Posted: September 7th, 2024

NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation

NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation
CC (chief complaint): Difficulty falling or staying asleep, anxiety, and daytime fatigue.
HPI: A 38-year-old Hispanic female patient comes to the clinic complaining of difficulty falling or staying asleep and daytime fatigue. She complains that the condition has persisted for the last three weeks. The condition has been persisting for the last one week with a severity rate of 8/10. She reports that she was diagnosed with depression 6 months ago, but did not adhere to the treatment.
Past Psychiatric History:
• General Statement: She reports signs of depression such as lack of interest in daily activities, lack of appetite, anxiety, and suicidal thoughts.
• Caregivers (if applicable): The patient has no caregiver, but lives with his husband and two daughters.
• Hospitalizations: The patient has not been hospitalized for psychiatric conditions but was diagnosed with depression for 6 months. A healthcare worker recommended therapy and medication, but she did not adhere to the treatment.
• Medication trials: The patient has taken a depression and PTSD test and the result showed she has no PTSD, but she has depression.
• Psychotherapy or Previous Psychiatric Diagnosis: She was diagnosed with depression.
Substance Current Use and History: The patient has a history of substance use especially marijuana. She was taken to a rehabilitation center at 27 years but did not recover completely. She currently takes alcohol and marijuana occasionally. She started smoking and drinking alcohol at 18 years.
Family Psychiatric/Substance Use History: The patient has several families who take drugs and suffer from psychiatric conditions. The mother, 65, still smokes and takes alcohol. His father died out of intoxication. She has two elderly brothers who are currently in the rehabilitation centers recovering from alcohol and substance use addiction. Her sister is in hospital suffering from lung cancer after she started smoking at an early age.
Psychosocial History: The patient lives with his husband and two daughters. Her husband is not a heavy drinker but has been arrested on several occasions for driving while under the influence of alcohol. The husband smokes a packet of cigarettes daily. The two work in a local casino. The two have been arrested several times for causing chaos in the streets and neighborhoods. The school-going children are healthy and do not take any drugs.
Medical History: The patient has a history of depression and anxiety attacks.
• Current Medications: The patient takes multivitamin tablets daily. She did not complete an earlier prescription of Zoloft 10mg orally daily.
• Allergies: She is allergic to seasonal changes, dust, and pollen. She is allergic to penicillin and no other known allergy.
• Reproductive Hx: The patient is sexually active and faithful to her husband. She has given birth to two daughters without complications. She intends to have one more child. She takes reproductive screening test to check for breast, ovarian, and cervical cancer.
ROS:
• GENERAL: According to the assessment, the patient is alert and oriented. She is calm during the interview. Her speech is audible and appropriate voice intonations. Her thought process is not normal. She experiences a lack of sleep and suicidal thoughts. According to the assessment, the patient is not distracted. She maintains eye contact although his face is pale and looks dull. She is still with no unusual movement. She experiences regular hallucinations especially at night when she cannot sleep.
• HEENT: The assessment shows the patient has no hearing or vision problems. She reports no history of complications related to the eyes or ears. She takes an annual eye examination. Her nose is accurate in smelling and no nasal congestion. She takes a regular dental examination. Her teeth are slightly discolored due to cigarette smoke. No sore throat was reported.
• SKIN: No bruises, lesions, wounds or rashes.
• CARDIOVASCULAR: No edema or pressure on the chest.
• RESPIRATORY: No breathing difficulties.
• GASTROINTESTINAL: No nausea or vomiting. Normal bowel sounds.
• GENITOURINARY: No urine pattern complications.
• NEUROLOGICAL: No seizures or falls.
• MUSCULOSKELETAL: No history of gout or arthritis.
• HEMATOLOGIC: No history of blood disorders.
• LYMPHATICS: No swollen lymph nodes.
• ENDOCRINOLOGIC: The patient has no endocrine issues.
Physical exam: Physical examination is not applicable or relevant for a psychiatric evaluation.
Diagnostic results: The patient was subjected to a PTSD test to confirm if she is suffering from the condition or rule out its possibility. The test was positive since the patient has recurring traumatic memories.
Assessment
Mental Status Examination: The patient is a 38-year old Hispanic female who is cooperative and settled during the interview. She resembles her age. She is neatly dressed and appropriate for the event. Her hair is neat and smells fresh. The patient’s motor activity is normal. Her speech is clear and coherent. The tone of the voice is normal with no abnormal intonation. The thought process is logical with no disruptions during the conversation but she has a problem concentrating. She has no flight during the conversation. According to the assessment, she has a euthymic mood and smiles appropriately during the interview. She has reports history and symptoms of auditory and visual hallucinations. She reports suicidal ideation. The patient is oriented to time and place. The memory and concentration are normal.
Differential Diagnoses:
Anxiety disorder
Anxiety disorder is characterized by excessive worry. The condition leads to sleep problems, uneasiness, and difficulty in concentrating. Other symptoms include fatigue, irritability, and sleeplessness (Bouchard et al., 2017). The disorder affects 18.1 percent or 40 million Americans 18 years and older. Only 36.9 percent of the people suffering from the condition receive treatment (Bouchard et al., 2017). People suffering from anxiety disorders require psychotherapy and medication such as antidepressants. The treatment will depend on the severity of the symptoms and the causes. Health practitioners will diagnose underlying conditions that may trigger anxiety disorders (Bouchard et al., 2017). There is no treatment for anxiety disorder but psychotherapy and antidepressants can minimize the effects of the condition on the quality of life.
Therapy and medications such as antidepressants are the primary treatment method for the condition. Treatment of anxiety disorder requires medications such as Zoloft 10mg orally daily (Price et al., 2019). The antidepressant will help patients to avoid constant worry. Psychiatrists should avoid a high dosage of Zoloft since it can trigger adverse reactions (Price et al., 2019). Treatment requires adherence to psychotherapy and medication. Patients who fail to adhere to the treatment will not enjoy the benefits of the treatment. Patient support including the family is crucial in the treatment process. A psychiatrist should notify the family members to support the patient at home and accompany her to the clinic.
Generalized anxiety disorder (GAD)
GAD is a disorder that occurs due to excessive worry about different things. People with the disorder will anticipate danger or loss in their jobs, marriage, or school work (Gottschalk & Domschke, 2017). Individuals suffering from the disorder find it hard to control their worry. People with the condition experience fatigue, sweating, lack of concentration, difficulty sleeping, restlessness, unwanted thoughts, and excessive worry (Gottschalk & Domschke, 2017). The condition occurs due to a family history of anxiety, excessive use of caffeine, childhood abuse, and exposure to stressful situations. People with a history of traumatic events in their life are at a higher risk of GAD (Ruscio et al., 2017). According to Price et al. (2019) 6.8 million Americans are suffering from GAD with only 43.1 percent of the patients receiving treatment. GAD co-occurs with major depression resulting in adverse effects if necessary treatment approaches are not taken.
Sleep disorder
Sleep disorder is a common condition in America since it affects 50-70 million adults. The condition is characterized by the inability to enjoy regular sleep patterns. One of the major symptoms is excessive daytime sleepiness (Seow et al., 2018). Other symptoms include difficulty in falling asleep, unusual breathing patterns, and unintentional changes in the sleep or wake schedule. A sleep disorder can occur in various forms such as insomnia, sleep apnea, and restless leg disorder (Seow et al., 2018). Some of the treatment methods for the condition include sleeping pills and treatment of underlying conditions.
Reflections:
Anxiety disorders can interfere with the quality of life of patients. Immediate and elaborate treatment is essential to ensure the symptoms subside. I have learned that patient education is important to encourage the patients to adhere to the treatment. Adherence involves attending all the psychotherapy sessions to improve the recovery process (Bouchard et al., 2017). Patients should provide a medical history to ensure the psychiatrists diagnose the underlying health conditions. Psychiatrists should encourage the use of pharmacological and non-pharmacological approaches to improve the success of recovery. Patients should use prevention strategies such as reducing exposure to the causes of worry or anxiety.

