Assignment: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders

Assignment: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders

Assignment: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders

CC (chief complaint): “I have come for a prescription for oxycodone.”

HPI: Daniela Petrov is a 47-year-old Russian female who presented to her family physician for an oxycodone prescription to alleviate elbow pain. The family physician referred her for psychiatric evaluation due to concerns that the oxycodone can interact with some drugs Daniela is taking. The client states that the elbow pain is only alleviated by oxycodone, which also relieves her headaches. Daniela reports that other pain medications were ineffective, including Ibuprofen, acetaminophen, morphine, codeine, and Dilaudid. Non-pharmacological approaches like massage, Yoga, and meditation are also ineffective. She reports that she dislikes taking multiple medications because they are not good for her body and prefers taking one medication. The client has never been prescribed oxycodone and has been taking her boyfriend’s prescription, which he uses for shoulder and back pain.

ORDER A PLAGIARISM-FREE PAPER HERE ON; Assignment: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders

Past Psychiatric History:

• General Statement: The patient first presented for psychiatric assessment following concerns about misusing oxycodone.
• Caregivers (if applicable): None
• Hospitalizations: None
• Medication trials: Previously used Klonopin, Ativan, and Xanax for Anxiety.
• Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History:

The client takes alcohol on special occasions average twice a week and on special occasions. She uses Marijuana 2-4 times a week since it helps alleviate headaches. Besides, she used cocaine about two months ago to ease anxiety and get closer to her boyfriend. The patient has used Ecstasy and LSD 1-2 times in the past year. She smokes tobacco 2PPD and takes lots of caffeine. She occasionally takes stimulants, like Adderall and Xana bars, to ease anxiety.

Family Psychiatric/Substance Use History: No history of mental health or substance use disorders in the family.

Psychosocial History:

Daniela was born in Russia and moved to Everett, WA, with her parents when she was 16. She has three older sisters and one younger brother. She has a part-time job as a cashier at Save A Lot Grocery Store. She studied up to 10^th grade and dropped out after that. The client has one son who currently lives with the ex-husband’s parents. She lost her son’s custody after her boyfriend was detained for selling marijuana to an undercover cop. She averagely sleeps 5–6 hours and has a good appetite. She has a legal history because of over-speeding while under the influence of alcohol and using marijuana.

Medical History:

• Current Medications: Oxycodone and Vitamin supplements.
• Allergies: Allergic to Codeine- causes flushing.

• Reproductive Hx: Regular menses; uses condoms for contraception.

ROS:

• GENERAL: Denies fever or weight changes.
• HEENT: Denies vision change, eye pain, hearing loss, rhinorrhea, or sore throat SKIN: No rashes, discoloration, or lesions.
• CARDIOVASCULAR: No palpitations, chest pain, edema, or breathlessness.
• RESPIRATORY: No breathlessness, wheezing, or productive cough.
• GASTROINTESTINAL: No anorexia, abdominal cramping, diarrhea, constipation, or tarry stools.
• GENITOURINARY: Regular menses. No vaginal or urinary symptoms.
• NEUROLOGICAL: Reports headache and memory loss. No fainting or numbness.
• MUSCULOSKELETAL: Reports elbow pain and fibromyalgia.
• HEMATOLOGIC: No bleeding or bruising.
• LYMPHATICS: No swelling of lymph nodes.
• ENDOCRINOLOGIC: No profuse sweating, polyphagia, polydipsia, polyuria, or heat/cold intolerance.

Physical exam:

Vital Signs: BP- 132/90; HR- 84; RR- 20; Temp-98.8; Ht 5’8; Wt 128lbs

Diagnostic results: No tests were ordered. 

Assessment

Mental Status Examination:

A female client in her late 40’s; is alert, well-groomed, and dressed appropriately. The client has clear speech with normal volume, rate, and tone. She has a coherent and logical thought process. She has no hallucinations, delusions, phobias, obsessions, suicidal thoughts, or ideations. She is alert and oriented to person, place, time, and event. She has sound judgment and intact short-term memory.

Differential Diagnoses:

Opioid Use Disorder (OUD): OUD is the compelling, long-term self-administration of opioids for non-medical uses. Patients with OUD take opioids in large amounts or for a longer period than purposed. They constantly desire or unsuccessfully attempt to reduce opioid use, craving for opioids, and develop tolerance to opioids (Hoffman et al.,2019). Besides, they use opioids in physically hazardous conditions and repeatedly fail to meet social and occupational obligations due to opioids (Strang et al., 2020). OUD is a likely diagnosis considering the client’s history of self-prescribing oxycodone for elbow pain and headaches. She has persistently used oxycodone resulting in dependency and cannot benefit from other analgesics.

