHP referral 02:12:00 - Seroquel dosing 02:15:45 - McLean Hospital Discussed 02:17:47 - Cross-Examination: Kevin Reddington 02:40:02 - Challenging the clinical picture 03:03:19 - Mood chart and records dive 03:13:17 - Taper vacation and late December 03:23:42 - Redirect Examination Lindsay Clancy Trial Playlist:    • MA v Lindsay Clancy - Jury Selection Day 1