References
Bouchard, S., Dumoulin, S., Robillard, G., Guitard, T., Klinger, E., Forget, H., … & Roucaut, F. X. (2017). Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: a three-arm randomised controlled trial. The British Journal of Psychiatry, 210(4), 276-283.
Gottschalk, M. G., & Domschke, K. (2017). Genetics of generalized anxiety disorder and related traits. Dialogues in Clinical Neuroscience, 19(2), 159.
Price, M., Legrand, A. C., Brier, Z. M., & Hébert-Dufresne, L. (2019). The symptoms at the center: examining the comorbidity of posttraumatic stress disorder, generalized anxiety disorder, and depression with network analysis. Journal of Psychiatric Research, 109, 52-58.
Ruscio, A. M., Hallion, L. S., Lim, C. C., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., … & Scott, K. M. (2017). Cross-sectional comparison of the epidemiology of DSM-5 generalized anxiety disorder across the globe. JAMA Psychiatry, 74(5), 465-475.
Seow, L. S. E., Verma, S. K., Mok, Y. M., Kumar, S., Chang, S., Satghare, P., … & Subramaniam, M. (2018). Evaluating DSM-5 insomnia disorder and the treatment of sleep problems in a psychiatric population. Journal of Clinical Sleep Medicine, 14(2), 237-244.

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