ANSWER 2 QUESTIONS OUT OF THREE QUESTIONS ON EACH 3 PRESENTATIONS

PLEASE USE 3 REFERENCES ON EACH QUESTIONS

NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template

Week (enter week #7 ): Grand Rounds Discussion: Complex Case Study Presentation: ADHD

Angele Patricia Lemanga

College of Nursing-PMHNP, Walden University

PRAC 6675: PMHNP Care Across the Lifespan II

Dr. Elizabeth Connole-pond

07/13/2022

Objectives

1- To identify three different diagnoses with supporting evidence, listed in order from highest priority to lowest priority.

2- To understand the DSM-5 criteria for ADHD, Bipolar Disorder, and Generalized Anxiety Disorder.

3- To develop an appropriate care plan for the patient in the presented case including pharmacological and non-pharmacological interventions.

Subjective:

CC (chief complaint): “My daughter is irritable and blows up frequently. She cannot stay still, doesn’t pay attention in school, and has poor grades.”

HPI: MT is a 14-year-old African American female with a past psychiatric history of ADHD who was referred to the clinic by her pediatrician for psychiatric evaluation. The patient and mother were seen at the clinic for initial evaluation. MT was diagnosed with ADHD two years ago, and the mother declined pharmacological treatment. Then, MT started on psychotherapy for anger management and social skills, but she was not consistent with therapy sessions due to her mother’s work schedule conflict. According to her mother, MT does not share her feelings, and sometimes she will explode in anger. Recently she punched a hole in the walls on two occasions. She gets irritated when she is asked to complete house shores like washing dishes, cleaning her room, or organizing things. She will either start crying or hit the wall. MT mother is concerned about her daughter behavior because MT father has bipolar disorder and she wanted to know at which point MT could be affected by the same or similar condition. MT denies feeling depressed or losing interest in her pleasurable activities. She has been self-isolated from her friends, and sometimes, from her family. MT stated: “Sometimes I just don’t want to be bothered”. MT denies suicida/homicidal ideations. She also denies hearing voices or seing things that are not there.

Medications Trial: None

Psychotherapy or Previous psychiatric diagnosis: MT has a psychiatric history of ADHD. She is enrolled in psychotherapy for anger management and social skills.

Substance Current Use: MT denies smoking, drinking alcohol, or using illicit drug.

Medical History: None

· Current Medications: None

· Allergies: No known Drug, Food, or environmental allergy.

· Reproductive Hx: First menses at 13 y/o. Regular menses. Never been pregnant. Denies being sexually active. She is single and has no children.

Psychosocial History: MT is a 9th-grade student who lives with her mother and

NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template

Week 7: Bipolar I Disorder

Christina Miller

College of Nursing-PMHNP, Walden University

PRAC 6675-25: PMHNP Care Across the Lifespan II

Dr. Connole-Pond

07/17/2022

Subjective:

CC (chief complaint): “I thought nothing was real and they lied to me. I had the ideology of suicide and I had knives and pepper spray.”

HPI:
Patient is a 54 year old Caucasian/White male who presented to the ED via police with complaints of suicidal ideation with a plan to be murdered by police and was subsequently admitted for psychiatric treatment.

 
Patient reports having difficulties with a neighbor and expresses paranoid thoughts, stating “he is a man who can’t let it go. He is going to beat me up but I told him he would be dead. I can make myself invincible, and you can tell by my teeth.”

 
Patient reports feeling sad, down, depressed, hopeless, helpless and worthless for periods of months at a time, spanning his entire lifetime. He reports increased energy and a decreased need for sleep. Patient reports not sleeping for 3-4 days at a time, “as many times as I want.” Patient reports his appetite as good but states he often does not eat enough because he talks too much. Patient states “it’s one of those times when all I need is a small bowl of pasta salad and a glass of water for the whole day.” He reports poor concentration and has difficulty staying on-topic throughout the assessment due to flight-of-ideas. He has rapid, pressured, and tangential speech throughout the assessment. Patient reports impulsive, excessive spending on non-essential items, such as baskets to soak his feet in and comic books. He also reports spending in excess of five thousand dollars on a game called “League of Nations.”

 
Patient makes many grandiose and bizarre statements, such as “all of this is evidence so I can go to prison and get shanked. I would rather go to prison not to rat out people in Texas who are helping me defraud the government of five thousand dollars per week. I have a lot of money and like to spend more than five thousand dollars per week.”

 
Patient reports having obsessions and compulsions, such as needing to arrange items by their size and then re-arrange the items the opposite way, multiple times. Patient reports being particular about cleaning beer cans from guests and expressed he becomes upset when they do not follow the exact directions on how he wants them cleaned and disposed of. Patient reports excessive collecting of items, such as comic books. Patient states “I live in a hoarder house. It’s filled with stacks of comic books.”

 
Patient reports a compulsion with watching pornography. He reports having spent time in prison due to child pornography charges. Patient states “I love it. I love child porn. It gives me a rush b

Running head: DISCUSSION QUESTIONS 1

DISCUSSION QUESTION 2

SAMPLES

1 Great post Cynthia Nash

Response1 to question 1

1. Based on information presented, what medication might you have started the patient on if she was not currently on Seroquel, and why?

Lamictal would be my choice of treatment for Unspecified Mood Disorder with Anxious Distress especially because of the history of suicidal thought with and without a plan. In an exploratory study of  lamotrigine’s role in mood stabilization in adolescent with BPD. It found  effective in maintaining symptom control of a broad range of manic, depressive, irritable, and aggressive symptoms in PBD. There was no increase in suicidal ideation. Lamotrigine can be added to SGAs to gain effective symptom control and maintenance at an average dose of 200 mg/day. There was no weight gain or related metabolic abnormalities (Pavuluri et al., 2009).

Since  the rate of serious rash is greater in pediatric patients than in adults, Lamictal is approved only for use in pediatric patients below the age of 16 years who have seizures associated with the Lennox-Gastaut Syndrome or in patients with partial seizures. However, when confronted with the poor prognosis and suicide risk associated with treatment-resistant depression, LTG can be considered as a 3rd-line treatment option, as the benefits may outweigh the risks. Lamotrigine in Adolescent Mood Disorders: A Retrospective Chart Review study revealed that lamotrigine might be associated with a significant risk of benign rash. No serious rash such as Stevens Johnson Syndrome, Toxic Epidermal Necrolysis has occurred.  (Carandang et al., 2007).

Carandang, C., Robbins, D., Mullany, E., Yazbek, M., & Minot, S. (2007, February). Lamotrigine in adolescent mood disorders: A retrospective chart review. Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l’Academie canadienne de psychiatrie de l’enfant et de l’adolescent. Retrieved July 14, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2276172/

Pavuluri, M. N., Henry, D. B., Moss, M., Mohammed, T., Carbray, J. A., & Sweeney, J. A. (2009, February). Effectiveness of lamotrigine in maintaining symptom control in pediatric bipolar disorder. Journal of child and adolescent psychopharmacology. Retrieved July 11, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2692234/

2 Response 1 question 1

1. Describe knowledge of the association between obsessive-compulsive behaviors and paraphilias.

OCD is characterized by the presence of obsessions and/or compulsions. Obsessions are repetitive and persistent t