Psychiatric Case Presentation essay
Psychiatric Case Presentation essay
Subjective Data
Chief complaint: inability to fall asleep for three months
The paper should be written by experienced professional psychiatric nursing paper writer and should not be assigned to a novice writer
History of presenting illness: patient X accompanies her mother to the emergency department due to her inability to fall asleep for three months. The mother reports that her daughter spends most of the time in her room, she does not want to interact with other people and does not want to feed. She is always sad, complains of being tired all the time despite spending the whole day sitting, talks negatively about herself, and wishes to die. However, the patient states that she is not sick and does not understand why her mother is forcing her into the clinic. She denies hallucinations, delirium, and nightmares. Psychiatric Case Presentation essay
Psychiatric history: the patient has a positive history of generalized anxiety disorder and was given paroxetine and cognitive-based care until full recovery. She had post-traumatic stress disorder after the demise of her first child. She went through psychotherapy sessions until recovery. She has had a depressive mood disorder for six years and has not been compliant with treatment.
Psychiatric medication trial: the patient took paroxetine for three years which made her put on too much weight. She hates amitriptyline because she feels drowsy and tired the morning after taking the pill.
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Substance use: the patient admits to smoking marijuana when she feels stressed. Marijuana makes her feel relaxed and energized. She also smokes tobacco to make her calm down when she is angry. She takes alcohol (beer) three bottles daily and uses cocaine occasionally when she wants to feel good.
Family history: the patient is the firstborn in his family. She stays with her mother and father. Her father has paranoid schizophrenia, diabetes mellitus, and liver cirrhosis. The father has a positive history of drinking alcohol, smoking tobacco, and marijuana occasionally. Her mother had generalized anxiety disorder associated with hyperthyroidism. Her younger brother and sisters are alive and healthy. Her paternal uncle suffers from alcoholism. My paternal grandfather had alcohol-induced psychosis, diabetes mellitus, and head of pancreas cancer. Her paternal grandmother died of COPD due use of tobacco. Maternal grandparents died due to old age.
Social history: the patient is a divorcee. She separated from her husband three years ago due to an unresolvable family dispute. She had five children and four of them had unnatural deaths at their adult years. She did diploma in commerce in college and has been working as an assistant accountant. She resigned from her work three years ago due to poor job performance and loss of concentration. She has continuously lost interest in reading novels, working out at the gym, traveling, and singing in the church choir. She enjoys drinking alcohol because it helps her forget her problems. The patient denies having any legal convictions. She states that her most traumatic moments are when her four children passed on and her husband sent her back to her parent’s house. “It has been hard to recover from those moments in my life.”
Medical history: the patient has hypertension, diabetes mellitus, osteoarthritis, and DVT.
Current medication:
- metformin 500mg PO BD
- atenolol 50mg PO OD
- Tylenol 1g PO TDS
- Heparin 5000 units SC BD
Allergies: the patient denies food and drug allergy.
Reproductive history: the patient is two years post-menopausal. Her last menstrual period was on 7/7/2020. Her menarche was at the age of 15 years. She had a 28days regular cycle with four days of regular flow. She used an intrauterine contraceptive device before menopause. She has had one sexual partner in her lifetime. She states that her sexual urge decreased when she started taking amitriptyline. She further comments that it may have precipitated her divorce. She has no history of sexually transmitted diseases. Her last screen for STI and pap smear was three years ago. She had five children delivered via spontaneous vertex delivery at term with no associated post-partum complications. Psychiatric Case Presentation essay
Review Of Systems
General: the patient denies weight loss, fever, and sweating.
HEENT: she denies headache, eye pain, eye itchiness, tearing, blurring of visions, ear pain, sore throat, and running nose.
Cardiovascular system: she denies palpitations, syncope, dyspnea, lower limb swelling, orthopnea, and paroxysmal nocturnal dyspnea.
Respiratory system: the patient denies chest pain, coughing, running nose, wheezing, and sputum production.
Gastrointestinal system: the patient denies abdominal pain, diarrhea, constipation, reflux, heartburn, and vomiting.
Genitourinary system: the patient denies dysuria, polyuria, hematuria, urine incontinence, and urgency.
Neurological: the patient denies paralysis, numbness of extremities, facial droop, and tingling sensation.
Musculoskeletal system: the patient denies joint pain, muscle pain, stiffness, muscle spam, fracture, and dislocation.
Hematological system: the patient denies easy bruising, frequent infections, fever, and bleeding tendencies.
Lymphatic system: the patient denies lower limb edema, recurring infections, skin fibrosis, and lymph nodes.