Cannabis Use Disorder: Cannabis Use Disorder is characterized by persistent use of cannabis in spite of impairment in physical, psychological, or social functioning. Patients often take cannabis in large amounts or over an extended period than intended and have cravings. They also use cannabis in physically hazardous environments and develop tolerance with the need for increased amounts of cannabis to get the intoxicated or desired effect (Hasin & Walsh, 2020). Cannabis Use Disorder is a differential owing to the patient’s increased use of Marijuana 2-4 times a week and misusing it to relieve headaches. Besides, she continues to use cannabis despite being previously arrested for using the substance.

Stimulant Use Disorder: This is a substance use disorder involving drug classes like methamphetamine, cocaine, and prescription stimulants. Patients lose control, evidenced by taking stimulants in large amounts or for extended periods than intended, and have cravings or a powerful desire to use stimulants. They also have risky use of stimulants like continued use, even with associated physical or psychological problems (Ronsley et al., 2020). The use often causes social impairment. The patient has a history of using cocaine, Adderall, LSD, and high amounts of caffeine, making Stimulant Use Disorder a likely diagnosis.

Reflections:

In a different scenario, I would order a drug screen test to identify the drug substances the patient has been using. I will also inquire if the patient develops withdrawal symptoms (Krist et al., 2020). In addition, I would assess the patient for anxiety disorder owing to her history of using substances to ease anxiety. The PMHNP should consider ethical factors of beneficence and nonmaleficence by ensuring treatment interventions are established to promote better outcomes and are safe in patients with substance use disorders. Health promotion should be tailored for this client to educate her adverse effects of substance use and the resources available to help individuals with SUDs(Krist et al., 2020). She should be educated about the risks of using substances for her mental and overall health and well-being.

References

Hasin, D., & Walsh, C. (2020). Cannabis use, cannabis use disorder, and comorbid psychiatric illness: a narrative review. Journal of Clinical Medicine, 10(1), 15. https://doi.org/10.3390/jcm10010015

Hoffman, K. A., Ponce Terashima, J., & McCarty, D. (2019). Opioid use disorder and treatment: challenges and opportunities. BMC health services research, 19(1), 884. https://doi.org/10.1186/s12913-019-4751-4

Krist, A. H., Davidson, K. W., Mangione, C. M., Barry, M. J., Cabana, M., Caughey, A. B., … & US Preventive Services Task Force. (2020). Screening for unhealthy drug use: US Preventive Services Task Force recommendation statement. Jama, 323(22), 2301-2309. doi:10.1001/jama.2020.8020

Ronsley, C., Nolan, S., Knight, R., Hayashi, K., Klimas, J., Walley, A., Wood, E., & Fairbairn, N. (2020). Treatment of stimulant use disorder: A systematic review of reviews. PloS one, 15(6), e0234809. https://doi.org/10.1371/journal.pone.0234809

Strang, J., Volkow, N. D., Degenhardt, L., Hickman, M., Johnson, K., Koob, G. F., … & Walsh, S. L. (2020). Opioid use disorder. Nature reviews Disease primers, 6(1), 1-28. https://doi.org/10.1038/s41572-019-0137-5

BUY A CUSTOM- PAPER HERE ON; Assignment: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders

View your assigned video case and review the additional data for the case in the Case History Reports document, keeping the requirements of the evaluation template in mind.
Consider what history would be necessary to collect from this patient.
Consider what interview questions you would need to ask this patient.
Identify at least three possible differential diagnoses for the patient.
Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis.
Incorporate the following into your responses in the template:
Subjective:
What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis?
What are the duration and severity of their symptoms?
How are their symptoms impacting their functioning in life?
Objective:
What observations did you make during the psychiatric assessment?
Assessment:
Discuss the patients mental status examination results.
What were your differential diagnoses?
Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority.
Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rule out the differential diagnosis to find an accurate diagnosis.
Explain the critical-thinking process that led you to the primary diagnosis you selected.
Include pertinent positives and pertinent negatives for the specific patient case.
Reflection notes:
What would you do differently with this client if you could conduct the session over? 
Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!),
health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
Training Title 151
Name: Daniela Petrov
Gender: female
Age:47 years old
T- 98.8 P- 84 R 20 B/P 132/90 Ht 5’8 Wt 128lbs
Background: Moved to Everett, Washington from Russia with her parents when she was 16 years old. Currently lives in Boise, Idaho. She has younger 1 brother, 3 older sisters. Denied family mental health or substance use issues. No history of inpatient detox or rehab denied self-harm hx; Menses regular. uses condoms for birth control Has fibromyalgia. She works part time cashier at Save A Lot Grocery Store. Dropped out of high school in 10th grade. Sleeps 5-6 hours on average, appetite good.
Symptom Media. (Producer). (2018). Training title 151 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-151
Search transcript
00:00:15
>> I see in your chart that you asked

