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Mental and Behavioural Disorders



Case 1

Diagnosis: Psychotic Disorder NOS

The patient has been experiencing numerous difficulties in her life. She lost her job two months ago, and she has problems in conceiving a child. She has been facing problems with her fianc? since he seems to be oblivious to her situation. She is stressed and has auditory hallucinations. The patient has symptoms of Psychotic disorder NOS. She was brought to the psychiatric facility under Backer Act because she had suicidal attempts. The patient has been under treatment of anxiety and depression. The history shows that she had been experiencing anxiety even before she lost her job; she was taking Xanax, which is a treatment of panic or anxiety. The seizure she experienced two years ago was an effect of Xanax. The drug should not be stopped abruptly, and it can cause a seizure.

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Differential Diagnosis

Depression can be caused by various medical and psychiatric disorders. Psychotic disorder NOS is distinguishable from a depressive disorder with Severe Psychotic Features by the symptom of hallucinations. The patient has been having auditory hallucinations and had attempted suicide through an overdose. The patient had a feeling of hopelessness and helplessness that has resulted in suicidal attempts.

The symptoms of Psychotic disorder NOS are closely related to the symptoms of the depressive disorder. The disorder is different from depression due to hallucinations factor. Patients with psychotic disorder NOS do not show signs of helplessness in contrast to patients with depression disorder.

Planning

The goals of the assessment and planning are to promote a positive attitude in the patient. The assessment also aims at developing a trustworthy relationship with the patient and offer empathy. Planning should also aim at developing a problem-solving skill that can empower the patient. In addition, it aims at promoting positive self-regard, engagement of the patient in support networks.

The patient will go through a number of therapies to help her cope with the problems and develop problem-solving skills. Coping skills may include learning how to express one’s feelings through writing. The patient should be very honest while writing down their feelings and fears. The patient should be encouraged to talk about their problems rather than keeping the issues to themselves. Another solution to the stress problem is to learn how to improve oneself. The patient should develop a strategy on how to find another job or how to earn a living. She can also improve her condition through proper dieting and exercise. Apart from gaining physical fitness, exercises trigger the brain to release endorphins that are very important in elevating mood and ease anxiety. Endorphins also help the mind be focused and mentally sharp. Along with that, exercises serve as distractions from personal problems reducing stress. Exercises are important in boosting the immune system, and, as a result, the effects of stress and depression reduce. A nurse or a therapist should avoid using the negative response as the patient opens up to them. The patient should be also educated about the dangers of depression and how it can be prevented.

Family members and close friends are also important in the recovery process of the patient. Patient’s family should be involved in the therapy session and learn how to help the patient recover. The patient should be able to minimize stress and avoid it as much as possible. The stress can reduce if the patient can get a job and be able to conceive. The family members should help the patient solve her financial problems, and the fianc? should also get counseling for her to deal with the stress. The patient should continue taking her drugs (Abilify, Zoloft, and Trazodone) to treat depression. Lastly, the patient should be referred to a gynecologist to determine the reason behind her conceiving problems. The inability to conceive can cause much stress to the patient leading to depression. The patient might not be infertile; the problem of not conceiving immediately might have been caused by the side effects of contraceptives.

Case 2

Diagnosis: Psychosocial Anxiety

In the study, the patient is a nineteen years old boy who intends to join Florida University. At this age, people need a companion of their peers, they need to go clubbing, have night outs, and feel affection, among others. A company of friends with much storytelling and joking is one of the main agendas and fun making aspects in the life of early adult individuals. In this case, the patient is deaf and the primary form of communication he utilizes is American Sign Language (ASL). In such a way, none of his peers, brothers, sisters or parents understand this form of communication. His parents’ core communication language is Creole. Therefore, one of the diagnoses of the patient is psychosocial anxiety as there is minimum interaction of the patient with the environment and with the society at large.

As a result of the psychosocial problem that the young man has, he feels worried of how to cope with the lonely life. In universities, students interact much, especially by means of verbal communication. Such type of communication is inappropriate for the patient, and all that he can do is read lips of the communicator, which is very hard to understand and get the exact meaning. Though not depressed, the patient feels uneasy, nervous and gets irritated, which are the symptoms of anxiety. The anxiety results to frustration and anger that the patient depicts as he sees that people play or joke about his feelings. In fact, socializing and feel of affection is the nature of teenagers and young adults who are getting educated on various issues.

Planning

The goal of this assessment and planning is to make the patient appreciate nature and have confidence in future life that is ahead of him. It also provides tactics on how to control anxiety and have an acceptance attitude.

