Week 8 Assignment
For this Assignment, you will practice assessing and diagnosing a patient in a case study who is experiencing a substance-related or addictive disorder. With this and all cases, remember to consider the patient’s cultural background.
RESOURCES:
American Psychiatric Association. (2022). Substance related and addictive disorders. In Diagnostic and statistical manual of mental disordersLinks to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x16_Substance_Related_Disorders
Boland, R. & Verduin, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.
Chapter 4, “Substance Use and Addictive Disorders”
Chapter 2 only section 2.17, “Adolescent Substance Abuse”
Chapter 27 “Ethics and Professionalism”
Chapter 28 “Forensic and Legal Issues
Classroom Productions. (Producer). (2016). Addictive disordersLinks to an external site. [Video]. Walden University.
Complex Care Consulting. (2018, April 4). Addiction neuroscience 101Links to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=bwZcPwlRRcc
Video reference:
Training Title 151. . (2018).[Video/DVD] Symptom Media. Retrieved from https://video.alexanderstreet.com/watch/training-title-151
Symptom Media. (Producer). (2018). Training title 151Links to an external site. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-151
Training title # 151 additional information:
Training Title 151
Name: Daniela Petrov
Gender: female
Age:47 years old
T- 98.8 P- 84 R 20 B/P 132/90 Ht 5’8 Wt 128lbs
Background: Moved to Everett, Washington from Russia with her parents when she was 16 years
old. Currently lives in Boise, Idaho. She has younger 1 brother, 3 older sisters. Denied family
mental health or substance use issues. No history of inpatient detox or rehab denied self-harm hx;
Menses regular. uses condoms for birth control Has fibromyalgia. She works part time cashier at
Save A Lot Grocery Store. Dropped out of high school in 10th grade. Sleeps 5-6 hours on
average, appetite good.
Symptom Media. (Producer). (2018). Training title 151 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-151
TO PREPARE:
Review this week’s Learning Resources and consider the insights they provide.
Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment.
By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
Consider what history would be necessary to collect from this patient.
Consider what interview questions you would need to ask this patient.
Identify at least three possible differential diagnoses for the patient.
BY DAY 7 OF WEEK 8
Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.
Incorporate the following into your responses in the template:
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 the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
Transcript of video:
TRANSCRIPT OF VIDEO FILE:
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BEGIN TRANSCRIPT:
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DISCLAIMER
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THE INFORMATION CONTAINED HEREIN IS OF A GENERAL NATURE AND CANNOT SUBSTITUTE FOR THE ADVICE OF A MEDICAL PROFESSIONAL. THE CONTENT PROVIDED MAY NOT APPLY TO YOU OR YOUR SYMPTOMS. YOU SHOULD NOT RELY ON THIS INFORMATION AS A SUBSTITUTE FOR. NOR DO THEY REPLACE, PROFESSIONAL MEDICAL ADVICE, DIAGNOSIS OR TREATMENT. IF YOU HAVE ANY CONCERNS OR QUESTIONS ABOUT YOUR HEALTH OR THE CONTENT. YOU SHOULD ALWAYS CONSULT WITH A PHYSICIAN OR OTHER HEALTH CARE PROFESSIONAL. DO NOT DISREGARD. AVOID OR DELAY OBTAINING MEDICAL OR HEALTH RELATED ADVICE FROM YOUR HEALTH-CARE PROFESSIONAL. THE CONTENT SHOULD NOT BE USED IN PLACE OF A CALL OR VISIT TO A MEDICAL. HEALTH OR OTHER COMPETENT PROFESSIONAL. WHO SHOULD BE CONSULTED BEFORE ADOPTING ANY OF THE SUGGESTIONS IN THE CONTENT OR DRAWING INFERENCES FROM IT.
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SYMPTOM MEDIA. LLC DISCLAIMS ALL RESPONSIBILITY FOR ANY LIABILITY LOSS OR RISK. PERSONAL OR OTHERWISE. WHICH IS INCURRED AS A CONSEQUENCE. DIRECTLY OR INDIRECTLY. OF THE USE AND APPLICATION OF ANY OF THE CONTENT CONTAINED HEREIN.
