[ANSWERED 2023] In Weeks 4, 7, and 9 of the course, you will participate in clinical discussions called grand rounds. In one of these three weeks, you will be a presenter as well as help facilitate the online discussion

In Weeks 4, 7, and 9 of the course, you will participate in clinical discussions called grand rounds

In Weeks 4, 7, and 9 of the course, you will participate in clinical discussions called grand rounds. In one of these three weeks, you will be a presenter as well as help facilitate the online discussion; in the others you will be an active discussion participant. When it is your week to present, you will create a Focused SOAP note and a short didactic (teaching) video presenting a real (but de-identified) complex patient case from your practicum experience.

You should have received an assignment from your Instructor letting you know which week of the course you are assigned to present.

To prepare: 

• Review this week’s Learning Resources and consider the insights they provide. Select a child/adolescent or adult patient from your clinical experience that presents with a significant concern. Create a focused SOAP note for this patient using the template in the Resources.
• Then, based on your SOAP note of this patient, develop a video case study presentation.
• Your presentation should include objectives for your audience, at least 3 possible discussion questions/prompts for your classmates to respond to, and at least 5 scholarly resources to support your diagnostic reasoning and treatment plan.
• State 3–4 objectives for the presentation that are targeted, clear, use appropriate verbs from Bloom’s taxonomy, and address what the audience will know or be able to do after viewing.
• Present the full complex case study. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; current psychiatric diagnosis including differentials that were ruled out; and plan for treatment and management.
• Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.
• Pose three questions or discussion prompts, based on your presentation, that your colleagues can respond to after viewing your video.
• Be succinct in your presentation, and do not exceed 8 minutes. Specifically address the following for the patient, using your SOAP note as a guide.
  • 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 their mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses and why you chose them. List them from highest priority to lowest priority. What was your primary diagnosis, and why? Describe how your primary diagnosis aligns with DSM-5 diagnostic criteria and is supported by the patient’s symptoms.
  • Plan: What was your plan for psychotherapy (include one health promotion activity and patient education)? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan.
  • Reflection notes: What would you do differently with this patient if you could conduct the session again? If you are able to follow up with your patient, explain whether these interventions were successful and why or why not. If you were not able to conduct a follow-up, discuss what your next intervention would be.

Expert Answer and Explanation

Subjective:

CC (chief complaint): “I have difficulty falling asleep, am always sad, and am easily distracted.’

HPI: The patient is a 26-year-old female who presented to the office complaining of anxiety, depression, and insomnia. The patient notes that she has been having problems with falling asleep, is easily distracted, is always sad, and has difficulties completing tasks. The patient also complains that she has trouble wanting to see people and associating with people.

The patient notes that she finds comfort in isolating herself. She reports anhedonia and cried during the interview. She also reports severe anxiety. She says that her anxiety became more severe when she had that the person who raped her was released from jail. The symptoms have negatively affected her life. Her therapist pulled her out of work, and she hardly made friends with people. She rates her anxiety and depression as 8/10.

Substance Current Use: She reports no current use of illicit drugs.

Medical History: The patient has no medical problems.

• Current Medications: She is not on any medications at the moment.
• Allergies: She reports no allergies.
• Reproductive Hx: No reproductive problems.

ROS:

• GENERAL: She denies fatigue, weight loss, chills, or fever.
• HEENT: Eyes: No yellow sclerae, visual loss, or double vision. Ears, Nose, Throat: No hearing problems, runny nose, congestion, sore throat, or sneezing.
• SKIN: No rash or itching.
• CARDIOVASCULAR: No chest pain, edema, chest discomfort, or palpitations.
• RESPIRATORY: No shortness of breath.
• GASTROINTESTINAL: No diarrhea, vomiting, abdominal blood, or pain.
• GENITOURINARY: She reports no odd urine color, no odor of urine, or burning on urination.
• NEUROLOGICAL: No dizziness, headache, syncope, ataxia, paralysis, numbness, or tingling in the extremities.
• MUSCULOSKELETAL: No joint or muscle stiffness or pain.
• HEMATOLOGIC: No anemia, HIV, bleeding, or bruising.
• LYMPHATICS: No enlarged nodes.
• ENDOCRINOLOGIC: No reports of health intolerance, cold, or sweating abnormities.

Objective:

Vital Signs: BP 102/90, P 67, RR 17, Ht. 5’4″, Wt. 67kgs, Temp 36.5.

