NRNP 6635:ASSESSING AND DIAGNOSING PATIENTS WITH SUBSTANCE-RELATED AND ADDICTIVE DISORDERS ESSAY

NRNP 6635:ASSESSING AND DIAGNOSING PATIENTS WITH SUBSTANCE-RELATED AND ADDICTIVE DISORDERS ESSAY

NRNP 6635:ASSESSING AND DIAGNOSING PATIENTS WITH SUBSTANCE-RELATED AND ADDICTIVE DISORDERS ESSAY

Name : Katarina BykovGender: Female Age: 41 years

Subjective:

CC (chief complaint):Patient for psychiatric review with history of prolonged elbow pain and chronic headaches.

HPI: A 41 year old Caucasian female patient on psychiatric follow up presents to the clinic for psychiatric review. She is only complaining of elbow joint and has requested her primary physician to prescribe oxycodone for the pain as she belives that this is the only drug that works for her pain. She has a long history of substance abuse where she reports of using alcohol in the past, she takes marijuana for her headaches twice every week and has ever used cocaine which led to her separation from the father of her son. She admits to having memory problems but she does not associate it to the drugs she uses but rather reports that it is a problem she has had since  childhood. She is afraid of trying out morphine for her pain since she knows it is addictive reports that yoga if quite helpful for this pain too. She has been arrested before for alcohol intoxification and after her boyfriend was found selling marijuana. She reports that she at times uses prescribed medications i.e. Xanax when she feels anxious but she hates taking medication. Her appetite is intact and denies any sleep disturbances or insomnia as she usually sleeps for 4-9 hours on average.

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Past Psychiatric History:

• General Statement: A patient with a long standing history of substance abuse for review. She reports that she does not believe in taking medication but at times takes Xanax when her anxiety is acting up. She is trying to cut down on cigarretes but continues to take majiana, and alcohol.
• Caregivers (if applicable): She has no significant impairemeents that can warrant a caregiver.
• Hospitalizations: she denies history of inpatient detox or rehab.
• Medication trials: No records of medication trials.
• Psychotherapy or Previous Psychiatric Diagnosis:Thereis no record of previous psychiatric diagnosis or psychotherapy.

Substance Current Use and History:Admits to taking alcohol occasionallyand takes marijuana twice a week for her headaches. She also admits to using cocaine though hardly uses it.She has tried ecstasy and LSD before and takes lots of caffeine. She is currently smoking cigarretes (2 packets per day) though she reports that she is trying to cut down.

Family Psychiatric/Substance Use History: She denied family mental health or substance use.

Psychosocial History:  She moved to Washington state from Russia  with her parents  when she was 12 years old and has 2 brothers and two sisters. She dropped out of school in 11^th grade and iss a part time cashier at Aldi Grocery store.She is separated from her ex patner whom they have a son together.She lost custody of her son after her boyfriend was arrested for selling marijuana She is currently in a relationship with a man who has two children.

Medical History:

• Current Medications: She is not on any psychiatricmedications but occasionally takes Xanax when anxious.
• Allergies:Allergic to codeine

• Reproductive Hx:She has one child with her ex partner, denies being pregnant. Her menses are regular.

ROS:

• GENERAL: She denies having general body weakness, fever and weight loss.
• HEENT: She admits to having occasional headaches, no history of photophobia, blurred vision or excessive lacrimation. She denies having hearing problems or discharge.has no sore throat.
• SKIN: she has no itchiness or wounds. Denies hair loss or nail infections.
• CARDIOVASCULAR: Negative of any palpitations, peripheral odema,difficulty in breathing.
• RESPIRATORY: Denies having difficulty in breathing, chest pain or cough.
• GASTROINTESTINAL: she has no abdominal pain, diarrhea or vomiting
• GENITOURINARY: denies having hematuria, painful micturition,frequency and urgency.
• NEUROLOGICAL: she has no history of loss of counsiouness,cnvusions or loss of sensation.
• MUSCULOSKELETAL: reports of elbow pain. No history of joint deformities or muscle wasting.
• HEMATOLOGIC: she denies easy brusing,easy fatigability or prolonged bleeding.
• LYMPHATICS: Has no swollen and painful lympnodes.
• ENDOCRINOLOGIC: No hot/cold intolerance or polyuria.

Objective:

Physical exam:

T– 97.4, P– 74, R– 120, BP– 100/70, Ht 5’8 ,Wt 117 lbs

Diagnostic results: None

Assessment:

Mental Status Examination: A middle aged woman in the psychiatric unit for assement. She is unkempt with shaggy hair and unironed clothes. She is oriented in time place and person and is cooperative but is quite evasive to some questions.Her hands kept shaking during the interview and she could not maintain eye contact. Her immediate memory is intact but she does not remember alot of things from her childhood. Her speech is normal with a good fund of knowledge.She appears anxious and denies having suicidal or homicidal ideations, hallucinations or illusions.No other aaddditional risks were noted. She has a poor insight of her current condition and is not open to the idea of taking medications.

Differential Diagnoses:

Substance Use Disorder( F19:20)

According to DSM-5 substance abuse disorder involves symptoms caused by use of substances that the individual continues to use despite the obvious side effects.the individuals usually have physical dependence to these agents and they are known to indulge in reskybehaviours(Livne et al., 2021).They can try to cut down on these substances but in other cases continue to use them neglecting their responsibilities and even and giving up on important activities.In this case the patient is tring to cut down on smoking and has neglected her responsibility of being a mother.

