Management Of Psych Mental Health Essay

Management Of Psych Mental Health Essay

Case Overview

The video describes a patient sent to the psychiatric clinic due to her mother’s worry about her constant mood change at that season of the year. The patient admits to being moody at this season of the year. She feels down, angry and miserable. Her friends are constantly annoying her, have gained 10ponds weight, have difficulties finishing her assignments and projects, concentrating, and have poor sleeping patterns. The patient is well-kempt, appropriately dressed, and well-built. She is easy to create rapport with but does not maintain eye contact. Her facial expression is flat, disengaged, and fidgeting. Her speech is slow, with a soft tone and volume. She has a low mood and flat affect throughout the conversation. Her insight and judgment are intact with a congruent thought process. She has no hallucinations, delusions, and suicidal ideation. Management Of Psych Mental Health Essay

Psychological Symptoms And Psychiatric Diagnosis

The psychological symptoms in this patient are depressed mood when admits that she is sad and angry every time. She has diminished her loss of interest by her friends are annoying and have difficulties finishing a task. She has significant weight by gaining 10pounds within a short time. She has sleep disturbance and stays indoors the whole time sleeping. She feels miserable and diminished her ability to concentrate. She has no allergies and medical history. The patient psychiatric diagnosis is depression because she meets the DSM 5 criteria. The American psychiatric association states that the patient should meet at least five of; depressed mood, diminished interest, significant weight change, sleep disturbance, psychomotor agitation, feelings of worthlessness, loss of concentration, and recurrent suicidal ideation (Tolentino, J. C., & Schmidt, S. L. 2018). The patient presents with more than five of these symptoms.

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Differential Diagnoses

The dysthymic mood is a persistent depressive mood characterized by a chronic course and an early insidious onset. it is highly associated with personality disorders. According to the American psychiatric association DSM 5, the patient presents with feeding disturbances, sleep disturbance, loss of interest, poor concentration, low self-esteem, and feelings of hopelessness. However, this is not the diagnosis because the patient’s depressive mood is seasonal.

Hypomanic bipolar is a severe and persistent mental illness presenting with a depressed mood, loss of interest, significant weight gain, feelings of worthlessness, and loss of concentration. It usually proceeds with grandiosity, racing thoughts, excessive pleasurable activities, and a diminished need for sleep. This is not the diagnosis because the patient had no manic symptoms before the depressive mood.

Suicidal Or Homicidal Risk Assessment

The patient has a history of recurrent depressive moods during the winter season because she finds the snow dark and ugly. She further explains that the winter season restricts her from visiting the beach with her friends. Her current mental state is depressive because she feels sad, angry, and miserable. She has no history of previous suicidal attempts, plans, or ideation. She does not take alcohol or use other substances. She has no other psychological factors. The trigger of her symptom is climatic change. Therefore, she is not at risk of suicide attempt or ideation

Psychiatric Tools Or Scales Do You Use To Help Support Your Diagnosis

Becks depression inventory is a report inventory with psychometric tests for measuring the severity of depression (Wong, et al, 2022). In this case, the patient has a score of 26 indicating moderate depression. Patient health questionnaire-9 monitors the severity of depression and response to treatment. in this case, the patient scores 21 indicating severe depression. Management Of Psych Mental Health Essay

Pharmacological Treatment

Paxil is a selective serotonin reuptake inhibitor with a high affinity for muscarinic, adrenergic, dopaminergic, serotonergic, and histaminergic receptors thus, it improves mood, energy, and sleep patterns. Paxil administration dose is 20mg orally daily at any time with or without food. It has a contraindication in pregnancy and infancy due to an increased risk of cardiovascular diseases (David, et al, 2022). Additionally, there should be no co-administration with other antidepressants to reduce the risk of cardiac arrhythmias. Compared to other antidepressants, Paxil does not cause weight gain or precipitate suicidal ideation.

Non-Pharmacological Treatments

Cognitive-behavioral therapy is widely used psychotherapy in patients with depressive moods. It involves cognitive restructuring, and an activity schedule to change the negative automatic thoughts and maladaptive schemas. Karyotaki, et al (2021) conducted a study among adult patients with depression showing that patients who underwent cognitive behavioral therapy sessions had a better outcome compared to those who did not have therapy sessions.

