Out Patient Therapy Case Studies

The specifiers of Atypical Features, Severe and Early onset were all included as Ellen describes

Her most severe symptoms of anger, fear, and shame are leading her to self harming behaviors such as suicide, burning, and overdosing on prescription medication and alcohol. I believe that treating these symptoms to include fear of abandonment, rejection, and being alone would minimize her self-harming behavior. These symptoms are complex due to her early sexual abuse and rape. She has been diagnosed with BPD, PTSD, and Alcohol Use Disorder. Furthermore, she has many symptoms under the criteria of PTSD such as: Intrusive memories; dissociative reactions; recurrent distressing dreams; avoidance of external reminders; inability to remember parts of the traumatic event; persistent negative emotional state (depression, anger, and anxiety); feeling detached; self destructive behaviors; problems with concentration; sleep difficulties; significant distress and impairment in relationships (American Psychiatric Association, 2013). Secondly, Rosa’s symptoms associated with BPD are: instable relationships; impulsivity; frantic efforts to avoid abandonment; unstable and intense interpersonal relationships; unstable sense of self; self harming behaviors (over spending, burning, suicide, sex, substance use, and binge eating); chronic feelings of emptiness; transient, stress-related paranoid ideation; and affective instability (panic, anger, and despair) (American Psychiatric Association,

HEENT: Head is normocephalic; PERRLA, EOMs intact, sclera clear, conjunctiva unremarkable. TM’s dull, grey, with cone of light reflex bil. Nares patent, oral mucosa pink and moist. All teeth present except final set of molars upper and lower. Good dental hygiene.

How you, as a social worker, might interpret the needs of Paula Cortez, the client, through the two cultural lenses you selected.

Substance/medication-induced depressive disorder appears to be related to Mrs. Smith mood disturbance; it has been used for many years as a coping mechanism. Based on the medications that Mrs. Smith has taken prior, this diagnosis best fits her symptoms and treatments. The secondary differential diagnosis is acute stress disorder acute stress disorder is caused by a traumatic event that has occurred in an individual’s life. Mrs. Smith has endured traumatic events in her life and these events occurred when she was a child. Child-abuse, self-mutilating and then eventually substance abuse is what brought me to this

The consequences of post-traumatic stress disorder (PTSD) cuts across the age barrier of several mental illness, as it affects both the young and the old. Likewise, the understanding of the triggers, risk factors, symptoms, diagnostic features, and pharmacotherapeutic and psychotherapy options are some of the learning objectives for this unit’s clinical experience. Also, the ability to carefully weigh on some of the differential diagnosis prior to the inference of this disorder is paramount as the psychiatric nurse practitioner (PNP) student critically considers in other not to misdiagnosis the patient (Sadock, Sadock, & Ruiz, 2014).

Pt is 43 years old AA female who decided to return to OMHC after the program that she attended, Universal Counseling, was closed down. Initial admission to OMHC was around 2012. Pt has been diagnosed with PTSD, Bipolar, and Anxiety Disorder in the past. Her depressive episodes started at the age of 13 and after she was sexually assaulted by distant uncle. She later developed aggressive behavior around late teen and was involved in numerous arrests, starting the age of 18. Pt grew up in violence environment. "I used to watch my father beating up my mother." In 2003, pt was involved with a man, who later became her husband. The relationship was abusive. "He was verbally and emotionally abusive." The instability in the relationship has also led to numerous arrests for both pt and ex-husband. "He got arrested but he always got away with it. I was the one who would usually stay in jail." At times, her husband would change the stories of their verbal and physical altercation, leading to pt being arrested.

The patient is a 53 year old male who presented to the ED via EMS intoxicated and reporting suicidal thoughts. The patient denies homicidal ideations and symptoms of psychosis. The patient endorses depressive symptoms including: tearfulness, isolation, and insomnia.

D-The patient was placed on HOLD to address her no show for last week. This writer asked the patient if she was okay with tomorrow 's appointment based on her appointment letter. The patient to do the session today since she 's already present and waited for this counselor. This writer agreed to conduct the session. Reports stable on her dose and deny the need for a dose decrease as she denies any cravings/withdrawals.

I: CM greeted client and followed up on last week’s session. CM reintegrated goal of the Harm Reduction program was to provided a referral for housing. Intern discussed plan of action to help manage the Client’s access to VA benefits and referral for VASH. Intern validated the progress the client is making and his interest in doing well.

Dr. Keith requested a mental health evaluation on a Mr. Alewine. He is a 28 year old male who presented to the ED via EMS for chest pains, suicidal ideation, and symptoms of psychosis. Mr. Alewine reported arriving in Siler City from Tennessee after a 16 hour bus trip. He reports after his 16 hour trip, he went to a mechanic shop to call 911 for chest pain and suicidal ideation without a plan after stressing about having a place to stake for a few days. Per documentation Mr. Alewine was asked about current chest pain on a scale of 1 to 10, he reports a 1. At the time of the assessment Mr. Alewine endorse suicidal ideation with a plan to overdose on his medications and experiencing auditory and visual hallucinations. He reports seeing demons

The patient is a 52 year old female who presented to the ED via EMS with bizarre behaviors. Per documentation neighbors found the patient screaming in her house. Per documentation LEO found the patient attempting to drink a closed bottle of alcohol hand sanitizer fluid. Patient presents with disorganized thoughts and irrelevant subject matter when asked questions about behavior upon arrival. Nursing staff was asked about status before the assessment and reports improvements in the patient bizarre behavior.

Mrs. Weston has a history of psychological abuse as a child. She stated her mother occasionally degraded and mocked her as a child, as a result she harbors animosity towards her mother. Client was diagnosed with cancer of the mouth, in which she was forced into early retirement. As a result of her diagnosis, client is taking numerous pain medications (Valium, OxyContin, Darvon, Vicodin, Darvocet, Dilaudid, Percodan, and Xanax) in which she has developed a dependence. Client also show signs of depression, she often feels fatigue, has trouble sleeping and may be the cause of her

Jessica Stemp is a 27-year-old female army veteran with no pertinent past medical history presents with insomnia and irritability. Jessica, an administrator assistant at the chaplain services at Veteran Affairs was urged to come in by her employer or boss following a verbal and physical altercation two days ago with a client who wanted to reschedule an appointment with her boss - This event happen in light of her potentially being laid off because of her performance at work as well as her tardiness. She doesn’t remember the progression of the encounter however, she just remembers shoving the client. She describes how this never happen before. Additional symptoms she has been experiences has been lack of focus, nightmares, depressed, anxious, headaches with double vision and increased sensitivity to light about 2 times a week or 3 time per month, experiencing flashbacks following certain smells and loud noises. To alleviate her

Jebera Coughmen presented the following four symptoms of Depression for at least three weeks . Coughmen has expressed several significant problems including continued sadness that has led him to underperform at his new job. He has near daily Insomnia. For the last three weeks, he has shown no interest in family, gardening, and tinkering all of which use to be important activities to him and most days he has been eating very little with the complaint that he is not hungry. Finally, he still expresses guilt for having been laid-off after the factory he worked at closed down despite having started a new job that pays less but is more stable. There is some financial trouble as they are in the low to 1ow-average income bracket. His guilt, however,