use the biopsychosocial formulation grid from the weekly reading to formulate your diagnosis and develop a comprehensive treatment
use the biopsychosocial formulation grid from the weekly reading to formulate your diagnosis and develop a comprehensive treatment
For your initial post, use the biopsychosocial formulation grid from the weekly reading to formulate your diagnosis and develop a comprehensive treatment plan for the case scenario.
Respond to the posts of at least of your two peers and provide a suggestion for another appropriate intervention or treatment of a biopsychosocial factor that they may not have addressed.
If you can, give an example from your clinical experience. How was your suggested intervention received by the client and how did they respond to the treatment?
Post 1:
Hello fellow classmates and Professor.
HPI: Patient is a 32-year-old homosexual male. He is married with two children. He came to the emergency department with CC of mood swing and stress. Patient stated that “my mood swings are all over the place.” In the past two weeks he asked his husband for a divorce, he has made a lot of impulsive decisions, such as, launched a new business, made new investments. He stated that in the middle of all that he had an affair. Patient stated that “He felt like he’s on top of the world” Patient stated that in the past two weeks he found out his business partner is conning him, he lost $100,000 in the investment. He feels that he broke up his family.
PMHx: Patient does not have any past medical history
PsychHx:
- Psych Hospital: Patient has never been admitted to a psychiatric hospital
- SI: Patient stated he had thoughts of suicide in the past two weeks.
- Self-Harm: Denies
- HI: Denies
- Substance Use: Patient stated he used substances heavily after he graduated college
- Trauma: Denies
PSHx: No past surgical history
PsychFHx:
- Mother has a history of depression and anxiety
- Father left when patient was 5 years old. Father was admitted in psychiatric hospital for a diagnosis patient is unaware of
Medications: Patient currently is on Escitalopram 20mg daily
Current working diagnosis: F31.0 Bipolar effective disorder, with current episode hypo-manic. According to the HPI, patient has been feeling like he’s “on top of the world” for the past two weeks. During this time, he made irrational business decisions and had an affair. After two weeks, patient feels that “everything has crashed,” he feels suicidal, he feels that he has broken up his family. According to the DSM-5 TR “The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes” (DSM-5, 2016). Patient also stated that few months ago, the PCP started him on Escitalopram 20mg daily, which “made him feel amazing within a week” That could be an indication that the patient went in mania due to taking an SSRI while being bipolar. Lastly, patient’s mother has a history of depression and anxiety, and his father was admitted in psychiatric hospital for an unknown diagnosis. Both of patient’s mother and father have psychiatric illnesses, which is an indication the patient may have a psychiatric illness as well.
Patient was diagnosed with depression in the past. Patient admitted to severe mood swings (manic or major depressive episodes). “Period of abnormally elevated, irritable mood and increased energy and activity lasting at least one week” (DSM-5, 2016)
Differential Diagnosis: Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD)
Treatment Plan: Instruct patient to continue Lexapro 20mg daily. I will adjunct therapy with Lamotrigine (Lamictal XR) 25 mg daily for two weeks. I will perform a physical examination, order laboratory tests, with close attention to CBC and thyroid panel. I will provide teaching on bipolar disorder and the mood stabilizer. I will stress the important of side effects such as GI symptoms and appearance of a rash, which should be notified immediately. I will also stress the importance of adherence to medical regimen. I will assess the patient for suicide risk and provide him with a 24-hour crisis hotline and instruct to call 911 in emergency.
I believe this patient will benefit from CBT as it can help improve medication adherence and help the patient recognize mood swings and triggering situations. Family counseling will also be beneficial for this patient with his partner due to the recent infidelity.
F/U in 2 weeks.
References
Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 12, DSM-IV to DSM-5 Bipolar I Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519712/table…
Post 2:
Hello Class,
Oliver has a very high likelihood of suffering from both Major Depressive Disorder and Generalized Anxiety Disorder, as indicated by the information that was provided earlier in this discussion. He has a history of depression, which has been made worse by different stressors, the loss of his employment, and problems regarding the loss of money for his kids’ education fund. He also has problems with alcohol. In addition to this, he has been battling the symptoms of anxiety, which include erratic mood changes, irritability, and difficulty concentrating. He has been going through this for quite some time.
Oliver needs to participate in cognitive behavioral therapy in addition to taking antidepressant medication as part of his treatment strategy. Because of its demonstrated efficacy in the past, the antidepressant medication escitalopram should continue to be a component of his treatment plan. Additionally, he needs to begin attending counseling sessions on a weekly basis in order to support him in the management of his tension and the development of his coping mechanisms. Oliver may receive additional help from the therapist in the form of recommendations for contemplative techniques or other forms of coping skills in order for the therapist to assist Oliver in controlling his anxiety and depression.
Biological | Psychological | Social | |
| Predisposing: What predisposes the patient to illness? | Mother was diagnosed with depression and anxiety. Father was hospitalized for unknown psychiatric disorder. | Adverse childhood events including estrange relationship with mother and father. | Father left him when he was 5 years old. |
| Precipitating: What precipitated this episode? | Patient was diagnosed with anxiety/depression a few months ago. | Abandoned by his new business partner. Had an affair outside the marriage | Lost money for his kids’ college fund. Fear he will lose his family. |
| Perpetuating: What is perpetuating or prolonging this illness episode? | Patient would take illegal substances and drink alcohol to cope with stress. | Coping style tends to be avoidance with his depression. | Lack of financial stability after college due to not finding a job. |
| Protecting: What are the protective factors? | No longer does drugs and drink alcohol to cope with stress. | Expressed suicidal thoughts but could never do that to his kids. | Patient has a husband and two kids. |
Requirements: minimum 100 words per post
Nursing
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