Diagnostic Investigation

There are no diagnostic tests available to make a diagnosis for depression. However, some organic causes of depression may include sepsis, liver failure, and hypothyroidism. Therefore, it is necessary to request a complete blood count with white blood cell differential to rule out sepsis. Liver function tests help rule out chronic liver disease. Renal function test checks for glomerular filtration rate that rules out kidney injury. Thyroid function tests rule out hypothyroidism and hyperthyroidism.

Questions That You Would Ask To Help Further Solidify Your Diagnosis (Brief List)

1. How do you feel about yourself?
2. Do you have little interest or pleasure to do things?
3. Are you feeling tired or having little energy?
4. Do you have trouble falling asleep or sleeping too much?
5. Do you feel down, depressed, or hopeless?

Follow Up Plan

The patient should come back to the clinic after four weeks of drug intake to monitor its tolerance and effects on the patient. the patient should attend psychotherapy sessions to improve their behavior and cognitive functions.

For this assignment, you will watch an assigned video clip that depicts a patient needing psychiatric/mental health treatment. You then will complete a treatment plan for this patient, following the attached formatting. You are required to follow APA 7, which includes, a title page, your typed treatment plan, and a references page. Each video case that is assessed should result in a treatment plan that is a minimum of 3 pages in length, in addition to the title page and references page. This is a treatment plan, not a research paper. Follow the rubric guidelines for grading criteria.

Just like in practice, there are times when all the preferred information may not be available, yet you still will need to formulate a treatment plan for the patient. Your treatment plan must include in-text citations and proper APA 7 formatting. You are writing this as if you are the licensed PMHNP writing orders for this patient.

The following reference materials are required to be utilized and referenced:

• DSM-5
• Course Textbook
• Drug guide of your choice (text or online) (that has a current DATE)
• 1 scholarly peer reviewed journal article, dated within the last 5 years, that supports your treatment plan. UptoDate is a wonderful site, but it is not considered a scholarly peer reviewed journal article. Management Of Psych Mental Health Essay

The APA 7 style of writing is required. This includes (but is not limited to):

• Proper grammar and composition, capitalization and sentence structure
• APA 7 approved font (such as 12-point Times New Roman)
• Double spaced paper with 1” margins
• Paragraphs are to be left margin justified only
• Paragraph indentions
• Heading Levels (see APA 7, p. 47-48)
• References that are formatted as per APA 7. See chapter 9 of the APA 7.

How to properly cite and reference the DSM-5. Points WILL BE DEDUCTED for not referencing the DSM-5 correctly. Here, is the correct way to reference it on the references page and as an in-text citation.

For electronic versions:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th

ed.). https:doi.org/10.1176/appi.books.9780890425596

For printed version:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th

ed.). American Psychiatric Association.

Basic in-text citation for the DSM-5:   (American Psychiatric Association, 2013).

Treatment Plan: What to include and how to format the treatment plan

Your Treatment plan should include the following categories:

1. Title page
2. Content of treatment plan (The title of your treatment plan should be on line 1 of page 2).
   1. Which Video # are you doing?
   2. Brief description of the patient (do not repeat the entire video – BRIEF)
   3. Brief explanation of the presenting psychological symptoms (delusional, jealous, moody, talkative, appears depressed, etc)
   4. Any known medical history, allergies, etc. (If none, state No known allergies, No known medical history).
   5. Your psychiatric diagnosis (supported by the DSM-5 criteria). You can state something like, This patient met criterion 1, 2, 4, 5,A, C, D and 7 from the diagnostic criteria on page 163-164 of the DSM-5 for the diagnosis of ……………
   6. List 2- 3 of the differential diagnosis from the DSM-5, and briefly state why that was chosen as a differential diagnosis, and not as the main diagnosis. (See course materials on Differential Diagnosis) (supported by the DSM-5).
   7. Suicide and/or homicidal risk assessment (Include the 5 components of a suicide risk assessment, do you want to kill yourself, what is your plan, do you have access to that plan, what is your intention, and what is keeping you here (the mitigating factors) See Nursing Suicide Risk Assessment PPT/Kaltura Module 1. Points are deducted if the 5 components of a suicide risk assessment are not written out.
   8. What psychiatric tools or scales you used to help support your diagnosis (include citations).
   9. Medications being ordered (include a citation)
      1. Include name of medication(s) and what the med is used for
      2. Include the route, dosage, frequency
      3. Include black box warnings or what the pt needs to know/foods to avoid, etc.
   10. Non-pharmacological treatments that are being ordered (include citation that supports these). Different diagnoses respond better to different forms of therapy. Some respond to CBT, others to Behavioral Therapy, others to Family Therapy, etc.
   11. Any labs or medical tests that need to be completed to rule out organic causes, for medication monitoring, and so forth (include citation). (include a short line stating why each lab/test is being ordered)
   12. Questions that you would ask to help further solidify your diagnosis (brief list)
   13. Any further directives/resources for the patient (this would include, follow up with primary doctor to monitor HTN or diabetes; directives to follow-up with other members of the comprehensive treatment team; safety plan if you are sending the pt home and they have suicidal or homicidal thoughts; return for medication assessment in x number of weeks, etc. This also includes support group and hotline phone numbers for things like SI and SUD).
3. References Page – include all citations used in the paper, formatted per APA 7, double spaced and in alphabetical order. References are to include the DSM-5, the course textbook, a drug book of your choice (text or online that has a date), and 1 scholarly journal article reference within the last 5 years, for each of the videos or discussion board prompts being assessed.

