NURS 6635 Psychopathology Assignment

Major Depressive Disorder

Name: L.M

Age: 16-years

Diagnosis: Major Depressive Disorder

S: L.M is a 16year-old A.A male on psychotherapy after exhibiting depressive symptoms. The client reports that in the past six weeks, he had lost interest in most activities, including school. He also feels sad and empty most of the day and nearly every day. He reports mainly being fatigued and often sleeps in class. He says his appetite has worsened in the past weeks, and he has lost some pounds. The symptoms have significantly affected his school performance since he has a decreased concentration capacity. He denies alcohol, tobacco, or illicit drug use. He is currently on Prozac 20mg P.O. once a day.

O: The client is neat and dressed appropriately for the weather. He is alert but maintains minimal eye contact. The self-reported mood is “low,” and the affect is constricted. Speech is clear but speaks in low tones. He has a coherent thought process with no delusions or hallucinations. Denies suicidal/homicidal ideations. He is oriented to person, place, and time, and his recent and long-term memory are grossly intact. Judgment, abstract thought, and insight are intact.

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A: Depressed mood. Disturbed sleep pattern and Nutrition imbalance less than body’s requirements. No risk of self-injurious behavior. PHQ-9 score- 12. No reported Prozac side effects.

P: Begin weekly CBT sessions. CBT to include Mindfulness-based cognitive therapy to reduce the risk of relapse of depressive symptoms.

Depression

Name: C.W

Age: 29-years

Diagnosis: Major Depressive Disorder

S: C.W is a 29-year-old AA female who presented with reports of a depressed mood. She stated that she had a low mood and had lost interest in various activities that she had previously enjoyed. She has lost interest in going out with her friends and often avoids social gatherings. She stated that she often felt sad and empty most of the time. She had lost interest in her poetry work, something that brought immense pleasure in the past. The client reports often feeling fatigued, which affects her creativity, and she always feels sleepy. She had also noted a decreased ability to make decisions and concentrate on her job. Besides, she had gained about 8 pounds in the past month, which she attributed to the increased appetite ad reduced physical activity in the past weeks. The PMNHP prescribed Zoloft 50 mg P.O. once a day.

O: The client is neat and dressed appropriately for the weather. She is alert and maintains adequate eye contact. Her self-reported mood is sad, and her affect is constricted. Her speech is clear, but the volume and rate vary from normal to low. She has a coherent thought process, and no delusions, hallucinations, or suicidal/homicidal ideations noted. She is oriented to person, place, and time and her recent and long-term memory are grossly intact. Judgment, abstract thought, and insight are intact.

A: Depressed mood. Disturbed sleeping pattern; Overweight; No risk of self-mutilating behavior. PHQ-9 score- 13.

P: Begin psychotherapy with weekly CBT sessions along with Zoloft therapy. Monitor for side effects of Zoloft. Incorporate Mindfulness-based cognitive therapy to reduce the risk of relapse of depressive symptoms. Also, incorporate Problem-solving therapy in psychotherapy sessions.

Generalized Anxiety Disorder

Name: D.K

Age: 17-years

Diagnosis: Generalized Anxiety Disorder

S: D.K is a 17-year-old Caucasian female on psychotherapy after exhibiting excessive anxiety. The client reports that she experiences excessive worries about her school performance since she wants to get a scholarship to Princeton. The anxiety began almost six months ago when she applied to be considered for the Ivy-League sponsorship program in her school. She is now worried that she must meet the required grades to be selected for the sponsorship, which will change her life. The client reports that she is nervous most of the day most days and is ever worried about school. The excessive worries have affected her sleep as she has difficulties maintaining sleep, which is starting to affect her concentration in class since she experiences daytime sleepiness and fatigue.

O: The client is well-groomed and appropriately dressed for the weather. She is alert and cooperative during the session and maintains eye contact but appears anxious. The self-reported mood is “nervous,” and affect is appropriate. Her speech is clear, but volume and rate vary. She has a logical thought process but is preoccupied with thoughts about school. No phobias, delusions, or hallucinations were noted. She is oriented to person, place, and time. Memory, abstract thought, judgment, and insight intact. GAD score-12.

A: Excessive anxiety; Sleeping disturbances.

P: Continue weekly CBT sessions to alter the distorted thoughts causing anxiety. Incorporate social skills training to help the client create and maintain relationships and manage herself and the stressors.

Attention Deficit Hyperactive Disorder

Name: W.P

Age: 6-years

Diagnosis: Attention Deficit Hyperactive Disorder

S: W.P is a 6-year-old AA male with ADHD referred for psychotherapy by his PCP as an adjunct to stimulant therapy. The boy exhibits hyperactive, impulsive behavior and inattention. The mother states that the behavior started when he was about four years old and has worsened. He had temper tantrums in pre-school and still has major issues with anger management. The boy’s behavior has interfered with learning since he cannot stay still in class and often disrupts the class. His teacher reported that it was difficult to contain the child in class since he would move when a class was in session, and he would talk excessively. He is also easily distracted and makes impulsive decisions. The pediatrician has prescribed Methylphenidate 36 mg P.O. once a day.

