NRNP 6635: Psychopathology and Diagnostic Reasoning Essay Discussion

Posted: January 20th, 2023

NRNP 6635: Psychopathology and Diagnostic Reasoning Essay Discussion

CC (chief complaint): “I would like to learn to live my life by myself. I depend on my kids a lot because in our customs when the parents get old and have hard walking and caring for themselves, the children help.”

HPI: Pattie is a 40-year-old woman who comes in for family psychotherapy. She is originally from Iran and has five children: three daughters, Sheela (24 years old), Sharleen (23 years old) (who is presently enrolled in family therapy), and Shireen (21 years old), and two sons, Armin Jr. (18 years old) and Sam (21 years old). For the last 18 months, they have been undergoing family and individual therapy. The mother sought intervention at the facility after her daughter was reunited with her family for the first time in 10 years. She was experiencing problems. initially, the family was pleasant, but after several weeks, Shireen informed her family about her father’s physical, psychological, and sexual assault, which they were unaware of. She felt as though her mother had abandoned her. When Pattie sustained an injury to both of her feet, she was rendered disabled and in excruciating agony after surgery.   Because of the surgery and incapacity, there is more strain and tension in the household. Pattie shares her home with her two boys, but her daughter is on her own. As a result of her recent separation from their mother’s home and marriage to someone the family does not know, Shireen has become seldom in touch with her family. Sheela visits her mother on a daily basis. The feeling of being lonely, dejected, dismal, and hopeless has been overwhelming for Pattie, who wishes for her daughters to remain and spend quality time with her NRNP 6635: Psychopathology and Diagnostic Reasoning Essay Discussion.

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Past Psychiatric History:

• General Statement: Approximately one year and a half ago, the mother and her children started therapy sessions. Her daughter Shireen has returned to live with the family after a 12-year break from them. Shireen informed her family that her father had assaulted her sexually. She is enduring mental distress as a result of the trauma she has experienced, which includes feelings of guilt, shame, and embarrassment, as well as increased strain from her family.
• Caregivers (if applicable): None
• Hospitalizations: Mother denies past hospitalizations
• Medication trials: No medication trials
• Psychotherapy or Previous Psychiatric Diagnosis: Over the course of the previous eighteen months, the family has participated in family and individual therapy. Shireen came in for one session, after which she stopped coming and has refused to continue to do so at this time. There have been five visits to therapy for the family so far. Pattie is under stress since she underwent foot surgery in the previous six months and is unable to work due to the arthritis-related disability in her feet.

Substance Current Use and History: Pattie consumes caffeinated drinks on a regular basis, but she does not smoke or use alcohol.

Family Psychiatric/Substance Use History: Pattie denies any drug or alcohol abuse. She is currently unaware that anybody in her family has a problem with substance abuse or alcoholism. Her spouse consumes alcoholic drinks on a daily basis. He has not, however, sought treatment for his drinking. Pattie denies that she or anybody in her family has ever received psychiatric treatment.

Psychosocial History: Pattie grew up in Iran with her parents. She is the only child in the family. Pattie’s parents planned for her to marry Armin, a renowned car industry supervisor in Iran, when she was 14 years old. With her husband, Pattie relocated to Tehran, where she gave birth to her five children. In order to care for the family, Pattie remained at home with the children whereas her husband worked. While she was in the U.s for therapy for her two children, Sheela, 11, and Sharleen, 12, her primary care physician found that both girls had health issues that required intervention. Pattie and her four children immigrated to the U.s.. Shireen, one of her children, was left behind.   Pattie had decided that she did not wish to return to Iran after many years had gone. She agonized with the idea of leaving Shireen behind and was worried that if she went to Iran, she might not be able to go back to the US  for her other children. Pattie had been assaulted by her husband Amir on many levels, including psychologically, sexually, and physically, throughout their marriage. Pattie worked tirelessly to get Shireen to the U.s, a process that took a long time. Her 18-year-old daughter, Shireen, was eventually reunited with her family. As soon as Shireen arrived in the US a few weeks later, she started to share details of her father’s psychological, sexual, and physical assault with her family. After hearing the story, Pattie was in a state of complete astonishment. Shireen was enraged and accused her mother of abandoning her in Iran with her father. The trauma had left Pattie feeling ashamed and guilty, so she sought therapy to help her deal with it.