As psychosocial anxiety is not a disease but rather is a deficiency in human surrounding requirements, there needs to be a way to get the young man connected to the environment. While in the Vocational Rehabilitation Center (VRC), it is a must that the family members undertake the American Sign Language courses. This action will assist them communicate with their child and help him out of the loneliness he feels while he cannot communicate with other people well. Friends should visit him in the rehab and show him the importance of communication and how to cope with other people’s reaction to deafness. Along with that, antipsychotic drugs help to relax the mind of the patient and make his nerves adapt to new situations. Therefore, proper dosage of the drugs will make the patient superb and able to cope with the rehabilitation process.

Anxiety care is a rather complex process as it has a chemical imbalance, and there is the psychological perspective in it. Use of the antidepressant helps put back the chemical imbalance in the body and the brain, which stimulates irritation. After reducing the irritation stimulants, psychological processes will follow. Using cognitive behavior therapy and the behavior therapy, the situation of the patient will be under control. Cognitive behavior therapy will identify such issues as separation, avoidance by other people, lack of proper communication with others, which makes the patient feel irritated. As a way, the therapy will help the patient be mentally and psychologically prepared for the rejection and separation he will face in the campus. However, he should constantly be reminded of the fact that even people with all senses working still face stigmatization.

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Case 3

Diagnosis: Adjusted Disorder with Mixed Anxiety and Depression Mood

The patient could be suffering from an adjusted disorder with mixed anxiety and depression mood. These cases do not occur as a result of deficiency or any injury in the parts of the body. Due to the divorce, the patient is much worried about her life without a partner. Once a person divorces, he or she faces mixed reactions related to analyzing the reasons of this act and solving the accompanying problems. For a 32 years old individual, a happy marriage is a necessity, and it results in stress if it does not work accordingly. Divorce provokes mixed reactions and triggers moods in the body to a level that an individual may not control easily. Depression mood is also the result of the pressure in the working place whereas the stock broker deals with numerous clients, which requires concentration and much efforts. Mixing the work with the stressing divorce issue makes the patient lack even sleep.

Differential Diagnosis

The client is not suffering from the bipolar disorder; in most cases, this disease is genetically transferred. If a member of the family has a bipolar disease or one parent has the disease, siblings are at risk. There are main symptoms of bipolar disorder that this patient does not demonstrate such as the intensive alcohol intake and drug abuse, inflated self-esteem, among others. The patient is also not suffering from Major Depressive Disorder Recurrent Episode. The symptoms for this diagnosis are much severe than the ones the patient is experiencing. High irritability rate and remorse are one of the symptoms that the patient does not have. However, he has a depressive mood, but not to the extent when sleep disturbances are observed. Adjusted insomnia is the last case not associated with this patient. The patient claims that he sleeps good though there is a problem with oversleeping. Although he is late to work, it does not distract his activities much and does not makes him feel worthless, which are the symptoms of insomnia.

Planning

The main goal is to give the client direction on how to overcome the adjusted disorder with mixed anxiety and the depression mood. A therapy should be used for him to cope with life after divorce and regain the work attitude that he had prior to the divorce.

This diagnosis is not difficult to manage as the patient has exceeded six months with the disorder. Inducement of insulin in the blood makes the patient more relaxed. The collect dosage of tranquilizers makes the brain become relaxed and reduces anxiety that makes the patient worried very much. These drugs will help the patient regulate normal sleep and relax muscles thus reducing the irritability rate. Professional advice on how well to manage stress is another core activity for the patient. Advising the patient to have reduced induction in the activities he did with his wife is very important. Focusing more on the things the patient did with his wife before divorce results to lack of sleep and irritation. It is recommended to take a leave for about a month and visit family and friends as it makes one see life in a different perspective. The patient will communicate with the friends and in the process distract from his problems and get new experience. Discussing other people’s problems him feel more motivated to solve his own difficulties. Zoloft, Prozac, Celexa, Lexapro, and Paxil are drugs used as antidepressants that calm the different parts of the body. While visiting friends and taking the leave, the patient should use these drugs to make the body parts function accordingly.

Case 4

Diagnosis: Alzheimer Disease

This case involves an elderly person of 70 years old. He has a history of non-insulin dependent diabetes mellitus, hypertension, and benign prostatic hyperplasia. The patient is very aggressive and acts bizarre for the past 2-3 days. He is diagnosed with Alzheimer, and his blood glucose also needs to be checked to determine whether it can affect brain functionality. Alzheimer is a disease that implies slow memory in a patient. The disease also affects reasoning and thinking skills. It is caused by an accumulation of amyloid beta-peptide in the brain. The parts of the brain that are affected by the disease are the hippocampal, aphasia, parietal and frontal areas, and the transentorhinal complex.