Physical Exam 

• HEENT: Noncontributory.
• Skin: No rash or itching.
• Cardiovascular: Regular heart rhythm and heart rate. No cracks on the chest walls. No edema.
• Respiratory: Normal breathing sounds, no wheezing, no fluids in the lungs, crackles, and no inspiratory crackles.

Diagnostic results:

1. Beck Anxiety Inventory (BAI): Lemos et al. (2019) noted that BAI is used to measure the severity of patients’ anxiety. The authors found that the tool’s reliability is (Cronbach’s α=0.92) in terms of internal consistency. The patient scored 37, meaning that she has severe anxiety.
2. Beck’s Depression Inventory (BDI): BID is a screening tool used to screen for depression (García-Batista et al., 2018). The patient scored 23, meaning that she has moderate depression.

Assessment:

Mental Status Examination: 

The patient is well-dressed, and her clothing is consistent with the day’s weather. She was well-behaved during the interview. However, she was crying while answering questions. She maintained eye contact during the interview. She reports sadness and affect consistent with her mood. Her speech is intact. She denies hallucinations, delusions, suicidal thoughts, or homicidal thoughts. Her memory is intact. Through process is also intact.

Diagnostic Impression:

1. Generalized Anxiety Disorder (GAD) DSM-5 300.02 (F41. 1)
2. Mood disorder, ICD 10 Code: F33.2 – Major Depressive Disorder, Severe, Recurrent
3. Insomnia Disorder DSM-5 780.52 (G47.00)

The primary diagnosis for this case is GAD. According to Price et al. (2019), GAD is associated with extreme anxiety, which cannot be controlled easily. The anxiety must be characterized by at least three symptoms: fatigue, irritability, difficulty sleeping, impaired concentration, restlessness, and muscle pain.

The patient is diagnosed with anxiety because she reports extreme anxiety because she heard that the person who raped her was recently released from jail. The second diagnosis is MDD. MDD is one of the mood disorders that affect a patient’s mood. The disease is part of the diagnosis because the patient reports sadness and anhedonia (Cherukupally et al., 2020).

However, it is not the main disorder because the patient scored 23 in BDI. The last diagnosis is insomnia. Insomnia was included because the patient had sleeping problems. However, the disorder is a secondary disorder because it is caused by GAD (Price et al., 2019).

Reflections:

This case is a complex case. The patient has both GAD and MDD. Her symptoms meet the criteria for both GAD and MDD. Therefore, her treatment should consider symptoms of both disorders. If I was given the case, I would diagnose the patient with both MDD and GAD and the primary disorders. Insomnia she is experiencing is a result of the two disorders. The ethical consideration I would consider in this case is acting for the patient’s good. The treatment plan I would develop should not harm and be in the patient’s best interest.

Case Formulation and Treatment Plan:

The primary diagnosis for this case is GAD. However, the patient also has MDD. MDD affects her mood and makes it hard for her to connect with people. The patient is currently attending a therapy session twice a week. She was asked to stop working during treatment by her therapist. The wants to start Zoloft 50 MG Oral Tablet 1 tablet daily, traZODone HCl 50 MG Oral Tablet one tablet daily, and RTC in two weeks. Chowdhuri et al. (2019) noted that Zoloft is an effective medication for depression and anxiety. Trazodone HCl is an effective medication for anxiety. Erickson et al. (2021) noted that trazodone relieves anxiety.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (DSM-5®). American Psychiatric Pub.

Cherukupally, K. R., Kodjo, K., Ogunsakin, O., Olayinka, O., & Fouron, P. (2020). Comorbid Depressive and Anxiety Symptoms in a Patient with Myasthenia Gravis. Case Reports in Psychiatry, 2020. https://doi.org/10.1155/2020/8967818

Chowdhuri, S., McCrea, S., Fushman, D. D., & Taylor, C. O. (2019). Extracting biomedical terms from postpartum depression online health communities. AMIA Joint Summits on Translational Science proceedings. AMIA Joint Summits on Translational Science, 2019, 592–601.

Erickson, A., Harbin, K., MacPherson, J., Rundle, K., & Overall, K. L. (2021). A review of pre-appointment medications to reduce fear and anxiety in dogs and cats at veterinary visits. The Canadian Veterinary Journal = La Revue Veterinaire Canadienne, 62(9), 952–960.

