Anorexia Nervosa Essay Paper
Anorexia Nervosa Essay Paper
Initials: A.S
Age: 39 years,
Gender: female
Ethnicity: Brazilian
The primary source of information: spouse
Reason for referral: for psychiatric evaluation
Chief complaint: headache Anorexia Nervosa Essay Paper
History of presenting complaint: A.S is a 39years old female accompanied to the emergency department with complaints of headache that is diffuse and throbbing. The headache is intermittent and does not radiate. It is of gradual onset aggravated by exertion. Associated symptoms are dizziness, amenorrhea, inability to concentrate, constipation, cold extremities, and dry hair. In addition, the patient reports excessive fear of feeding and feels sick at the sight of food because of the fear of adding weight. The onset of these symptoms was since the age of 14years. She however denies being obsessed with any type of food. Anorexia Nervosa Essay Paper
Medical history: the patient had Anorexia nervosa when she was 14years old. This caused her hospitalization for one week to initiate re-feeding and psychotherapy. However, she has not undergone major and minor surgical procedures and blood transfusions. She has no known history of food and drug allergies.
Family history: the patient is the firstborn in a family of two. His parents and sister are alive and healthy. She denies a family history of mental health disorders, cancer, and asthma. Anorexia Nervosa Essay Paper
Social history: The patient is married and has one child. She works as a secretary in an accounting consultancy. She has studied diploma in secretarial and business administration. She is a staunch catholic and enjoys singing in the choir. She does not take alcohol and does not smoke. She has no legal or military issues.
Review of the system: the patient denies cough, chest pain, dyspnea, orthopnea, abdominal pain, heartburn, reflux, nausea, vomiting, muscle pain, numbness of extremities, lower limb swelling, and urinary symptoms.
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Objective Data
The patient is in fair general condition. She looks underweight for her age. She is pale and has wrinkles. However, she has no jaundice, dehydration, or lymphadenopathy.
Vitals: blood pressure 90/60mmHg, pulse rate 50, the temperature at 35 degrees, height 161 cm, weight 40kgs, and BMI at 15kg/m2.
Mental state examination: the patient is alert and oriented. She is well-kempt for the occasion and weather. She seems to have lost weight, has dry skin, and has thin hair. The patient avoids eye contact and seems irritable. She does not have unnecessary movements. Her speech is soft-spoken with a low tone and volume. Her mood is angry and has an irritable affect. She thinks that she might gain too much weight and look ugly. However, she is not comfortable with her current body shape and size because she feels that she is too big. She has no hallucinations or delirium. She has no suicidal ideation. Anorexia Nervosa Essay Paper
Assessment
Differential diagnosis
Anorexia nervosa
Avoidant restrictive food intake disorder
Anorexia nervosa is an eating disorder characterized by the inability to maintain a healthy weight due to the fear of gaining weight (Dobrescu, et al, 2020). This disturbs the patient’s physical and psychological function. The presenting signs and symptoms are intense fear of gaining weight, disturbance in the way which body type is experienced, and restriction of energy intake relative to its requirements. This is the patient’s actual diagnosis because of her clinical presentations.
Avoidant restrictive food intake disorder is a feeding disturbance manifested by food avoidance due to psychological disorder (Bourne, et al, 2020). it results in significant weight loss. Its clinical manifestation includes; hypotension, headache, dizziness, and bradycardia.
Obsessive-compulsive disorder is a mental health disorder characterized by intrusive thoughts and repetitive acts (Robbins, et al, 2019). This patient has repetitive thoughts regarding weight gain and is uncomfortable about her body shape. This makes her starve so as not to gain weight.
Plan
Re-feeding
Psychotherapy-individual insight-oriented therapy
Pharmacotherapy-fluoxetine 20mg PO OD
Patient education
Grading Rubric for Psychiatric Evaluations and Psychiatric Case Presentations
| Category | Unacceptable | Acceptable | Good | Excellent |
| Demographic Data | 0
Does not adequately convey topic. Missing all or most key elements. |
1
Includes minimal identifying information. Primary source of information and reliability as well as reason for referral and patient understanding of referral are not included or are unclear. Anorexia Nervosa Essay Paper |
3
Includes identifying information but leaves out some key elements. Primary source of information and reliability as well as reason for referral and patient understanding of referral are noted. |
5
Includes identifying information including initials, age, gender, ethnicity. Primary source of information and reliability as well as reason for referral and patient understanding of referral are clear. |
| Subjective Data
History of Present Illness (HPI) |
0
CC is not recorded. HPI does not reflect a chronological account of symptoms that are sufficiently descriptive to validate Dx per DSM-5 criteria. Pertinent negatives are not included. The longitudinal course of illness is nonexistent.
|
8
CC is clear. HPI provides an account of symptoms that are descriptive, nonchronological, without context, and do not clearly validate Dx per DSM-5 criteria. Few pertinent negatives are included. A longitudinal course of illness is unclear. Current medications are included.