O: The boy is well-groomed and appropriately dressed for the function and weather. He fidgets on the chair and maintains minimal eye contact. He wanders around in the office and stares through the window. His self-reported mood is “nervous,” and the affect is elevated. His speech is clear but loud, and his thought process is coherent. No hallucinations or delusions were noted. No self-injurious thoughts were noted. Exhibits a short attention span and is easily distracted. Recent memory is impaired, but long-term is intact. Deficits are noted in calculation concentration. Judgment and abstract thought are intact.

A: Impaired attention span; Easy distractibility; Hyperactivity; Impulsivity; Deficits in thinking and memory.

P: Initiate Behavioral psychotherapy alongside pharmacological therapy. Involve the child’s class teacher in making the environment conducive to allow the child to focus and maintain attention in class. Start the parents on Behavioral parent training. Introduce the child to a social skills group for children with ADHD.

Post-Traumatic Stress Disorder

Name: S.M

Age: 17-years

Diagnosis: Post-Traumatic Stress Disorder.

S: S.M is a 17-year-old female client on psychotherapy for Post-Traumatic Stress Disorder. The client witnessed a shooting attack 12 weeks ago in her neighborhood where two people were shot and died on the spot. She states that she persistently re-experiences the shooting event with intrusive thoughts. She often has flashbacks of how the two men who were shot screamed and groaned in pain before they died and the blood on their bodies. In addition, she has been experiencing distressing dreams about the incident, which have resulted in sleeping difficulties and an increased startle reaction. The flashbacks and distressing dreams began six weeks ago, leading to significant psychological distress. She is currently on Zoloft 20 mg P.O. once a day.

O: The client is well-groomed and appropriately dressed for the weather. She is alert but appears anxious and maintains minimal eye contact. The self-reported mood is nervous, and the affect is congruent. Her speech is clear, but the rate and volume increase when the client talks about the RTA. She also develops tremors when discussing the sight of the dead passengers. Thought-process is coherent and goal-directed. No delusions, hallucinations, or suicidal ideations were noted. Orientation, memory, abstract thought, judgment, and insight are intact.

A: Sleeping disturbances; Avoidance of people and activities that may trigger recollections of the shooting event; Vigilance and startle response. Emotional distress when discussing the shooting attack.

P: Begin weekly sessions of Trauma-Focused Cognitive-behavioral therapy (TF-CBT). Continue with pharmacotherapy with Zoloft and monitor for side effects. Include Prolonged Exposure (P.E.) Therapy to CBT.

Bipolar Disorder

Name: W.G

Age: 39-years

Diagnosis: Bipolar Disorder

S: W.G is a 39-year-old White male on psychotherapy after he exhibited manic symptoms and was diagnosed with Bipolar disorder. The client reports having an elevated mood with lots of excitement. He says he has made many plans at work and home but often lacks adequate time to carry them. As a result, he sees no need for sleep, and 2-3 hours of sleep per day are enough for him. He says that he wants to do everything before he gets into that period where he becomes depressed and lacks interest in almost all activities. He states that during this period, he sleeps a lot, is always fatigued, and feels like he is crashing. He attributes this to becoming fatigued when during his creative days. He is currently on Lithium carbonate XR 300 mg B.D.

O: The client is unkempt and wears boots and a raincoat coat in the summer season. He is alert and oriented but restless and somewhat distracted, but this improves with time. His self-reported mood is elated,’ and his affect is expansive. He has an illogical thought process with a flight of ideas and pressure of speech. The client is very talkative with a high volume and rate of speech. Hallucinations and delusions are absent, and he denies suicidal or homicidal thoughts. His memory is intact, but impaired judgment and insight is absent.

A: Manic symptoms. No improvement in symptoms of pressure of speech and flight of ideas. No reported side effects with Lithium.

P: Continue with weekly Interpersonal therapy in addition to treatment with Lithium. If no significant improvement is noted, introduce family-focused therapy.

Obsessive-Compulsive Disorder

Name: S.B

Age: 24 years

Diagnosis: Obsessive-Compulsive Disorder

S: S.B is a 24-year-old White female on psychotherapy due to OCD. The client reports experiencing recurrent and persistent thoughts about her safety for the past four months. This began about three months ago when she moved out of her family’s home and moved to a residential area with security issues. The intrusive thoughts cause marked disturbance resulting in marked anxiety and distress. She often experienced intrusive thoughts about not having locked her door and windows, especially at night. Besides, when at work, she often experiences persistent thoughts if she has locked the door appropriately. She repetitively calls the building manager when she is at work to check for her house to see if she has closed the house. She also wakes up at night to check if she locked the door and windows appropriately.