García-Batista, Z. E., Guerra-Peña, K., Cano-Vindel, A., Herrera-Martínez, S. X., & Medrano, L. A. (2018). Validity and reliability of the Beck Depression Inventory (BDI-II) in general and hospital population of Dominican Republic. PloS One, 13(6), e0199750.

Lemos, M. F., Lemos-Neto, S. V., Barrucand, L., Verçosa, N., & Tibirica, E. (2019). Preoperative education reduces preoperative anxiety in cancer patients undergoing surgery: Usefulness of the self-reported Beck anxiety inventory. Revista Brasileira de Anestesiologia, 69, 1-6. https://doi.org/10.1016/j.bjane.2018.07.004

Price, M., Legrand, A. C., Brier, Z., & 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. https://doi.org/10.1016/j.jpsychires.2018.11.016

Place your order now for a similar assignment and get fast, cheap and best quality work written by our expert level  assignment writers.Use Coupon Code: NEW30 to Get 30% OFF Your First Order

Rubric Detail

FAQs

Generalized Anxiety Disorder: Symptoms, Treatment, and Support

Generalized Anxiety Disorder (GAD) is a prevalent mental health condition characterized by excessive and uncontrollable worry about various aspects of life, often with no apparent reason. Individuals with GAD experience persistent anxiety that can interfere with their daily functioning. This article explores the symptoms, diagnosis, treatment options, and specific considerations for children with GAD.

Symptoms of Generalized Anxiety Disorder:

1. Excessive Worrying: Individuals with GAD may find it challenging to control their worrying, and their concerns may extend to various aspects of life, such as work, relationships, health, and finances.
2. Restlessness and Irritability: GAD often manifests physically, leading to restlessness and irritability. Individuals may have difficulty relaxing and may feel on edge.
3. Physical Symptoms: GAD can cause a range of physical symptoms, including muscle tension, headaches, stomachaches, and fatigue.
4. Difficulty Concentrating: People with GAD may struggle to concentrate, experiencing their thoughts as racing or scattered.
5. Sleep Disturbances: Insomnia or disrupted sleep patterns are common in individuals with GAD.

Generalized Anxiety Disorder in Children:

GAD can also affect children, presenting unique challenges. Children with GAD may exhibit symptoms such as excessive worrying about school performance, social interactions, and family matters. Physical symptoms like stomachaches and headaches are common in children with GAD. Identifying and addressing GAD in children is crucial for their emotional well-being and academic success.

Diagnosis:

A healthcare professional typically diagnoses GAD through a thorough assessment of symptoms and medical history. The process may include discussions about the duration and intensity of anxiety symptoms. Additionally, a mental health professional may use standardized tests, like the Generalized Anxiety Disorder 7 (GAD-7) questionnaire, to aid in the diagnosis.

Generalized Anxiety Disorder Treatment:

1. Therapy: Cognitive-behavioral therapy (CBT) is a widely used and effective therapeutic approach for GAD. It helps individuals identify and challenge irrational thoughts and behaviors, providing coping strategies to manage anxiety.
2. Medication: Medications, such as selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines, may be prescribed to manage symptoms. However, these medications should be used cautiously, especially in the case of benzodiazepines, due to their potential for dependence.
3. Lifestyle Changes: Incorporating healthy lifestyle habits, such as regular exercise, sufficient sleep, and stress management techniques, can complement other treatment modalities.
4. Mindfulness and Relaxation Techniques: Practices like mindfulness meditation and deep breathing exercises can be beneficial in reducing anxiety symptoms.

Generalized Anxiety Disorder Medication:

Medication is often considered in the treatment of GAD, particularly when symptoms are severe. SSRIs, such as fluoxetine and sertraline, are commonly prescribed due to their effectiveness in managing anxiety over the long term. Benzodiazepines may be used for short-term relief, but their potential for dependence makes them less desirable for extended use.

Generalized Anxiety Disorder Test:

The GAD-7 questionnaire is a widely used tool to assess and measure the severity of anxiety symptoms. It consists of seven questions that ask individuals to rate the frequency and intensity of their anxiety over the past two weeks. A higher score indicates a higher level of anxiety.

Generalized Anxiety Disorder ICD 10:

In the International Classification of Diseases, 10th Edition (ICD-10), GAD is classified under code F41.1. This coding system is used for billing and statistical purposes, providing a standardized way to classify and document mental health disorders.