Medical History: NRNP 6635: Psychopathology and Diagnostic Reasoning Essay Discussion

 

• Current Medications:

Trazodone 50 mg or 100 mg po prn at night for sleep

Ibuprofen 800 mg by mouth twice a day as required for mild pain

Tramadol 100 mg po thrice a day as needed for the severe pain

Lexapro 20 mg every morning for anxiety and depression

• Allergies: No known drug, food, and seasonal allergies
• Reproductive Hx: Pattie is a para 5 gravida 5. There are no abortions or miscarriages reported by the patient. Since arriving in the United States, the patient has been refraining from sexual activity. The patient asserts that he or she does not have any sexually transmitted diseases. According to pt, she began menstruating when she was fourteen years old. All of the menstrual cycles have been regular and uncomplicated, with no major problems.
  

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Objective:

Diagnostic results: CBC- within normal limits.

Assessment:

Mental Status Examination: A 40-year-old Iranian woman who seems to be her mentioned age. well groomed Normal posture and behavior within normal bounds are noted. Fair  eye contact noted. The rhythm, tone, and volume of speech are all normal. Rational and goal-oriented thought-processes. Nothing odd about the content of thoughts, no hallucinations, flashbacks, or delusions. The patient has an anxious and depressed mood. The patient’s affect is often blunted, no suicidal or homicidal ideation.  Intact memory. Good judgment and insight with good attention.

Differential Diagnoses:

• Adjustment disorder with depressed mood

Pattie’s children are growing older, and she is beginning to feel lonely. During times of loneliness, she reports that she feels powerless and forlorn. Since she is having problems adapting to the fact that her children are not at home as much, she would want them to remain with her. In the past 4 months, she also underwent surgery and is learning to live with the constraints of limited movement and chronic pain that come with it. IAs a result of three specific stresses, Pattie is feeling despair and pessimism:  past surgery, children relocating from home, and guilt and blame over her child’s past trauma. fThe patient meets all of the requirements for the diagnosis of this disorder (APA, 2013). This illness is characterized by a stressor that isn’t as severe as that necessary for post-traumatic stress disorder (PTSD). Stressors that may not fit the criteria for posttraumatic stress disorder (PTSD) might also suggest adjustment disorder NRNP 6635: Psychopathology and Diagnostic Reasoning Essay Discussion.

• Major depressive disorder

This is a common and serious medical ailment that may have a detrimental impact on a person’s ability to think, feel, and behave. MDD is characterized by feelings of melancholy and/or a lack of interest in previously appreciated activities. It may result in a wide range of mental and physical difficulties, as well as a reduction in the capacity to operate at home and at work (Torres, 2020). The presence of five or more symptoms during a two-week period is necessary for the diagnosis of MDD. Anhedonia, sometimes known as a sad mood, is one of the symptoms. Change in appetite , sleep problems, irritability or retardation, exhaustion or lack of energy, decreased attention, feelings of worthlessness or excessive guilt, and suicidal ideation are additional symptoms (Tolentino & Schmidt, 2018). Pattie may be suffering from MDD as a result of her feelings of hopelessness, loneliness, and sadness.

• Depressive Disorder related to chronic pain.

Following her surgeries, Pattie became more unhappy, filled with pessimistic thoughts, and her longing for her daughter became more intense. It became more difficult for Pattie to maintain her independence. She also lost interest in activities that restricted her movement. Several recent studies have shown a relationship between chronic pain and depression. Adapting to a new family dynamic may result in conflict within the family unit. As a result of the demands of family life, individuals may experience depression and have difficulty managing their pain (Boone & Kim, 2019). It is unlikely to diagnose this condition in Pattie since she loves spending time with her family, friends, and her dogs.