Differential Diagnosis

Alzheimer and Senile dementia uncomplicated have many similarities. However, senile dementia affects communication while Alzheimer affects language and memory, as well as controls thoughts. A patient with dementia has symptoms of impaired speech and thoughts, and has signs of confusion. Another condition that can be confused with Alzheimer is dementia with behavioral disturbance. The common symptom of Alzheimer and dementia with behavioral disturbance is aggression that occurs in the late stages of dementia. However, in severe stages of dementia with behavioral disturbance, behavioral problems become less dramatic. Another differential condition is impaired fasting glucose that is also referred to as prediabetes. The patient has much glucose in the blood, but the high level of glucose is not caused by prediabetes; it is caused by non-insulin dependent diabetes mellitus.

Planning

Alzheimer is not curable, but its symptoms can be controlled. Therefore, the main goals of this plan are to improve the quality of life of the patient. It is crucial to control the level of insulin in the blood by providing treatment for non-insulin dependent diabetes mellitus. Another goal is to improve functionality in patient's daily activities. The hospital and the family need to create a safe environment that is important for quick recovery of the patient and to promote social life. The treatment plan also aims at promoting positive mood, cognition, and behavior.

The patient will take the insulin therapy to manage the level of glucose in the blood. Excess glucose in the blood leads to the malfunction in brain and can slow down the recovery process. Caregivers’ attention is essential for the patient’s recovery. Therefore, they should be educated on how to take care of the patient after his discharge from the hospital. The clinician should give a helpline number to family members for them to call anytime they need help. The progress of the patient should be monitored every two weeks after the discharge. In the meanwhile, the patient needs to be admitted and be treated with drugs that slow progression of symptoms, such as the acetylcholinesterase inhibitors (AChEIs). The drug slows down the symptoms and improves the quality of life of the patient and the caregivers.

The patient has a history of hypertension. As a result, the clinician should measure the patient’s blood pressure to define overall health condition. Hypertension can be dangerous because it can cause heart attacks and stroke. If the blood pressure is high, the patient should be given diuretics to lower the pressure. 5-Alpha reductase inhibitorsshould should be administered for the treatment of benign prostatic hyperplasia. The drug works by inhibiting the hormone that causes the growth of the prostate gland.

Case 5

Diagnosis Mood Disorder NOS (MD-NOS)

In this case, the patient has a chief complaint of living in anguish, and she feels she cannot take it anymore. She has a history of psychiatric hospitalization. Her symptoms include extreme anxiety, vivid nightmares, insomnia, and the feeling of despair. The patient does not get enough sleep, and she only sleeps for 2-3 hours per day. She does not feed well as she takes saltines. The patient is suffering from a mood disorder. Mood disorder is the disturbance of normal personal emotions. However, the symptoms do not fall under a specific type of mood disorder. For instance, the patient has some symptoms of bipolar mood disorder, but the symptoms are not enough to confirm that the patient is suffering from bipolar disorder. The symptoms can also be confused with major depressive disorder recurrent episode severe.

Differential Diagnosis

The first differential diagnosis is full bipolar remission. Both bipolar and MD-NOS have the anxiety symptoms. However, a person with full bipolar remission has extreme mood swings. The mood swing can be very high and at another time, very low; the patient, in this case, does not suffer from extreme mood swings. Another differential disorder is Major Depressive Disorder Recurrent Episode severe. A person with major depression disorder should have major signs of depression such as suicidal thoughts, irritability, and the feeling of worthlessness and hopelessness. In this case, the patient only shows the signs of despair and hopelessness but does not show the other signs of major depression disorder. The patient also has the symptoms of anxiety state unspecific. These symptoms include lack of sleep, extreme anxiety, and vivid nightmares. The vivid nightmares could have been caused by particular fears in life that the patient has not yet disclosed. No other symptoms of anxiety state unspecific are observed, and that is the reason as to why it is ruled as a diagnosis.

Planning

The objective of the plan is to improve the behavior of the patient through behavior therapy. The plan also helps to improve cognition and stabilize patients' mood. The patient should also get medication that will reduce anxiety. Medication includes Ativan or other antidepressants that would help to ease the anxiety. The patient has undergone treatment in a different hospital for five days, but there was no improvement. The clinician should determine whether the patient had used the same type of medication in the previous hospital. It would not be right to use the same medications that had failed previously.

Behavioral therapy will involve educating the patient on how to deal with anxiety and be able to handle a difficult situation. During therapy sessions, the behavioral therapist should encourage the patient to open up and talk about any fears or feeling of hopelessness. In the process, the behavioral therapist should present problem-solving skills to the patient. It seems that the patient has a history of depression that means she lacks the skills of problem-solving. The next important thing is to advise the patient on the importance of proper dieting. The patient eats only saltines. The body needs a balanced diet for it to function properly. Therefore, it is important for the patient to take food that has all nutrients. The patient should also exercise, as exercises help relieve stress and anxiety. The treatment plan should also provide a support network that would help the patient in the healing process. The support network helps the patient connect with other people who have recovered from the same condition.

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