Skin: the patient denies skin rash, stretch marks, and itchiness.
Endocrine: patient denies weight fluctuation, weakness, fatigue, heat and cold intolerance, mood swings, and hyperglycemia.
Objective Data
General examination: the patient is calm, alert, and oriented. She seems to be obese for her height. However, she does not have pallor, jaundice, cyanosis, edema, dehydration, and lymphadenopathy.
Vitals: her blood pressure is 167/88mmHg, her pulse rate at 68 beats per minute, her temperature at 36.4 degrees Celsius, her BMI at 34kg/m2, and her respiratory rate of 22 breaths per minute.
Chest examination: the chest wall has a symmetrical expansion upon inspiration and expiration. There is no scar, mass, or bruising at the chest wall. The heart is normal-active at 5th ICS MCL. There is a resonant percussion note over the lung fields. However, there are no parasternal heaves, thrills, and rubs. The clung fields are clear with no crackles, stridor, and rhonchi. The heart sounds S1 S2 is present. There are no murmurs and bruits.
Abdominal examination: the abdomen is round and has a normal contour. There is no scar and flank fullness. The bowel sounds are present and regular in the four quadrants. There is a tympanic percussion note. There is no shifting dullness and fluid thrill. There is no organ enlargement. Psychiatric Case Presentation essay
Mental state examination: the patient is well-kempt. She has dressed appropriately for the event. She is alert and oriented to time, place, and person. She makes slow spontaneous movements when responding to commands. She does not maintain eye contact during the interview. She seems to be very tired and her speech is slow and lacks spontaneity. She expresses sadness alternating with a lack of emotional range. Her affect is flat and blunted. She has a negative thought about herself that portrays guilt and hopelessness. Her judgment and insight are poor. She has suicidal ideations as she says that there is no need for lining another day. However, she has no hallucinations, delirium, and paranoid behavior.
Assessment
The patient presents with insomnia, loss of interest or pleasure, fatigue, hopelessness, loss of appetite, and suicidal ideation. She has a positive history of mental illness; depression, post-traumatic stress disorder, and anxiety disorder. She has had a traumatic past after the loss of her children and marriage break up. She has a positive history of alcohol and substance abuse to relieve stress. There is a history of mental illnesses in her family. She has lifestyle diseases (hypertension, diabetes mellitus, osteoarthritis, and DVT) whose triggers could be depression and traumatic life events. Upon mental state examination, she portrays a sad mood, psychomotor retardation, loss of concentration, guilt, and poor insight.
Differential diagnosis
- Depressive mood disorder
- Bipolar disorder
- Dysthymic mood
Depressive mood disorder is a mental illness that disrupts interpersonal relationships, substance abuse, work, and the patient’s medical outcome. Depression has significant potential for mortality due to the increase in associated suicide cases. It is more common in women between 40-and 59 years compared to other age groups. Causes of depression are bereavement, loneliness, impaired social support, negative life events, aging, genetic predisposition, and environmental factors (Aalbers, et al, 2019). The American psychiatric association DSM-5 criteria for depression includes sleep disturbance, eating disorders, suicidal ideation, hopelessness, loss of concentration, fatigue, loss of interest, and psychomotor agitation or retardation (Helm, et al, 2018). The patient meets the diagnostic criteria for depression through her presenting symptoms, risk factors, and mental state assessment.
Bipolar disorder is a mood disorder with alternating high and low moods. The mood changes affect the patients sleeping patterns, concentration, and energy that impact their work, relationships, and behavior. The mood changes can be mania or hypomania and depressive mood. The manic phase presents with increased energy, high levels of self-confidence, engaging in risky behaviors, and racing thoughts (Vieta, et al, 2018). Depressive bipolar present with sadness, insomnia, fatigue, anxiety, feeling of hopelessness, and a sense of guilt. However, this is not the actual diagnosis because the patient does not present with alternating maniac mood symptoms.