Reflections:The family psychotherapy session was causing friction between the patient and her children. Pattie is depressed as a result of a variety of underlying circumstances. The family, on the other hand, is attempting to heal and move on. The family’s situation deteriorated, and the friction caused by cultural differences intensified the situation further. It is a difficult familial situation. With their own lives and ambitions, the children are keen to make their own decisions. When trying to establish a resolution for both the mother and her grown children, it is critical to acknowledge and appreciate their differing perspectives.

Case Formulation and Treatment Plan:

Interventions in psychotherapy groups that take into consideration the family’s background and present condition are required.

Diagnostic studies:

Order a thyroid panel. Individuals with thyroid diseases are more likely than the general population to have symptoms of depression, and depression may be associated with a variety of minor thyroid problems (Kafle et al., 2020)

Referrals:

Referral to physical therapy is advised in order to increase mobility and prevent worsening. Referral to a nutritionist for assistance with weight control improves self-esteem and promotes participation in social activities.

Therapeutic interventions:

• Review the significance of not discontinuing any medicine without first checking with a doctor and alerting the doctor if any adverse effects emerge during treatment.
• Discussion of the importance of refraining from alcoholic beverages and illegal drugs, which may negatively impact a patient’s mental wellbeing, mood, sleeping pattern, and physical wellbeing.
• Schedule an appointment with a mental health professional within one week
• Schedule an appointment with a primary care physician within five days.
• Provide contact information for local crisis services and the closest hospital if she expresses suicidal or homicidal thoughts NRNP 6635: Psychopathology and Diagnostic Reasoning Essay Discussion.

 

References

APA. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). [MBS Direct]. https://mbsdirect.vitalsource.com/#/books/9780890425572/

Boone, D., & Kim, S. Y. (2019). Family Strain, Depression, and Somatic Amplification in Adults with Chronic Pain. International Journal of Behavioral Medicine, 26(4), 427-436. https://doi.org/waldenulibrary.org/10.1007/s12529-019-09799-y

Kafle, B., Khadka, B., & Tiwari, M. L. (2020). Prevalence of Thyroid Dysfunction Among Depression Patients in a Tertiary Care Centre. JNMA; Journal of the Nepal Medical Association, 58(229), 654-658. https://doi.org/10.31729/jnma.5296

Tolentino, J. C., & Schmidt, S. L. (2018). Dsm-5 criteria and depression severity: Implications for clinical practice. Frontiers in Psychiatry, 9. https://doi.org/10.3389/fpsyt.2018.00450

Torres, F., MD. (2020, October 1). What Is Depression? American Psychiatric Association.. https://www.psychiatry.org/patientsfamilies/depression/what-is-depression NRNP 6635: Psychopathology and Diagnostic Reasoning Essay Discussion

 