Note:

                Direct quotations should be kept to a minimum and properly cited as per the APA 7. It is imperative that you synthesize the course information into your own words, using minimal direct quotations from scholarly journal articles to support your treatment plan. Academic integrity is essential as proper citations give credence and reliability to your treatment plan. If your TII score is over 35%, see what areas of your paper you can re-word to avoid a grade of zero.

 DSM-5 & Differential Diagnosis

To effectively treat patients, a reliable diagnosis and treatment recommendation is essential. The DSM-5 provides a definition for each mental health disorder along with diagnostic criteria that must be met for each diagnosis. These diagnoses are designed to “help clinicians to determine prognosis, treatment plans, and potential treatment outcomes for their patients” (American Psychiatric Association, 2013, p. 20). Diagnoses are then made after performing a clinical interview with the patient, using DSM-5 descriptions, criteria, and using clinician judgment (American Psychiatric Association, 2013).

1. All psychiatric disorders have a categorical place in the DSM -5. It includes the symptoms that must be present with specifiers that allow for a more specific diagnosis that help with the development of a treatment plan. (Example: Major depressive disorder with psychotic features).

1. Most psychiatric disorders (and psychiatric emergencies) require a thorough suicide risk assessment. Include all 5 components of the suicide risk assessment we learned in Module 1 Nursing Suicide Risk Assessment PPR/Kaltura. (Desire, plan, access, intent, mitigating factors). If you don’t ask them, your professor can not assess if you know how to do a suicide risk assessment.

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1. Differential diagnoses: A reliable diagnosis is required to effectively treat the patient and to have positive treatment outcomes. The differentials provide for clinicians and alternate diagnosis that could be considered if it is proven that the patient does meet the criteria for the primary diagnosis that was chosen.

A clinician does not randomly come up with a differential diagnosis on their own. The DSM-5 provides for clinicians, differential diagnosis for each primary diagnosis. They are listed in the DSM-5 at the end of each diagnosis chapter. The differentials are listed in order of prevalence. For example, of all the patients diagnosed with Bipolar 1, if that diagnosis was proven not to be correct, most often the correct diagnosis is found to be first, major depressive disorder, then second most frequent is the 2^nd differential listed, then the 3^rd most frequent is the 3^rd differential that is listed. So the differentials should be alternate diagnosis that you considered or wrestled with as you were determining the primary diagnosis for the patient. Management Of Psych Mental Health Essay

For example, if you have a patient who appears with a mood disorder, you may be considering depressive disorder or bipolar 1 disorder. Upon examining the diagnostic criteria in the DSM-5 for bipolar 1 (page 123-131) you determine that bipolar 1 is the diagnosis that the patient meets the criteria for. You must then look to the differential diagnosis that are listed in the DSM-5 (for bipolar 1 the differentials are on page 131-132) and you choose 2 or 3 of them that your patient closely matches the criteria for. You then briefly explain why you chose bipolar 1, as opposed to the differential diagnosis of major depressive disorder (for example)

If you have questions, please reach out to your professor for your section. It is better to ask early and then know how to do it correctly for the 7 weeks then to struggle without asking. We are here for you! Management Of Psych Mental Health Essay