Dysthymic disorder is a persistent depressive disorder caused by recurrent stressful life events and genetic predisposition. Medication, chronic diseases, and work problems. Its onset is at 21 years old and is associated with a high risk of personality disorder and substance use disorders. The clinical presentation includes sadness, loss of enjoyment, insomnia, fatigue, hopelessness, and difficulties in concentration (Schramm, et al, 2020). The American psychiatric association states that dysthymia is not associated with manic and hypomanic episodes, persistent schizoaffective disorder, and the psychological effect of drugs and medical illness. However, this is not the patient’s diagnosis because the patient has had no other associated personality disorders in her lifetime. Psychiatric Case Presentation essay
Treatment Plan
The patient has pre-existing medical illnesses and is currently under treatment. Additionally, she has a psychiatric history and she is not compliant with treatment. Therefore, I will request diagnostic tests like thyroid function tests to rule out hypothyroidism and a complete blood count to rule out anemia and sepsis. I will consider the drug’s side effects and interactions while writing the prescription. I would advise the patient to enroll in psychotherapy sessions to improve their cognitive and behavioral functions (Al-Qahtani, et al, 2018). I will refer the patient to a physician due to her medical disease for follow-up. A nutritionist and physical exercise specialist will help the patient to lose weight. Fluoxetine 20mg PO OD is the drug of choice for depression. Fluoxetine is a selective serotonin inhibitor that has minimal effect on the reuptake of norepinephrine and dopamine (Zhang, et al, 2021). It helps in improving the patient’s energy and mood. It has non-severe side effects like sedation and dry mouth. I will continue the patient on the prescribed drug list. I will review the patient after four weeks to evaluate the effectiveness of treatment.
Health Promotion
Depression is a mental illness common in society today due to the daily challenges. However, the majority of the patients are diagnosed to have depression when they attempt suicide. This is because they shy from seeking professional help due to stigma. To reduce the rise of suicides associated with depression, the care providers should create public awareness of depression by educating on the signs and symptoms, treatment methods, and prognosis (Mohamed, et al, 2022). Moreover, to ensure early diagnosis, there should be a screening tool in the emergency departments. The community health workers should reach out to the people in the society facing life trauma and challenges and refer them for mental health assessment and psychotherapy.
Health Education
Patient education plays an important role in recovery. I will disclose to the patient about depression, the symptoms, and the causes. This enables the patient to know the signs of relapse and seek early treatment (Taple, et al, 2022). I will explain the various treatment methods and the expected outcome. The patient should know the possible side effects of drugs and the therapeutic goal. This improves patients’ compliance to medication and hence improves their quality of life.
Peer Questions
- The patient presents with suicidal ideation and self-harm. What are the screening tools used to assess to suicide?
- Hamilton depression rating scale is commonly used tool by the psychiatrists. What are the other screening instruments?
Research Article
According to Helm, et al, (2018), depression is the most common psychiatric disorder whose remains unclear. The neuroimaging contribute to the understanding of the mechanisms of the depressed mood and the cognitive impairment. The depressed mood includes sadness, loss of pleasure, agitation, suicidal ideation, and hopelessness. The cognitive symptoms are loss of concentration, isolation, fatigue, and sleep disturbance. These symptoms are a result of disruption of neural connectivity in the brain.
References
Aalbers, G., McNally, R. J., Heeren, A., De Wit, S., & Fried, E. I. (2019). Social media and depression symptoms: A network perspective. Journal of Experimental Psychology: General, 148(8), 1454.
Al-Qahtani, A. M., Shaikh, M. A. K., & Shaikh, I. A. (2018). Exercise as a treatment modality for depression: A narrative review. Alexandria journal of medicine, 54(4), 429-435.
Helm, K., Viol, K., Weiger, T. M., Tass, P. A., Grefkes, C., Del Monte, D., & Schiepek, G. (2018). Neuronal connectivity in major depressive disorder: a systematic review. Neuropsychiatric disease and treatment.
https://psycnet.apa.org/doi/10.2147/NDT.S170989
Mohamed, A. F., Isahak, M., Awg Isa, M. Z., & Nordin, R. (2022). The effectiveness of workplace health promotion program in reducing work-related depression, anxiety and stress among manufacturing workers in Malaysia: mixed-model intervention. International Archives of Occupational and Environmental Health, 1-15.
Schramm, E., Klein, D. N., Elsaesser, M., Furukawa, T. A., & Domschke, K. (2020). Review of dysthymia and persistent depressive disorder: history, correlates, and clinical implications. The Lancet Psychiatry, 7(9), 801-812. Psychiatric Case Presentation essay
Taple, B. J., Chapman, R., Schalet, B. D., Brower, R., & Griffith, J. W. (2022). The impact of education on depression assessment: differential item functioning analysis. Assessment, 29(2), 272-284.
Vieta, E., Berk, M., Schulze, T. G., Carvalho, A. F., Suppes, T., Calabrese, J. R., … & Grande, I. (2018). Bipolar disorders. Nature reviews Disease primers, 4(1), 1-16.
Zhang, C. L., Li, Y. J., Lu, S., Zhang, T., Xiao, R., & Luo, H. R. (2021). Fluoxetine ameliorates depressive symptoms by regulating lncRNA expression in the mouse hippocampus. Zoological research, 42(1), 28.