00:00:15
your family physician to

00:00:20
prescribe oxycodone for your elbow pain,

00:00:20
and that your family physician

00:00:25
is worried that some of other medications,

00:00:30
drugs you may use may interact with the oxycodone?

00:00:35
>> Oxycodone is that’s the same as OxyContin?

00:00:35
>> Yeah. Oxycodone is the generic name.

00:00:40
>> Yeah, I did ask for OxyContin,

00:00:45
but I don’t take any other medications or drugs.

00:00:50
I’m opposed to putting anything unhealthy in my body.

00:00:55
>> Okay. What else have you tried?

00:01:00
>> Nothing else works.

00:01:00
>> Ibuprofen, acetaminophen?

00:01:00
>> Not even close.

00:01:05
>> No?

00:01:05
>> Yeah. I mean,

00:01:05
I’m allergic to codeine.

00:01:05
>> Allergic?

00:01:05
>> Yeah, like in Tylenol three.

00:01:10
A little while back, my friend

00:01:10
was in a motorcycle accident and had some leftover,

00:01:15
and I tried one of those,

00:01:15
and I was way allergic.

00:01:20
>> What was the allergic response you had?

00:01:25
>> My face flushed like real bad,

00:01:25
besides it didn’t work.

00:01:30
>> Have you tried morphine?

00:01:30
>> Well, that’s addictive, isn’t it?

00:01:35
>> Yeah, well all the pain medications

00:01:35
or most of them are addictive.

00:01:35
Anti-inflammatory medications are not usually addictive.

00:01:45
>> Yeah, I tried morphine and the codeine, didn’t work.

00:01:50
>> Okay.

00:01:50
>> Yeah, I get headaches too,

00:01:55
so ideally I need something that works for both.

00:02:00
I’d rather not take two medications if I don’t have to.

00:02:05
Less medications the better,

00:02:05
that’s what grandma always said.

00:02:05
>> Grandma? Okay.

00:02:05
>> Yeah.

00:02:10
>> Have you ever tried Dilaudid?

00:02:10
>> Yeah. They gave that to me in the ER once,

00:02:15
but just made me dizzy and constipated.

00:02:20
Constipated for like a month.

00:02:25
>> Oh, wow.

00:02:25
>> I almost had to go back to

00:02:25
the hospital for constipation.

00:02:25
Can you imagine having to go to

00:02:25
the hospital for constipation?

00:02:30
>> Oh my goodness.

00:02:30
>> Yeah, that’s how bad it was.

00:02:30
>> Have you tried Demerol?

00:02:35
>> Yeah, it kind of worked for my headache.

00:02:40
It comes in a shot, right?

00:02:40
>> Yeah. An injection.

00:02:45
>> Yeah, they gave that to me at the hospital.

00:02:45
But that’s the thing, you

00:02:50
can only get it at the hospital,

00:02:50
so it’s not like it’s going to work for me everyday.

00:02:55
It didn’t do anything for my elbow.

00:02:55
OxyContin it’s the only thing that works for both.

00:03:00
The only thing that works for both.

00:03:00
>> You do seem set on the oxycodone?

00:03:00
>> Because it works.

00:03:05
>> What else have you tried other than medications?

00:03:10
>> Other than medications?

00:03:10
>> Yeah.

00:03:10
>> Yoga.

00:03:10
>> Okay.

00:03:10
>> Yeah. Tried that. Other kinds of meditation.

00:03:20
I mean, that’s the thing with meditation is,

00:03:20
it works while you’re doing it,

00:03:25
but then as soon as you stop, zilch. Biofeedback.

00:03:30
>> Good.

00:03:30
>> One doc tried that, same thing.

00:03:30
Works while you’re doing it,

00:03:35
but then when you stop doesn’t help at all. What else?

00:03:40
Like warm, hot compresses,

00:03:45
candles, long walks on the beach, massages.

00:03:50
>> Wow.