|
14
CC is clear, concise and verbatim from pt. HPI is thorough yet concise and provides a chronological account of symptoms with some contextual factors that are sufficiently descriptive (oldcarts) to validate Dx per DSM-5 criteria. Pertinent negatives are included. A longitudinal course of illness is appreciable. Current psychiatric medications and response are included.
|
20
CC is clear, concise and verbatim from pt. HPI is thorough yet concise and provides a chronological account of symptoms and contextual factors that are sufficiently descriptive (oldcarts) to validate Dx per DSM-5 criteria. All pertinent negatives are included. A longitudinal course of illness is clear. Current psychiatric medications and response are included.
|
| Past Psychiatric History | 0
PPH contains no previous treatment Hx including previous Dx, hospitalizations, outpatient treatments, suicide attempts, self-harm, nor is there descriptions of previous medications with detailed trial and response history. Pertinent negatives are not included.
|
1
PPH contains sparse data regarding previous treatment including previous Dx, hospitalizations, outpatient treatments, suicide attempts, self-harm. Previous medication history is sparse and without detailed trial and response history. Pertinent negatives are unclear. |
3
PPH contains most data regarding previous treatment including previous Dx, hospitalizations, outpatient treatments, suicide attempts, self-harm, and previous medications with detailed trial and response history. Pertinent negatives are also included. |
5
PPH contains all previous treatment including previous Dx, hospitalizations, outpatient treatments, suicide attempts, self-harm, and previous medications with detailed trial and response history. Pertinent negatives are also included. |
| Substance Use History | 0
Substance use history is not documented. No inclusion of addictive behavioral patterns. Anorexia Nervosa Essay Paper |
1
Substance use history is documented but data is sparse. Pertinent negatives are unclear. Age of onset, duration, frequency/pattern of use, route of administration, last use, consequences of use are not all included. Not limited to illicit substances. Review of addictive behavioral patterns absent. |
3
Complete substance use history is documented. Most pertinent negatives are documented. Age of onset, duration, frequency/pattern of use, route of administration, last use, consequences of use. Not limited to illicit substances. Inclusive of addictive behavioral patterns. |
5
Complete substance use history is documented. Pertinent negatives are clear evidenced by appropriate pt. responses ie. “denies”. Age of onset, duration, frequency/pattern of use, route of administration, last use, consequences of use. Not limited to illicit substances. Inclusive of addictive behavioral patterns. |
| Past Medical History and Review of Systems (ROS) | 0
Medical history is incomplete or absent. ROS is not complete or is not free from objective assessment data ie. “lungs clear” “BS present” |
1
Medical history includes previous and current medical problems, surgeries, and allergies. ROS may be extraneous or incomplete for the presenting psychiatric problems and is not free from objective assessment data ie. “lungs clear” “BS present” |
3
Medical history includes previous and current medical problems, surgeries, and allergies. ROS is germane to the presenting psychiatric problems but is not free from objective assessment data ie. “lungs clear” “BS present” |
5
Medical history includes previous and current medical problems, surgeries, and allergies. ROS is germane to the presenting psychiatric problems and is free from objective assessment data ie. “lungs clear” “BS present”. |
| Family History Psychosocial and Developmental History | 0
Family Hx is minimal or nonexistent and does not include identified relational status with current or historical psych illness, treatments, responses, suicides, or self-harm. Dev’t Hx minimally or does not include info regarding family of origin, siblings, birth order, family dynamics, relational patterns and status, educational, employment, abuse, spirituality, legal, military. Dev’t milestones for child & adolescents are not included |
3
Family Hx includes some of the identified relational status with current or historical psych illness, treatments, responses, suicides, or self-harm. No indication if biologically related. Dev’t Hx includes minimal info regarding family of origin, siblings, birth order, family dynamics, relational patterns and status, educational, employment, abuse, spirituality, legal, military. Few dev’t milestones for child & adolescents are included |
7
Family Hx includes current or historical psych illness without clear identification of relation, but does include treatments, responses, suicides, or self-harm. Dev’t Hx includes most info regarding family of origin, siblings, birth order, family dynamics, relational patterns and status, educational, employment, abuse, spirituality, legal, military. Dev’t milestones for child & adolescents are included |
10
Family Hx includes identified relational status with current or historical psych illness, treatments, responses, suicides, or self-harm. Indication if biologically related. Dev’t Hx includes info regarding family of origin, siblings, birth order, family dynamics, relational patterns and status, educational, employment, abuse, spirituality, legal, military. Dev’t milestones for child & adolescents are included |
| Objective Data
Mental Status Exam Physical Exam (as appropriate) vital signs, height, weight, labs or other relevant diagnostics. |
0
MSE missing most elements. Physical exam not documented |
5
MSE contains all elements as outlined in addendum.. Is in narrative form and effectively and vividly describes the patient’s presentation. Concrete examples of all assessment results are included ie. “able to correctly interpret 2/3 simple proverbs” to validate documentation of “abstract thought intact”.
|
10
MSE contains all elements as outlined in addendum.. Is in narrative form and effectively and vividly describes the patient’s presentation. Concrete examples of all assessment results are included ie. “able to correctly interpret 2/3 simple proverbs” to validate documentation of “abstract thought intact”.