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[sil.]
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UNKNOWN I see in your chart that you asked your family physician to prescribe oxycodone for your elbow pain, and that your family physician is worried that some of other medications, drugs you may use may interact with the oxycodone?
00:00:35
UNKNOWN Oxycodone is that’s the same as OxyContin?
00:00:40
UNKNOWN Oh, yeah, yeah. Oxycodone is the generic name.
00:00:45
UNKNOWN Yeah, I did ask for OxyContin, but I don’t take any other medications or drugs. So I’m kind of opposed to putting anything unhealthy in my body.
00:00:55
UNKNOWN Okay. So what else have you tried?
00:01:00
UNKNOWN Nothing else works.
00:01:00
UNKNOWN Ibuprofen, acetaminophen?
00:01:00
UNKNOWN Not even close.
00:01:05
UNKNOWN No?
00:01:05
UNKNOWN Yeah. I mean, I’m allergic to codeine.
00:01:05
UNKNOWN Allergic?
00:01:10
UNKNOWN Yeah, like in Tylenol 3. A little while back, my friend was in a motorcycle accident and had some leftover, and I tried one of those, and I was way allergic.
00:01:20
UNKNOWN What was the allergic response you had?
00:01:25
UNKNOWN My face flushed like real bad, besides it didn’t work.
00:01:30
UNKNOWN Have you tried morphine?
00:01:30
UNKNOWN Well, that’s, that’s addictive, isn’t it?
00:01:35
UNKNOWN Yeah, well all the pain medications or most of them are addictive. Anti-inflammatory medications are not usually addictive.
00:01:45
UNKNOWN Yeah, I tried morphine and the codeine, didn’t work. Yeah. I get headaches too. So ideally I need something that works for both. You know, I’d rather not take two medications if I don’t have to, you know. Less medications the better, that’s what grandma always said.
00:02:05
UNKNOWN Grandma? Okay.
00:02:05
UNKNOWN Yeah.
00:02:10
UNKNOWN Did you… Have you ever tried Dilaudid?
00:02:15
UNKNOWN Yeah. Yeah. They gave that to me in the ER once, but just made me dizzy and constipated. Constipated for like a month.
00:02:20
UNKNOWN Oh, wow.
00:02:25
UNKNOWN Yeah. Yeah. I almost had to go back to the hospital for constipation. Can you imagine having to go to the hospital for constipation?
00:02:30
UNKNOWN Oh, my goodness.
00:02:30
UNKNOWN Yeah, that’s how bad it was.
00:02:30
UNKNOWN Have you tried Demerol?
00:02:35
UNKNOWN Yeah, it kind of worked for my headache. It comes in a shot, right?
00:02:45
UNKNOWN Yeah. An injection.
00:02:45
UNKNOWN Yeah, yeah, they gave that to me at the hospital. But that’s the thing, you know, you can only get it at the hospital, so it’s not like it’s going to work for me every day. And it didn’t do anything for my elbow. So, uh… OxyContin, it’s the only thing that works for both. The only thing that works for both.
00:03:00
UNKNOWN You do seem set on the oxycodone?
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UNKNOWN Because it works.
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UNKNOWN What else have you tried other than medications?
00:03:10
UNKNOWN Other than medications?
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UNKNOWN Yeah.
00:03:10
UNKNOWN Yoga.
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UNKNOWN Okay.
00:03:15
UNKNOWN Yeah. Tried that. Other kinds of meditation. I mean, that’s the thing with meditation is, it works while you’re doing it, but then as soon as you stop, zilch. You know, biofeedback.
00:03:30
UNKNOWN Good.
00:03:30
UNKNOWN One doc tried that, same thing. You know works while you’re doing it, but then when you stop doesn’t help at all. What else? Like warm, hot compresses, candles, long walks on the beach, massages.
00:03:50
UNKNOWN Wow.
00:03:50
UNKNOWN And my boyfriend is really good at massages actually. He’s studied with this guru in India.
00:03:55
UNKNOWN Oh, wow.
00:03:55
UNKNOWN Yeah, swear to God.