Conclusion:

Generalized Anxiety Disorder is a prevalent mental health condition that can significantly impact an individual’s quality of life. Timely diagnosis and appropriate treatment, including therapy, medication, and lifestyle changes, are crucial for managing symptoms effectively. Recognizing and addressing GAD in children is equally important to ensure their well-being and future success. If you or someone you know is experiencing symptoms of GAD, seeking professional help is essential for a comprehensive and tailored treatment plan.

Mood Disorders: Understanding, Identifying, and Managing

Mood disorders encompass a diverse range of mental health conditions that impact a person’s emotional state and overall well-being. This article delves into the meaning of mood disorders, explores various types, examines symptoms, discusses examples, and provides insights into the treatment and assessment of mood disorders.

Mood Disorder Meaning:

A mood disorder refers to a category of mental health conditions characterized by disruptions in a person’s emotional state, leading to persistent feelings of sadness, elation, or fluctuations between extreme highs and lows. These disruptions often interfere with daily functioning, relationships, and quality of life.

Mood Disorders Types:

1. Major Depressive Disorder (MDD): Commonly known as depression, MDD involves persistent feelings of sadness, hopelessness, and a lack of interest in activities. It can affect sleep, appetite, and energy levels.
2. Bipolar Disorder: Bipolar disorder involves alternating periods of depression and mania. During manic episodes, individuals may experience heightened energy, impulsivity, and euphoria, while depressive episodes mirror symptoms of major depressive disorder.
3. Persistent Depressive Disorder (Dysthymia): Dysthymia is a chronic form of depression characterized by a milder, yet persistent, depressive mood lasting for at least two years.
4. Cyclothymic Disorder: Similar to bipolar disorder but with less severe mood swings, cyclothymic disorder involves chronic mood instability, with periods of hypomania and mild depression.
5. Premenstrual Dysphoric Disorder (PMDD): This disorder is marked by severe mood disturbances occurring in the luteal phase of the menstrual cycle.

Mood Disorder Questionnaire:

The Mood Disorder Questionnaire (MDQ) is a screening tool designed to assist in the assessment of bipolar disorder. It includes questions about the presence of manic or hypomanic symptoms and helps healthcare professionals evaluate whether further diagnostic evaluation is necessary.

Mood Disorders Symptoms:

The symptoms of mood disorders vary depending on the specific type but often include:

1. Emotional Symptoms: Intense feelings of sadness, hopelessness, irritability, or euphoria.
2. Cognitive Symptoms: Difficulty concentrating, indecisiveness, and negative thought patterns.
3. Physical Symptoms: Changes in appetite, sleep disturbances, fatigue, and psychomotor agitation or retardation.
4. Behavioral Symptoms: Withdrawal from social activities, decreased interest in hobbies, and in severe cases, thoughts of self-harm or suicide.

Mood Disorders Examples:

1. Major Depressive Disorder (MDD) Example: A person experiencing MDD may struggle with persistent feelings of sadness, loss of interest in activities they once enjoyed, changes in appetite, and disruptions in sleep patterns.
2. Bipolar Disorder Example: During a manic episode, an individual with bipolar disorder may engage in impulsive behaviors, experience a decreased need for sleep, and exhibit excessive energy and talkativeness. Conversely, a depressive episode may involve overwhelming sadness, fatigue, and thoughts of worthlessness.

Mood Disorder Treatment:

1. Psychotherapy: Various forms of psychotherapy, such as Cognitive-Behavioral Therapy (CBT) and Interpersonal Therapy (IPT), can be effective in treating mood disorders by addressing negative thought patterns and improving coping strategies.
2. Medication: Antidepressants, mood stabilizers, and antipsychotic medications may be prescribed to help manage symptoms. It’s essential to tailor medication choices to the specific type of mood disorder and individual needs.
3. Lifestyle Changes: Regular exercise, a balanced diet, sufficient sleep, and stress management techniques contribute to overall mental well-being and can complement other treatment modalities.

Conclusion:

Mood disorders are complex conditions that require a comprehensive and individualized approach to diagnosis and treatment. Recognizing the symptoms, seeking professional help, and implementing appropriate interventions are crucial steps toward managing mood disorders effectively. With the right support, individuals with mood disorders can lead fulfilling lives and achieve emotional well-being. If you or someone you know is experiencing symptoms of a mood disorder, reaching out to a mental health professional is an important first step on the path to recovery.