Comprehensive Psychiatric Evaluation Essay Assignment Paper

, ,

Comprehensive Psychiatric Evaluation Essay Assignment Paper

Submit a Comprehensive psychiatric evaluation on a adult and aging adult with a mental illness.  Give a short synopsis of the case and why the patient has come to see you.

Comprehensive Psychiatric Evaluation

 

Source of Information

 

  
CASE PRESENTATION (Presenting features, medical/social/family history of Mental illness.) Comprehensive Psychiatric Evaluation Essay Assignment Paper

ORDER  HERE A PLAGIARISM-FREE PAPER HERE

 Mr. P.K is a 55 years old male, from Louisiana, a retired truck driver who presented with 6 weeks history of increased talkativeness, wandering behavior and easy irritability indicative of Bipolar 1 disorder. Notably he experienced seizures in his early teenage and has a history of sexual abuse in adulthood. He has a brother who suffers from schizophrenia. His mother is alive and has Parkinson’s disease. His wife plays a pivotal role in his care and accompanies his to appointments.
Demographics should include: age, sex, who they live with, who they are accompanied by for your interview, who referred them to you. P.K was a 55-year-old male, who lives with his wife in a three-bedroom apartment in Texas. He was accompanied by his son to the clinic and was referred to the psychiatric clinic by his therapist for further management.
Chief Complaint of Patient: Patient’s words Increased talkativeness, wondering behavior and easy irritability for 6 weeks.
History of Present Illness Mr. P.K is a 55-year-old male who presented with a chief complaint of increased talkativeness, wandering behavior, and easy irritability persisting for the last 6 weeks. According to the patient, his family has noted a significant change in his behavior during this time. He described feeling an incessant need to talk and being unable to sit still for long periods. Additionally, he expressed heightened irritability, finding himself easily agitated by trivial matters. These symptoms have started affecting his daily functioning, causing distress to both himself and his family. No significant recent stressors or changes in his life were reported. There is no history of substance abuse or recent medication changes. Further evaluation is needed to ascertain the underlying cause of these symptoms. Comprehensive Psychiatric Evaluation Essay Assignment Paper
Current Medications Haloperidol 2.5 mg P.O twice a day.

Enalapril 10 mg  P.O BID
Past Psychiatric History Mr. P.K was admitted in psych ward 3 years ago due to aggressive and wondering behavior.
Past Psychiatric Medications P.K has been previously managed on Olanzapine 20mg PO BID.
Substance Use/Abuse He admits having been using alcohol since he was 19 years old, but quit a decade ago.
Medical History Active Problem List

1.      Bipolar 1 disorder

2.      Hypertension

 
Allergies     NONE
Family History Mr. P.K’s father died at 84 years due to colorectal cancer. His mother is alive. Aged 82 years and has Parkinson’s disease. He has a brother who is managed for schizophrenia.
Psychiatric and Addiction History #1 – Paranoid Statements (Intermittent Explosive Disorder): P.K has a history of making statements accusing staff or peers of talking about him, withholding his personal items, and not providing the medical help he believes he needs. He also accuses others of having possessions that he claims belong to

 

#2 – Hallucinations (visual/auditory) (Bipolar Disorder, Type I, most recent episodes mixed, with psychotic features): P.K has reported experiencing visual and auditory hallucinations. He often claims to see or hear things/people that others cannot perceive (Larsson et al., 2021). Additionally, he frequently makes statements not grounded, including lse claims of pregnancy or having a husband. Comprehensive Psychiatric Evaluation Essay Assignment Paper

 

P.K denies any history of substance abuse or addiction issues. There is no reported abuse of alcohol, illicit drugs, or prescription medications in his past. He has consistently tested negative on urine toxicology screens conducted during routine medical care, and he exhibits no signs of substance abuse. P.K maintains a sober lifestyle without any legal or social consequences related to substance use. His responsible and healthy behavior suggests no current addiction or substance abuse concerns.
   
MSE: Appearance and behavior
   
   
  Mood Comprehensive Psychiatric Evaluation Essay Assignment Paper
  Affect
  Thought content
  Thought process
  Perceptual disturbances
  Cognition
  Abstract Reasoning
  Concentration
  Impulsivity
  Insight
  Judgment
  Threat to self or others
  Motivation

Strength and Weakness

 
  Motor activity
  Speech
Mr. P.K appeared well-groomed and appropriately dressed. He was oriented to time, place, and person, accurately stating the current date, his location, and his own identity. There were no noticeable mannerisms or unusual behaviors observed during the examination. His affect appeared consistent with his reported mood, and he described his mood as “anxious.” Mr. P.K’s thought content appeared relevant and free from any delusions or obsessions. His thought process was coherent and organized. He did not report any perceptual disturbances or hallucinations. In the cognitive assessment, he was able to recall three out of three objects after a brief delay, count backward from 100 by sevens, and name common objects. Abstract reasoning was intact (Young et al., 2021). Mr. P.K demonstrated good concentration and sustained attention. There were no signs of impulsivity. His insight into his condition appeared limited, as he downplayed the impact of his symptoms on daily life. Judgment was untested during this examination. He denied any thoughts of harm to self or others. His motivation to seek treatment was unclear. When asked about his strengths and weaknesses, he provided a limited response. Motor activity appeared normal, and his speech was coherent and at an appropriate rate and volume.