00:04:00
UNKNOWN You have tried a lot of solutions. Let me ask you more about your medication history.
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UNKNOWN I mean, I only take stuff for my headache and my elbow.
00:04:10
UNKNOWN Okay.
00:04:10
UNKNOWN Yeah. I don’t… Like I said, you know, I don’t like putting unhealthy things in my body. Vitamins, I take vitamins.
00:04:20
UNKNOWN Yeah? Okay.
00:04:20
UNKNOWN Like fish oils, some supplements, but nothing corporate, nothing pharmaceutical. You know, I don’t… I don’t want to put that in me. You know, I mean, even coming here today, you know, asking for this, it goes against my values.
00:04:35
UNKNOWN I see. Okay.
00:04:35
UNKNOWN But I got to function.
00:04:40
UNKNOWN Do you drink alcohol?
00:04:40
UNKNOWN On, I don’t know, like special occasions, you know, like weddings, funerals, birthdays. I got a ton of friends, so, you know, whenever we have a birthday we’re going to drink. Let me think, like holidays, New Years, and Christmases. There’s Christmas and then we also celebrate Russian Orthodox Christmas on January 7th.
00:05:10
UNKNOWN So how often on the average?
00:05:15
UNKNOWN Oh, I don’t know. When you add it all up, once, maybe twice a week, I guess.
00:05:20
UNKNOWN And will you drink enough to get intoxicated?
00:05:20
UNKNOWN Depends on who I’m drinking with. As Zane, that’s my boyfriend, he drinks a lot, so I drink a little more when I’m with him.
00:05:35
UNKNOWN Any legal problems from the drinking?
00:05:35
UNKNOWN Once. So dumb. Yeah, just one little charge for drinking. I was like the tiniest little bit over the limit. So, yeah, I got that and I had to take that course, that like stupid, boring course. But I learned my lesson. You know, if you’re a little bit over the limit, stick to the back roads.
00:06:00
UNKNOWN So you will still drive?
00:06:00
UNKNOWN Well, yeah, but I’m super careful.
00:06:00
UNKNOWN You think after you’ve been drinking, that’s an okay idea to drive?
00:06:05
UNKNOWN It’s better than letting Zano drive.
00:06:10
UNKNOWN Zano?
00:06:10
UNKNOWN Zane, Zano, same person. Yeah. I mean, he doesn’t even have his license anymore. Not that it stops him.
00:06:20
UNKNOWN Oh. What about marijuana?
00:06:20
UNKNOWN Do I use it?
00:06:25
UNKNOWN Yeah.
00:06:25
UNKNOWN Marijuana medically helps with my headaches, so, yeah, I use it. Yeah. It’s my right. Yeah, it’s your right. It’s everybody’s right.
00:06:40
UNKNOWN And how often?
00:06:40
UNKNOWN Not often. Two, four times a week, sometimes none. It’s expensive. So, you know, and then, you know, when you do get some, suddenly everybody is your best friend and you got to share, you know how it is.
00:07:00
UNKNOWN Do you ever grow marijuana?
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UNKNOWN I used to. But then we moved and it’s not legal in this backward state. And where we live it’s pretty public, it’s not really private.
00:07:10
UNKNOWN Do you ever have any side effects from using marijuana like memory problems?
00:07:15
UNKNOWN I was born with memory problems, Doc, I don’t think it’s from the marijuana.
00:07:20
UNKNOWN Any legal trouble with the marijuana?
00:07:25
UNKNOWN Once. I mean, I’m super careful. But Zano, he went away for a year for selling like the tiniest little bit to an undercover cop, which is total entrapment, which is how I lost custody of Camper.
00:07:40
UNKNOWN Camper?
00:07:45
UNKNOWN My son.
00:07:45
UNKNOWN Oh.
00:07:45
UNKNOWN Yeah. He’s staying with my ex-husband’s parents right now. They take good care of him.
00:07:50
UNKNOWN How long have you been divorced?
00:07:55
UNKNOWN Oh, no, I never married that guy.
00:07:55
UNKNOWN Oh.
00:07:55
UNKNOWN No way I would marry that jerk. No, no, I don’t know. It’s been like four years since I’ve even seen him. Something like that, four years.