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	Excellent 90%–100%	Good 80%–89%	Fair 70%–79%	Poor 0%–69%
Document the following for the family in the video, using the Comprehensive Evaluation Note Template: • Chief complaint • History of present illness • Past psychiatric history • Substance use history • Family psychiatric/substance use history • Psychosocial history/Developmental history • Medical history • Review of systems (ROS) • Physical assessment (if applicable)	18 (18%) – 20 (20%) The assignment includes an accurate, clear, and complete description of the subjective and objective information for the client family. The response addresses each of the required elements and demonstrates thoughtful consideration of the client family’s situation and culture.	16 (16%) – 17 (17%) The assignment includes an accurate, clear, and complete description of the subjective and objective information for the client family.	14 (14%) – 15 (15%) The assignment includes a description of the subjective and objective information for the client family but is somewhat general or contains small inaccuracies.	0 (0%) – 13 (13%) The assignment includes a description of the subjective and objective information for the client family but is vague or contains many inaccuracies. Or, several of the required elements are missing.
• Mental status exam • Differential diagnoses—Include a minimum of three differential diagnoses and include how you derived at each diagnosis in accordance with DSM-5 diagnostic criteria ORDER A PLAGIARISM-FREE PAPER HERE	18 (18%) – 20 (20%) The response thoroughly and accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the family in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.	16 (16%) – 17 (17%) The response accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.	14 (14%) – 15 (15%) The response documents the results of the mental status exam with some vagueness or innacuracy. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy.	0 (0%) – 13 (13%) The response provides an incomplete or inaccurate description of the results of the mental status exam and/or explanation of the differential diagnoses. Or, assessment documentation is missing.
• Case formulation • Treatment plan that includes psychotherapy interventions	23 (23%) – 25 (25%) Case formulation is thorough, thoughtful, and demonstrate critical thinking. The assignment includes an accurate, clear, and complete treatment plan for the client family that includes psychotherapy interventions. The response demonstrates thoughtful consideration of the client family’s situation and culture.	20 (20%) – 22 (22%) Case formulation demonstrates critical thinking. The assignment includes an accurate, clear, and complete treatment plan for the client family that includes psychotherapy interventions.	18 (18%) – 19 (19%) Case formulation is somewhat general or does not demonstrate critical thinking. The assignment includes a treatment plan for the client family that includes psychotherapy interventions but is somewhat general or contains small inaccuracies.	0 (0%) – 17 (17%) The assignment provides a vague and/or inaccurate description of the case formulation and treatment plan for the client family. Or, many of the required elements are missing.
• A psychotherapy genogram for the family	18 (18%) – 20 (20%) The assignment includes an accurate, clear, and complete genogram of the client family. The documentation style is consistent and a key is provided.	16 (16%) – 17 (17%) The assignment includes an accurate genogram of the client family. The documentation style is consistent and a key is provided.	14 (14%) – 15 (15%) The assignment includes a genogram of the client family but is somewhat limited or contains factual inaccuracies or inconsistencies in documentation style.	0 (0%) – 13 (13%) The genogram provided is vague or contains many inaccuracies. Or, the genogram is missing.
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided which delineate all required criteria.	5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.	4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.	3 (3%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.	0 (0%) – 2 (2%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity <60% of the time. No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation	5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors.	4 (4%) – 4 (4%) Contains 1 or 2 grammar, spelling, and punctuation errors.	3 (3%) – 3 (3%) Contains 3 or 4 grammar, spelling, and punctuation errors.	0 (0%) – 2 (2%) Contains many (≥5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.	5 (5%) – 5 (5%) Uses correct APA format with no errors.	4 (4%) – 4 (4%) Contains 1 or 2 APA format errors.	3 (3%) – 3 (3%) Contains 3 or 4 APA format errors.	0 (0%) – 2 (2%) Contains many (≥5) APA format errors.

https://video-alexanderstreet-com.eu1.proxy.openathens.net/watch/mother-and-daughter-a-cultural-tale *************** Please use the template (a#); I also uploaded the template exemplar (b#) The Assignment Document the following for the family in the video, using the Comprehensive Evaluation Note Template: Chief complaint History of present illness Past psychiatric history Substance use history Family psychiatric/substance use history Psychosocial history/Developmental history Medical history Review of systems (ROS) Physical assessment (if applicable) Mental status exam Differential diagnosis—Include a minimum of three differential diagnoses and include how you derived each diagnosis in accordance with DSM-5 diagnostic criteria Case formulation and treatment plan Include a psychotherapy genogram for the family Note: For any item you are unable to address from the video, explain how you would gather this information and why it is important for diagnosis and treatment planning NRNP 6635: Psychopathology and Diagnostic Reasoning Essay Discussion

 

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