ORDER  HERE A PLAGIARISM-FREE PAPER HERE
DIAGNOSTIC TESTS
Complete Blood Count (CBC): Within normal limits.

Liver Function Tests (LFTs): Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were mildly elevated.

Complete Metabolic Profile (CMP): Blood urea nitrogen (BUN) was elevated, indicating possible renal impairment. Glucose levels were within normal limits.

Thyroid Function Tests: Thyroid-stimulating hormone (TSH) was within normal limits, ruling out thyroid dysfunction. Comprehensive Psychiatric Evaluation Essay Assignment Paper
CASE FORMULATION

 

 Developmental History:

P.K’s developmental history does not provide specific information regarding prenatal or childhood events, traumatic brain injuries, or seizures..

Family History:

Mr. P.K is married and lives with his wife. Together they have 4 children who are alive and well.

Presenting Challenges:

P.K presents with symptoms of Bipolar 1 Disorder, characterized by increased talkativeness, wandering behavior, and easy irritability. He lacks a documented history of psychiatric conditions or treatment, making it challenging to assess any family history of mood disorders or psychiatric illnesses.

Social History:

P.K is a non-smoker, with no reported substance abuse or addictions. His level of family involvement remains unspecified, but it is essential to engage with family members for valuable insights into his condition, treatment, and support network.
DIFFERENTIAL DIAGNOSIS (with rationale based on DSM 5 and findings

 

 Schizoaffective Disorder:

The presence of mood symptoms alongside psychotic features, such as irritability and increased talkativeness, may suggest schizoaffective disorder. This diagnosis should be considered if these symptoms persist over time.

Generalized Anxiety Disorder:

Excessive worry, restlessness, and irritability could indicate generalized anxiety disorder, especially if no significant manic or depressive symptoms are present. A careful evaluation is necessary to differentiate this from bipolar disorder. Comprehensive Psychiatric Evaluation Essay Assignment Paper

Substance-Induced Mood Disorder:

Mr. P.K’s increased talkativeness and irritability could be related to substance use. It’s crucial to assess for any recent substance use, as drug-induced mood symptoms can mimic bipolar disorder.
DIAGNOSIS: (Include ICD 10 codes)

 

 Bipolar Disorder, Type I, Most Recent Episodes Mixed, with Psychotic Features (ICD Code: F31.2): P.K’s symptoms of increased talkativeness, wandering behavior, irritability, inappropriate social behavior, and hallucinations are consistent with a manic episode in bipolar disorder (Varcin et al., 2022). The presence of psychosis, such as hallucinations, aligns with the specifier for mixed episodes with psychotic features.
Treatment Plan:

 

Pharmacology

Psychotherapy

Referrals

Patient Education

 

 Lithium (mood stabilizer)

Initiate at 300 mg, 2 times daily, and titrate to maintain serum levels between 0.6 to 1.2 mEq/L.

Quetiapine

Start with 50 mg at bedtime and increase as needed up to 600 mg daily, divided into two doses.

D/C Haloperidol 2.5 mg Comprehensive Psychiatric Evaluation Essay Assignment Paper

 

Referral: Consider connecting him with a therapist experienced in bipolar disorder treatment for ongoing psychotherapy.

Educate Mr. P.K and his family about bipolar disorder, emphasizing the importance of medication compliance, recognizing early signs of mood changes, and the need for a stable routine. Provide information on support groups and crisis resources.
FOLLOW-UP Comprehensive Psychiatric Evaluation Essay Assignment Paper

 

 Schedule regular follow-up appointments every 4 weeks initially to monitor medication efficacy and side effects. Over time, extend follow-up intervals to every 3-6 months, depending on symptom stability. Continue to assess mood, medication compliance, and provide psychoeducation and support to Mr. P.K and his family.
   

References

Larsson, F., Kardell, M., Pålsson, E., & Landén, M. (2021). Bipolär sjukdom typ 1 – den mest stabila bipolära underdiagnosen [Bipolar disorder type 1 was the most stable bipolar subdiagnosis]. Lakartidningen, 118, 20153.