00:08:05
UNKNOWN What happened?
00:08:10
UNKNOWN Lucas, my ex, he freaked out because he caught me doing just a few lines of coke, but like everybody was doing it back then. So I… Anyway, his mom found the mirror, and the razors, and Lucas said I had to quit. But… For whatever I lied, and when he caught me, I know it was bad to lie about that, but I don’t know it’s in the past. You know, like, water under the bridge. You live, you learn, you move on.
00:08:50
UNKNOWN Right. Do you use cocaine now?
00:08:50
UNKNOWN No, hardly ever. I don’t know, it’s been like a month maybe, or two months or something since I have.
00:09:00
UNKNOWN Any legal problems from using cocaine or…?
00:09:05
UNKNOWN No. No, I mean, we hardly ever do it. So, yeah.
00:09:10
UNKNOWN Have you thought about stopping altogether?
00:09:15
UNKNOWN I mean, I hardly ever do it. Like, hardly even counts. I don’t know, when I do it, it’s just to relieve tension or, you know, it’s this thing Zano and I do to bring each other closer together, you know, but, like I could quit anytime I wanted, easy.
00:09:35
UNKNOWN Does your boyfriend have children?
00:09:35
UNKNOWN Yeah, yeah, he’s got two kids. Yeah. Yeah, but we don’t see them much. You know, his other with his ex.
00:09:45
UNKNOWN Oh?
00:09:50
UNKNOWN She’s like a real snobby type. You know the type? And it is a freaking tragedy because I see his two kids just going down that same path. You know, they’re just two little snobs. It’s a real shame. She… We’re not allowed to see them anymore though, so I guess, you know, like what’s the difference? She went to court and said we were unsuitable. Not suitable. You know, says it all real nice in court, and then not so nice over the phone, if you know what I mean? She’s a real bitch.
00:10:25
UNKNOWN Any other drugs? Ecstasy? LSD?
00:10:30
UNKNOWN All right. This is going to make me sound like I’m some 1970s hippy, druggo person. But I’ve tried ecstasy twice, just twice, and LSD once, last year. That was a bad trip. I am not doing that again.
00:10:55
UNKNOWN Anything else?
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UNKNOWN Like what?
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UNKNOWN Stimulants?
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UNKNOWN Like power drinks if I need to stay up?
00:11:05
UNKNOWN Sure.
00:11:05
UNKNOWN Caffeine, I drink a lot of coffee. I don’t know if cigarettes, do they count as stimulants?
00:11:10
UNKNOWN Yeah.
00:11:15
UNKNOWN Yeah, I’m trying to cut back. Two packs a day.
00:11:15
UNKNOWN Ritalin, Dexedrine?
00:11:20
UNKNOWN Oh, like stimulants?
00:11:20
UNKNOWN Right.
00:11:25
UNKNOWN Oh, yeah. Not a lot. Like hardly ever. I mean, like if Zano and I are down for whatever reason, or sluggish like, from smoking pot, or just like if I need to get back up again. Yeah, like Adderall, just 20 helps.
00:11:40
UNKNOWN Do you ever take prescription medications that are not prescribed for you?
00:11:45
UNKNOWN Well, are you kidding me? Why would I do that? I told you I don’t like medications in the first place.
00:11:55
UNKNOWN Klonopin, Ativan, Xanax?
00:11:55
UNKNOWN Oh, those?
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UNKNOWN Yeah.
00:12:00
UNKNOWN Yeah, I mean if, if my anxiety is acting up, if my meditation isn’t working? Yeah, a couple of Xana bars, you know, but not a lot.
00:12:15
UNKNOWN How often would you estimate that is?
00:12:15
UNKNOWN I don’t know. Two? I don’t know. I need like a freaking calendar to keep up with all your questions, Doc, God.
00:12:30
UNKNOWN So in the past, who prescribed the oxycodone for you?
00:12:35
UNKNOWN No one yet. Zano, he takes them because he’s got shoulder and back problems, and I tried one and, oh, man, it really works. To be honest it works fantastic.
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[sil.]
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END TRANSC
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