00:03:50
>> My boyfriend is really good at massages actually.

00:03:55
He’s studied with this guru in India.

00:03:55
>> Oh, wow.

00:03:55
>> Yeah, swear to God

00:04:00
>> You have tried a lot of solutions.

00:04:00
Let me ask you more about your medication history.

00:04:05
>> I only take stuff for my headache and my elbow.

00:04:10
>> Okay.

00:04:15
>> Like I said, I don’t like

00:04:15
putting unhealthy things in my body.

00:04:15
Vitamins, I take vitamins.

00:04:20
>> Yeah? Okay.

00:04:20
>> Like fish oils, some supplements,

00:04:20
but nothing corporate, nothing pharmaceutical.

00:04:25
I don’t want to put that in me.

00:04:30
Even coming here today,

00:04:35
asking for this, it goes against my values.

00:04:35
>> I see. Okay.

00:04:35
>> But I got to function.

00:04:40
>> Do you drink alcohol?

00:04:40
>> On special occasions

00:04:45
like weddings, funerals, birthdays.

00:04:50
I got a ton of friends, so

00:04:50
whenever we have a birthday we’re going to drink.

00:04:55
Let me think, like holidays,

00:04:55
New Years, and Christmases.

00:05:00
There’s Christmas and then we also celebrate

00:05:05
Russian Orthodox Christmas on January 7th.

00:05:10
>> How often on the average?

00:05:15
>> When you add it all up,

00:05:15
once, maybe twice a week, I guess.

00:05:20
>> Will you drink enough to get intoxicated?

00:05:20
>> Depends on who I’m drinking with.

00:05:25
As Zane, that’s my boyfriend,

00:05:30
he drinks a lot, so

00:05:30
I drink a little more when I’m with him.

00:05:30
>> Any legal problems from the drinking?

00:05:35
>> Once. So dumb.

00:05:40
Yeah, just one little charge for drinking.

00:05:45
I was the tiniest little bit over the limit.

00:05:45
So yeah, I got that and I had to take that course,

00:05:50
that stupid, boring course.

00:05:50
But I learned my lesson. If you’re

00:05:55
a little bit over the limit,

00:05:55
stick to the back roads.

00:05:55
>> So you will still drive?

00:06:00
>> Well, yeah, but I’m super careful.

00:06:00
>> You think after you’ve been drinking,

00:06:05
that’s an okay idea to drive?

00:06:05
>> It’s better than letting Zano drive.

00:06:10
>> Zano?

00:06:10
>> Zane, Zano, same person.

00:06:15
Yeah. He doesn’t even have his license anymore.

00:06:15
Not that it stops him.

00:06:20
>> What about marijuana?

00:06:20
>> Do I use it?

00:06:25
>> Yeah.

00:06:25
>> Marijuana medically helps with my headaches,

00:06:30
so yeah, I use it.

00:06:35
It’s my right. Yeah, it’s

00:06:35
your right. It’s everybody’s right.

00:06:40
>> How often?

00:06:40
>> Not often.

00:06:45
Two, four times a week, sometimes none.

00:06:50
It’s expensive. Then when you do get some,

00:06:55
suddenly everybody is your best friend and you

00:06:55
got to share, you know how it is.

00:06:55
>> Do you ever grow marijuana?

00:07:00
>> I used to. But then we

00:07:05
moved and it’s not legal in this backward state.

00:07:05
Where we live it’s pretty public,

00:07:10
its not really private.

00:07:10
>> Do you ever have any side effects

00:07:15
from using marijuana like memory problems?

00:07:15
>> I was born with memory problems,

00:07:20
Doc, I don’t think it’s from the marijuana.

00:07:20
>> Any legal trouble with the marijuana?

00:07:25
>> Once. I mean, I’m super careful.

00:07:30
But Zano, he went away for

00:07:30
a year for selling

00:07:35
the tiniest little bit to an undercover cop,

00:07:35
which is total entrapment,

00:07:40
which is how I lost custody of Camper.

00:07:40
>> Camper?

00:07:45
>> My son.

00:07:45
>> Oh.

00:07:45
>> Yeah. He’s staying with

00:07:45
my ex husband’s parents right now.

00:07:50
They take good care of him.

00:07:50
>> How long have you been divorced?

00:07:55
>> Oh no, I never married that guy.

00:07:55
>> Oh.

00:07:55
>> No way I would marry that jerk.

00:08:00
No, I don’t know.

00:08:00
It’s been like four years since I’ve even seen him.