Young, A. H., & Juruena, M. F. (2021). The Neurobiology of Bipolar Disorder. Current topics in behavioral neurosciences, 48, 1–20. https://doi.org/10.1007/7854_2020_179

Stone M. H. (2019). Borderline Personality Disorder: Clinical Guidelines for Treatment. Psychodynamic psychiatry, 47(1), 5–26. https://doi.org/10.1521/pdps.2019.47.1.5

Varcin, K. J., Herniman, S. E., Lin, A., Chen, Y., Perry, Y., Pugh, C., Chisholm, K., Whitehouse, A. J. O., & Wood, S. J. (2022). Occurrence of psychosis and bipolar disorder in adults with autism: A systematic review and meta-analysis. Neuroscience and biobehavioral reviews, 134, 104543. https://doi.org/10.1016/j.neubiorev.2022.104543

Patient himself (historian) Comprehensive Psychiatric Evaluation Essay Assignment Paper
Patient LM is a 63-year-old Caucasian male still working as a truck driver. He lives alone in the countryside after divorcing his wife five years ago. They did not have any children. Lately he has been having financial problems and lack of a social support system. He presented with complaints of unexplained sadness, low self-esteem, insomnia, and thoughts about death and dying. He refutes any family history of mental illness. He also denies a personal history of mental illness.
Patient LM is a male Caucasian who is 63 years old and lives alone in a trailer home in the countryside. He was referred for psychiatric evaluation by his PCP. When he came he was unaccompanied. Comprehensive Psychiatric Evaluation Essay Assignment Paper
“Unexplained sadness, low self-esteem, insomnia, and thoughts about death and dying.”
The client, who is a truck driver in his 63rd year, has the aforementioned concerns. He disputes having ever had the concerns that started around three months ago. The location of manifestations is within the mind. The signs are ever-present. Usually, the symptoms are debilitating and enduring. Two things that aggravate loneliness are family-related thoughts. There is some relief in being around coworkers. Both during the day and at night, the manifestations are visible. He rates the severity of his symptoms at seven out of ten.
He is currently not on any medications.
He denies any past psychiatric history.
He has never been put on any medication trials for psychiatric illness.
He denies any substance abuse including etoh and tobacco.
He had an elevated HbA1c of 6.7% three months ago. He is to get another test this month and he will be confirmed type II diabetic if it is also high. He has no other medical conditions. Comprehensive Psychiatric Evaluation Essay Assignment Paper
NKDA.
Both of his parents are deceased. His father died at 70 in a plane crash, while his mother died at 62 in a drowning accident. The family had no history of chronic medical conditions.
He denies any history of psychiatric illness or any addiction history.
He met all his childhood developmental milestones normally. He also got all his vaccinations. Socially he has few friends who are work colleagues. He never drinks or smokes and does not usually go out.
Client is a 63-year-old Caucasian male who is alert and oriented in all respects. His speech is clear and goal-oriented. He appears well groomed and does not show any mannerisms or tics. There is psychomotor retardation. His mood is “sad” and affect dysphoric. Denies HI but accepts having SI. Denies delusions and hallucinations. Abstraction and memory are good. Insight and judgment are intact. Comprehensive Psychiatric Evaluation Essay Assignment Paper
Lab tests are all normal. PHQ-9 however is positive for moderate depression.
The patient’s symptoms are suggestive of a DSM-5-TR diagnosis of MDD.
Dysthymia or Persistent Depressive Disorder: 300.4 (F34.1)

There must be symptoms such as fatigue, low self-esteem, poor appetite, poor attention, insomnia, and others (APA, 2022; Boland et al., 2021).

Bipolar I Disorder, Major Depressive Episode: 296.52 (F31.32)

To be diagnosed with bipolar depression, an individual must exhibit signs of the illness. Only after experiencing a manic episode once may a person be diagnosed with bipolar I disorder, which is typified by the occurrence of opposing emotions twice (APA, 2022).
Major Depressive Disorder (MDD): 296.22 (F32.1)

Some people struggle with sadness, worry, and sleeplessness; as a result, they often withdraw and prefer to be by themselves. They become dysfunctional as a result in terms of their employment, interpersonal interactions, and self-care (APA, 2022; Boland et al., 2021).
  • Sertraline (Zoloft) 100 mg orally OD (Stahl, 2020).
  • Cognitive behavioral therapy (CBT) weekly for 12 weeks (Wheeler, 2020).
  • Referral to local community social support organizations.
  • Educated on importance of medication compliance and medication side effects.
Next follow-up set after four weeks. Comprehensive Psychiatric Evaluation Essay Assignment Paper