|
15
MSE contains all elements as outlined in addendum.. Is in narrative form and effectively and vividly describes the patient’s presentation. Concrete examples of all assessment results are included ie. “able to correctly interpret 2/3 simple proverbs” to validate documentation of “abstract thought intact”.
|
| Assessment
|
0
Differential is impertinent to S&S or absent. Formulation does not support nor clearly outline thought process of diagnoses. Diagnoses tendered are not supported by criteria in the HPI description or substantiated with the MSE. |
3
Differential is impertinent to S&S, formulation appears rudimentary and vague. Diagnoses are made per DSM-5 but are marginally reasonable. Criteria for diagnoses tendered are not explicit in the HPI description or substantiated with the MSE. |
7
Differential is pertinent to S&S, formulation contains evidence of critical thought and subject knowledge, and reasonable diagnoses are made per DSM-5. Clearly met criteria for diagnoses tendered are explicit in the HPI description and substantiated with the MSE. |
10
List diagnosis and differential diagnosis. pertinent to S&S, formulation contains evidence of critical thought and subject knowledge, and reasonable diagnoses are made per DSM-5. Clearly met criteria for diagnoses tendered are explicit in the HPI description and substantiated with the MSE.
|
| Plan
|
0
Treatment plan is presented without sound rationales. There is no evidence of synthesis of information or critical thought. Anorexia Nervosa Essay Paper |
5
Evidence-based treatment plan is presented with minimal rationales. Rationales reflect the student’s marginal ability to choose treatments based not only on FDA approval or current evidence but also the nuances and unique characteristics of each. Treatment plan is reasonable but lacks comprehensiveness. There is minimal evidence of synthesis of information and critical thought. |
10
Evidence-based treatment plan is presented with rationales. Level of detail reflects the student’s moderate ability to choose treatments based not only on FDA approval or current evidence but also the nuances and unique characteristics of each. Treatment plan is holistic and comprehensive. There is some evidence of the student’s synthesis of information and critical thought. |
15
Evidence-based treatment plan is presented with detailed rationales. Level of detail reflects the student’s ability to choose treatments based not only on FDA approval or current evidence but also the nuances and unique characteristics of each. Treatment plan is holistic and comprehensive. There is strong evidence of the student’s synthesis of information and critical thought. |
| Writing, Support, APA | 0
The format is not consistent with the example provided in the course. No recent, scholarly, peer- reviewed support of topic. Substantial grammar, spelling, and punctuation errors detracting from the assignment. Writing mechanics include many awkward or unclear passages and informal tone not consistent with formal scholarly work. Substantial errors in APA style based upon the required APA manuals listed on the course syllabi. |
1
The format is marginally consistent with the example provided in the course. Limited recent (5-7 years), scholarly, peer- reviewed support of topics. Occasional spelling, grammar, and punctuation errors detracting from the assignment. Writing mechanics include awkward or unclear passages and informal tone not always consistent with formal scholarly work. Occasional errors in APA style based upon the required APA manuals listed on the course syllabi. |
3
The format is fairly consistent with the example provided in the course. Clear, recent (5-7 years), scholarly, peer- reviewed support of topics. Minimal grammar, spelling, and punctuation errors. Writing mechanics include minimal awkward or unclear passages but are consistent with formal scholarly work. Minimal errors in APA style manuals listed on the course syllabi. |
5
The format is consistent with the example provided in the course. Strong, recent (5-7 years), scholarly, peer- reviewed support of topics. No grammar, spelling, and punctuation errors. Writing mechanics are consistent with formal scholarly work. No errors in APA style based upon the required APA manuals listed on the course syllabi. |
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Addendum
Mental Status Exam Elements- All Borderline Subjects Are Tough Troubled Characters
A- Appearance
Height, build, hair color, style, facial hair, body modifications, facial features, scars, grooming, hygiene, odors, clothing, make-up, impression of general appearance and memorable aspects.
B- Behavior
Attitude
Motor activity
S- Speech
General quality
Fluency
Amount
Rate
Tone
Volume
Prosody
Spontaneity or Latency
A- Affect
Qualities of Affect
Stability
Appropriateness
Range
Intensity
Mood as defined by patient. Usually in quotation marks
T- Thought process
Flow and processing of thought. Examples:
Circumstantiality
Clang associations
Fight of ideas
Perseveration
Thought blocking
T- Thought content
Suicidal ideation (SI), Homicidal ideation (HI), Violent ideation (VI). If + comment on intent, plan, and preparation
Psychotic ideation or perceptual disturbances. Examples:
Delusions or hallucinations
Obsessional thoughts
Compulsions
Ideas of reference
Paranoia (suspiciousness)
Significant themes related to diagnosis
C- Cognitive exam – consider educational attainment when interpreting results.
Alertness
Orientation
Concentration
Memory (long and short term)
Calculation
Fund of knowledge
Abstract reasoning
Insight
Judgment
Physical Exam- Will be completed as appropriate to clinical setting. Physical exam results will vary in content. The instructor should use their discretion when considering the relative weight of this section. Anorexia Nervosa Essay Paper
