Plz use the information listed to answer the question/information below. -Thanks CC (chief complaint): my sister made me come in, I was living with my mom and she died and those people those people, they just wont leave me alone. HPI: 52-year-old African American male presents after his sister recommended that he come in for an assessment. Stating that those people, those people just wont leave him alone. States that he hears and see things, feels that the government is trying to take over his life and his sister is a part of that mission. Believes the government and his sister has his phone tapped. Was living with his mom until she passed three years ago and has been currently living on his own, however his sister is his primary caretaker and comes to check on him daily. Paranoid and suspicious of others, sees people and shadows outside of his apartment. Reports of hearing heavy metal music and does not go to the grocery store or anywhere because of the music that he hears and the plotting that they are doing against him. Has poor sleep, poor memory and poor appetite due to the voices and increased paranoia. Has recently locked up his refrigerator so that they wont plant any devices in his food. Hx of taking Haldol, Risperidone and Seroquel but states that they are poison, and he will not take them again. States that he has diabetes and has taken Metformin for it but unsure when his last dosage was. Hx of unknown past psychiatric hospitalizations x3 in his 20s. Hx of family mental health issues, dad has paranoid schizophrenia and mom had anxiety per client. Denies any hx of mental, sexual or physical abuse but states that his dad was rough on them. Mental Status Examination: The client is A&Ox3. Looks his stated age and is well groomed. Calm and cooperative. Speaks in normal tone. Flat affect. Guarded. Impairments in concentration and attention. Easily distracted. Requires prompting to stay on task. Thought process is illogical and irrelevant. Psychosis noted. Disorganized speech and thinking noted at times. Insight into problems appears to be poor. Judgment appears to be poor. A short attention span is evident. Delusions noted, feels that the government is plotting against him and trying to control him. Auditory and visual hallucinations noted, states that he sees birds and hear heavy metal music during assessment. Paranoid and suspicious. Poor sleep, memory and appetite due to hallucinations. Limited knowledge of current and past events noted. Patients behavior in the session was cooperative. Denies any thoughts of wanting to harm self or others. Diagnostic Impression: Paranoid Schizophrenia (accurate diagnosis) Major depressive disorder, Recurrent, severe with psychotic features Bipolar I Disorder with psychotic features What were your differential diagnoses? They are listed above. Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 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. What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy. *I would include these pharmacologic options which are monthly injections due to the patient not being complaint and paranoid of taking pills in the past. -Aripiprazole (Abilify Maintena, Aristada) -Haloperidol decanoate. -Paliperidone (Invega Sustenna) Reflection notes: What would you do differently with this patient if you could conduct the session again? Discuss what your next intervention would be if you could follow up with this patient.?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 (., socioeconomic, cultural background, etc.). (Please be sure to include this in reflection note.)Show more