00:08:05
Something like that, four years.

00:08:05
>> What happened?

00:08:10
>> Lucas, my ex,

00:08:10
he freaked out because he caught

00:08:15
me doing just a few lines of coke,

00:08:15
but everybody was doing it back then.

00:08:20
Anyway, his mom found the mirror,

00:08:25
and the razors, and Lucas said I had to quit.

00:08:30
For whatever I lied,

00:08:35
and when he caught me,

00:08:35
I know it was bad to lie about that,

00:08:40
but I don’t know it’s in the past.

00:08:45
Water under the bridge. You live, you learn, you move on.

00:08:45
>> Right. Do you use cocaine now?

00:08:50
>> No, hardly ever.

00:08:55
I don’t know, it’s been like a month maybe,

00:08:55
or two months or something since I have.

00:08:55
>> Any legal problems from using cocaine?

00:09:05
>> No, we hardly ever do it.

00:09:10
>> Have you thought about stopping altogether?

00:09:15
>> I hardly ever do it.

00:09:15
Hardly even counts.

00:09:20
I don’t know, when I do it,

00:09:20
it’s just to relieve tension

00:09:20
or it’s this thing Zano

00:09:25
and I do to bring each other closer together,

00:09:30
but I could quit anytime I wanted, easy.

00:09:35
>> Does your boyfriend have children?

00:09:35
>> Yeah, he’s got two kids.

00:09:40
Yeah, but we don’t see them much.

00:09:45
His other with his ex.

00:09:45
>> Oh?

00:09:50
>> She’s a real snobby type. You know the type?

00:09:50
It is a freaking tragedy

00:09:55
because I see his two kids

00:09:55
just going down that same path.

00:10:00
They’re just two little snobs.

00:10:00
It’s a real shame.

00:10:05
We’re not allowed to see them anymore though,

00:10:10
so I guess like what’s the difference?

00:10:10
She went to court and said we were unsuitable.

00:10:15
Not suitable.

00:10:20
Says it all real nice in court,

00:10:20
and then not so nice over the phone,

00:10:20
if you know what I mean?

00:10:25
She’s a real bitch.

00:10:25
>> Any other drugs?

00:10:25
Ecstasy? LSD?

00:10:35
>> This is going to make me sound like I’m

00:10:35
some 1970s hippy, druggo person.

00:10:40
I’ve tried ecstasy twice,

00:10:45
just twice, and LSD once, last year.

00:10:50
That was a bad trip. I am not doing that again.

00:10:55
>> Anything else?

00:10:55
>> Like what?

00:11:00
>> Stimulants?

00:11:00
>> Like power drinks if I need to stay up?

00:11:05
>> Sure

00:11:05
>> Caffeine, I drink a lot of coffee.

00:11:10
I don’t know if cigarettes,

00:11:10
do they count as stimulants?

00:11:10
>> Yeah.

00:11:10
>> Yeah, I’m trying to cut back.

00:11:15
Two packs a day.

00:11:15
>> Ritalin, Dexedrine?

00:11:20
>> Oh, stimulants?

00:11:20
>> Right

00:11:20
>> Oh, yeah. Not a lot.

00:11:25
Like hardly ever.

00:11:25
I mean, if Zano and I are down for whatever reason,

00:11:30
or sluggish from smoking pot,

00:11:35
or just like if I need to get back up again.

00:11:35
Yeah, Adderall, just 20 helps.

00:11:40
>> Do you ever take prescription medications

00:11:40
that are not prescribed for you?

00:11:45
>> Well, are you kidding me?

00:11:45
Why would I do that?

00:11:50
I told you I don’t like medications in the first place.

00:11:50
>> Klonopin, Ativan, Xanax?

00:11:55
>> Those?

00:11:55
>> Yeah.

00:12:00
>> Yeah, if my anxiety is acting up,

00:12:05
if my meditation isn’t working?

00:12:10
Yeah, a couple Xana bars,

00:12:10
but not a lot.

00:12:10
>> How often would you estimate that is?

00:12:15
>> I don’t know.

00:12:20
Two? I don’t know.

00:12:20
I need like a freaking calendar to keep up with

00:12:25
all your questions, Doc, God.

00:12:25
>> So in the past,

00:12:30
who prescribed the oxycodone for you?

00:12:30
>> No one yet. Zano he

00:12:35
takes them because he’s got shoulder and back problems,

00:12:40
and I tried one and it really works.

00:12:45
To be honest it works fantastic.