Week 4: Case Study

Posted: May 5th, 2020

PRAC 6675: PMHNP Across the Lifespan II

Week 4: Case Study

Objectives:

Identify the signs and symptoms of three different psychiatric disorders.
Explore psychopharmacology that may help with the treatment plan.
Examine the diagnostic criteria from the DSM-5 that can help lead to a diagnosis.
Subjective:
Chief Complaint (CC): “I think I have schizophrenia.”
History of Present Illness (HPI): MS is a 14-year-old Caucasian female who came to the clinic with her mother. She reports that she has been experiencing depression and anxiety for the past three years, which started when she was bullied at school. She reports a depression score of 8 out of 10 and experiences anxiety every day. She also reports having psychotic episodes, during which she sees “shadow people” and hears sounds with some words, but also states, “it’s my voice inside.” She reports experiencing paranoia and intrusive thoughts of harming herself that she cannot stop. She also reports dissociation and depersonalization. She has a history of cutting, skin picking, and eyebrow pulling. Additionally, her and her mother report that she has poor relationships, hates people, is impulsive, and is not happy. She states, “it is my psychosis that makes me see and believe things that aren’t real, and I feel very disconnected from reality.”
Past Psychiatric History:
• General Statement: Anxiety and depression starting three years ago. Autistic Spectrum Disorder.
• Caregivers (if applicable): Parents
• Hospitalizations: Two inpatient hospitalizations for suicidal ideation and self-harming.
• Medication trials: Geodon, Lithium, Prozac, Zoloft, Zyprexa, and Wellbutrin. (Doses and side effects unknown).
• Psychotherapy or Previous Psychiatric Diagnosis: Sees a therapist once a week for Dialectical Behavioral Therapy (DBT). Previously diagnosed with Major Depressive Disorder and Generalized Anxiety Disorder.
Substance Current Use and History: Denies
Family Psychiatric/Substance Use History: Depression and anxiety in mom, dad, and one brother. Grandmother with substance use disorder and suicide attempt.
Psychosocial History: MS was born and raised in Michigan by both parents. She lives with both parents and three older brothers. She recently switched from an in-person art school to a virtual school and is currently in 9th grade. She has a 504 plan for school. Her hobbies include music, drums, and guitar. She reports being bullied in school. She denies any legal history.
Medical History:
• Current Medications: Seroquel XR 100mg QD, Buspar 5mg BID
• Allergies: Penicillin (vomiting)
• Reproductive Hx: Not sexually active.
Review of Systems (ROS):
• General: Denies fever, chills, or weakness.
• Head, Eyes, Ears, Nose, Throat (HEENT): No trauma to head. Denies visual loss, blurred vision, or double vision. Denies hearing loss, congestion, sore throat, or runny nose.
• Skin: No rash or itching.
• Cardiovascular: Denies chest pain, pressure, or discomfort. Denies palpitations.
• Respiratory: Denies shortness of breath, cough, or difficulty breathing.
• Gastrointestinal: Denies vomiting or diarrhea. No abdominal pain.
• Genitourinary: Denies burning on urination.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Ceranoglu, T., Wozniak, J., Fried, R., Galdo, M., Hoskova, B., DeLeon Fong, M., Biederman, J., & Joshi, G. (2019). A retrospective chart review of buspirone for the treatment of anxiety in psychiatrically referred youth with high-functioning autism spectrum disorder. Journal of Child and Adolescent Psychopharmacology, 29(1), 28–33. https://doi.org/10.1089/cap.2018.0021
Gillespie, C., Murphy, M., Kells, M., & Flynn, D. (2022). Individuals who report having benefitted from dialectical behaviour therapy (dbt): A qualitative exploration of processes and experiences at long-term follow-up. Borderline Personality Disorder and Emotion Dysregulation, 9(1), 1–14. https://doi.org/10.1186/s40479-022-00179-9
National Institute of Mental Health. (n.d.). Suicide prevention. https://www.nimh.nih.gov/health/topics/suicide-prevention
Riffer, F., Farkas, M., Streibl, L., Kaiser, E., & Sprung, M. (2019). Psychopharmacological treatment of patients with borderline personality disorder: Comparing data from routine clinical care with recommended guidelines. International Journal of Psychiatry in Clinical Practice, 23(3), 178–188. https://doi.org/10.1080/13651501.2019.1576904
U.S. Department of Health and Human Services. (n.d.). Reduce suicide attempts by adolescents. https://health.gov/healthypeople/objectives-and-data/browse-objectives/mental-health-and-mental-disorders/reduce-suicide-attempts-adolescents-mhmd-02