Stimulant Induced Mild neurocognitive disrdors (F19:988)

According to DSM-5 this is a disorder that presents with neurocognitive symptoms such as learning disabilities and memory loss following use of stimulant(First et al., 2022). Our patient admits to having memory loss which can be due to the prolonged substance use.

Substance Induced Mood Disorders F19:24

This refers to depressive, anxiety or psychotic symptoms that occur following the use of substances(Mohamed et al., 2020).Sevral studies show that substance use disorders usually co occur with other mental health disorders This patient reports of having anxiety on several occasions and taking Xanax to calm down. She is also agitated during the interview.

Reflections:

Reflecting back on this case, I feel like the history taking was not well exhausted. The interview of the patient missed out on important issues  as suggested by the relevant bodies when taking the history of a psychiatric patient(Abd El-Hay, 2018). The interview did not explore to know more about the genesis of the substance use and when it started e.g. rule out history of trauma. History of hallucinations or other impairements has not been brought up clearly. It could have been important if the examiner could have probed further about the patients social life, if she has ever lost a job due to the substance abuse, her relationship with her family members, her relationship with her cowerkers and if she is willing to get help for current substance abuse disorder. On the other hand the interviewer was patient with the patient, listened without judging and allowed her time to talk without imposing his ideas on her. This was in accordance to the codes of ethics of psychatry(Appelbaum & Tyano, 2021).

References

Abd El-Hay, M. A. (2018). The Psychiatric Interview. In M. A. Abd El-Hay, Essentials of Psychiatric Assessment (1st ed., pp. 149–205). Routledge. https://doi.org/10.4324/9781315148137-3

Appelbaum, P. S., &Tyano, S. (2021). The WPA Code of Ethics for Psychiatry. World Psychiatry, 20(2), 308–309. https://doi.org/10.1002/wps.20861

First, M. B., Yousif, L. H., Clarke, D. E., Wang, P. S., Gogtay, N., & Appelbaum, P. S. (2022). DSM‐5‐TR: Overview of what’s new and what’s changed. World Psychiatry, 21(2), 218–219. https://doi.org/10.1002/wps.20989

Livne, O., Shmulewitz, D., Stohl, M., Mannes, Z., Aharonovich, E., &Hasin, D. (2021). Agreement between DSM-5 and DSM-IV measures of substance use disorders in a sample of adult substance users. Drug and Alcohol Dependence, 227, 108958. https://doi.org/10.1016/j.drugalcdep.2021.108958

Mohamed, I. I., Ahmad, H. E. K., Hassaan, S. H., & Hassan, S. M. (2020). Assessment of anxiety and depression among substance use disorder patients: A case-control study. Middle East Current Psychiatry, 27(1), 22. https://doi.org/10.1186/s43045-020-00029-w

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ASSESSING AND DIAGNOSING PATIENTS WITH SUBSTANCE-RELATED AND ADDICTIVE DISORDERS

An important consideration when working with patients is their cultural background. Understanding an individual’s culture and personal experiences provides insight into who the person is and where he or she may progress in the future. Culture helps to establish a sense of identity, as well as to set values, behaviors, and purpose for individuals within a society. Culture may also contribute to a divide between specific interpretations of cultural behavior and societal norms. What one culture may deem as appropriate another culture may find inappropriate. As a result, it is important for advanced practice nurses to remain aware of cultural considerations and interpretations of behavior for diagnosis, especially with reference to substance-related disorders. At the same time, PMHNPs must balance their professional and legal responsibilities for assessment and diagnosis with such cultural considerations and interpretations.

For this Assignment, you will practice assessing and diagnosing a patient in a case study who is experiencing a substance-related or addictive disorder. With this and all cases, remember to consider the patient’s cultural background.

LEARNING RESOURCES

Required Readings

• American Psychiatric Association. (2022). Substance related and addictive disorders. In Diagnostic and statistical manual of mental disordersLinks to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x16_Substance_Related_Disorders
• Boland, R. & Verduin, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.
  • Chapter 4, “Substance Use and Addictive Disorders”
  • Chapter 2 only section 2.17, “Adolescent Substance Abuse”
  • Chapter 27 “Ethics and Professionalism”
  • Chapter 28 “Forensic and Legal Issues”

Required Media

• Classroom Productions. (Producer). (2016). Addictive disordersLinks to an external site. [Video]. Walden University.
• Complex Care Consulting. (2018, April 4). Addiction neuroscience 101Links to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=bwZcPwlRRcc

TO PREPARE:

• Review this week’s Learning Resources and consider the insights they provide.
• Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment.
• By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. 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.

PLEASE USE VIDEO TRAINING TITLE 151 FOR THIS ASSIGNMENT.

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate 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 is 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 patient’s 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 rules 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.).

PLEASE USE VIDEO TRAINING TITLE 151 FOR THIS ASSIGNMENT.

PLEASE FOLLOW THE INSTRUCTIONS AND THE RUBRICS. USE THE TEMPLATE. USE 7TH EDITION APA FORMAT AND BOOKS NOT MORE THAN FIVE YEAR YEARS.