This case presentation should be written based on an older adult patient (65 yo) with generalized anxiety disorder and comorbid alcohol use disorder.
The paper should be written by experienced professional psychiatric nursing paper writer and should not be assigned to a novice writer
Overview
Select a patient encounter in which you wish to gain information from your peers. Write up a case presentation to post in this discussion forum that contains the patient’s history, diagnosis, treatment and plan of care. Then, pose two questions to your peers to (1) facilitate their learning, and (2) that would help guide care for this patient. As the Module continues, facilitate the interaction between your peers as you “discuss” this case. You will also submit this as an assignment in the Case Presentation-Presenter section below this one.
Introduction
PMHNP’s work with each other and members of the inter-professional team when providing care for patients. In some instances, the PMHNP will professionally present a case to others seeking input; at other times, the PMHNP will be called upon to give input to another provider’s case.
Do not include any identifying patient information on your assignment.
Purpose
The purpose of this assignment is to facilitate the learner’s ability to present a case presentation to others.
Assignment outcome
At the conclusion of this assignment, the learner will be able to:
- Present a comprehensive case presentation to peers
- Query peers regarding two questions that would help guide care for the presented case Psychiatric Case Presentation essay
Directions
Select a patient encounter in which you wish to gain information from your peers. Write up a case presentation to post that contains the patient’s history, diagnosis, treatment and plan of care. Then, pose two questions to your peers to (1) facilitate their learning, and (2) that would help guide care for this patient. As the Module continues, facilitate the interaction between your peers as you “discuss” this case.
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| Case Presentation-Presenter Rubric | ||||
| Criteria | 30 Points | 29 Points | 28 Points | 0 Points |
| Presents History | Communicates a clear & precise assessment data supported with objective and subjective findings.
This should include but not limited to biological, psychological, sociocultural, spiritual, ethnic, and family factors |
Communicates an assessment but may be missing one important piece of data | Communicates a brief & vague assessment while missing important details of the assessment data | No paper submitted or content missing |
| Criteria | 15 Points | 14 Points | 13 Points | 0 Points |
| Psychiatric and Mental Health Diagnosis | Thoroughly describes all relevant differential diagnoses. | Describes differential diagnoses but omits one that should be considered | Describes differential diagnoses but omits more than one that should be considered | No paper submitted or content missing |
| Treatment Plan | Develops and provides a clearly written treatment plan. Clearly defines and delineates the levels of evidence that support the treatment plan. | Develops a clear set of written orders but omits an important order for the diagnosis or outdated approach not supported by evidence | Develops and provides a brief set of orders for the treatment plan with more than one omission and lacks evidential support | No paper submitted or content missing |
| Criteria | 10 Points | 9 Points | 8 Points | 0 Points |
| Health Promotion and Patient Education | Develops and demonstrates a clear & precise educational plan for the patient and family including all relevant health promotion. | Educational topics and health promotion are described but no plan is developed for the patient and family | A general educational plan and health promotion is shared but is not specific to the current case. | No paper submitted or content missing |
| Peer Questions | Composes two questions to peers and strongly facilitates their learning to help guide care for this patient. | Composes two questions to peers and moderately facilitates their learning to help guide care for this patient. | Composes one question to peers and sufficiently facilitates their learning to help guide care for this patient or composes two questions to peers and inadequately facilitates their learning to help guide care for this patient. | Content missing |
| Research Article | Chooses an Evidenced-Based Research Article that supports the diagnosis and plan of care for the patient and critiques the article. Psychiatric Case Presentation essay | Chooses an Evidenced-Based Research Article that supports the diagnosis and plan of care for the patient but does not critique the article. | Chooses an article that is not research or evidence based to support the care of the patient | No paper submitted or content missing |
| Criteria | 5 Points | 4 Points | 3 Points | 0 Points |
| Grammar, spelling, and punctuation | There are no errors in grammar, spelling, and punctuation | There are a few minor errors in grammar, spelling, and punctuation that do not detract from the meaning | There are major errors in grammar, spelling, and punctuation that do not reflect scholarly writing | NA |
| APA and references | The paper meets APA format guidelines and/or all references are peer reviewed, relevant, scholarly and contemporary, up to 5 years. Psychiatric Case Presentation essay | There are minor APA format errors and/or references meet two requirements of relevant, scholarly or contemporary, up to 5 years. | There are significant errors in format and/o references meet one requirement of relevant, scholarly or contemporary. | NA |
| Total Points Possible = 100 | ||||