O: Female client, well-groomed, alert, oriented x3, and maintains eye contact. The self-reported mood is anxious, and the affect is broad. Her speech is clear, and her thought process is coherent. No delusions or hallucinations were noted. She admits to having intrusive and persistent thoughts about the safety of her house, which compel her to check her door and window locks frequently. The persistent thoughts have reduced at night, and she reports waking up less frequently to check her locks. Her cognition, memory, judgment, and insight are grossly intact.

A: Significant anxiety symptoms secondary to intrusive thoughts. Compulsive checkers behavior.

P: Continue with weekly CBT sessions, to help the client recognize and challenge the cognitive distortion of OCD symptoms. Integrate Exposure and response prevention in CBT.

Narcissistic Personality Disorder

Name: D.L

Age: 58-years

Diagnosis: Narcissistic Personality Disorder

S: D.L is a 58-year-old White male on psychotherapy after being diagnosed with Narcissistic Personality Disorder. The client thinks he is unique and special and should only interact with people who are also special and unique. To satisfy his ego, the client usually attends political meeting rallies to meet people in the political class since he believes he will be an elected legislator in the future. He usually takes numerous photos with politicians in these meetings. He posts them on social media to create a false image for others. This usually elevates his esteem when he receives admiration from others. In addition, he claims to have social connections with politicians and often lies that he has been invited for lunch and private meetings to discuss how he will get into a leadership position in the next elections.

O: The client is well-groomed and appropriately dressed for the weather. He is alert but resistant and arrogant during the entire session. His self-reported mood is happy, and his affect is congruent. His speech is clear with a normal rate and tone but has a high volume. He has a coherent thought process but is preoccupied with fantasies of becoming a politician. The client has a grandiose sense of self-importance. No hallucinations were noted, and he denies suicidal ideations. He is oriented to person, place, and time. Attention and concentration are good, but judgment is limited, and has poor insight.

A: Impaired social interaction; Inflated self-esteem; Ineffective coping.

P: Begin psychoanalytic psychotherapy to interpret the client’s narcissistic defenses and illuminate the client’s negative transferences.

Anxiety Disorder

Name: R.G

Age: 43-years

Diagnosis: Generalized Anxiety Disorder

S: R.G is a 43-year-old Asian female in psychotherapy diagnosed with Generalized Anxiety Disorder. The client reports that she experiences excessive worries about her children’s safety following a shooting incident near their school three months ago. The client reports that she is nervous most of the day and constantly worries about her children and if she will see them in the evening. She states that she has tried to avoid the invasive thoughts but has been unsuccessful. The excessive worries have affected her sleep since she keeps wondering what may happen to the kids the following day. This has affected her work output since she experiences daytime sleepiness and fatigue. Besides, her concentration levels have declined, which further affects her output.

O: The client is well-groomed and appropriately dressed for the weather. She is alert and cooperative during the session and maintains eye contact but appears anxious. The self-reported mood is “nervous,” and affect is appropriate. Speech is clear, but volume and rate vary. She has a coherent thought process, but the client is preoccupied with her job. No phobias, delusions, or hallucinations were noted. She is oriented to person, place, and time. Memory, abstract thought, judgment, and insight intact. GAD score-10.

A: The client is cooperative and interested in psychotherapy. Sleeping disturbances.

Insomnia

Name: W.A

Age: 26-years

Diagnosis: Insomnia

S: W.A is a 26-year-old White female on psychotherapy for Insomnia. She reports experiencing difficulties initiating and maintaining sleep. She sleeps for about four 4 hours with frequent nigh-time awakening. The sleeping disturbances began four months ago and have worsened over time. She usually stays for 1-2 hours before falling asleep and often rolls on the bed as she waits to find sleep. The client also states that she often wakes up in the middle of the night and lacks sleep for about two hours. The lack of sleep has affected her work since she feels fatigued during the day. She admits to taking lots of coffee since it stimulates her during the day. She has also resulted to taking 2-3 beers before going to bed to help her sleep. However, she denies smoking or using illicit substances. She is also taking OTC sleeping pills to induce sleep, but it has had minimal impact.

O: The client is neat and dressed appropriately for the weather. The self-reported mood is low, and the affect is appropriate. She appears bored during the psychotherapy session. Her speech is clear, and her thought process is coherent and goal-directed. No delusions, hallucinations, or suicidal ideations were present. She is oriented to person, place, and time. Memory, judgment, abstract thought, and insight are grossly intact.

A: Impaired interpersonal and social functioning.

P: Begin weekly CBT sessions for insomnia to help the client identify and replace thoughts and behaviors that cause sleeping difficulties with habits that promote sound sleep. Individual education on sleep hygiene emphasizing modification of lifestyle habits that influence sleep, such as drinking too much caffeine late in the day or not getting regular exercise.