Directions: Please read the following continuing case presentation.
Answers are to be typed, double-spaced and references must be in
APA format. References must include the DSM-5 and at least 2 current
scholarly references (Note that scholarly references are generally
peer reviewed articles – not quotes from a website.) The first section
is a reprint of the case study from summer semester.
A 60 year old caucasian male presents to the assessment office of your psychiatric facility. You are asked to evaluate
him. He has a chief complaint of “I just can’t take this anymore! I’m gonna END her and then ME!!! I’m Fred of
this!” PaFent reports over the past few several weeks feeling more irritable and frustrated with the pending divorce
with his wife of 20 years. The paFent admits to frequent crying spells, geOng easily distracted, having poor sleep
iniFaFon with frequent awakening throughout the night, and having difficulty making work decisions. He says that
in the past couple of days he just “flies off the handle” at work and got sent home yesterday. He does not report
any history of auditory or visual hallucinaFons. He also tells you that since the separaFon from his wife he can drink
only diet sodas or beer. So he says that he drinks a six pack of beer alone between Friday evening and Sunday
evening. He denies any illicit drug use. He hasn’t smoked cigareUes in over ten years. He is staying at a family cabin
30 miles from town due to the pending divorce. The couple’s only son lives three states away. The paFent told your
assessment coordinator that he keeps a loaded gun “under his pillow” because there are “bad people in this
world.” PaFent has never had any psychiatric treatment and is on medicaFon for diabetes, COPD, and
hypertension. He has no surgical history and no allergies. He has no history of legal problems, military service, or
trauma. He has no history of violence. He is from Mississippi and has been married 20 years. He reports no other
significant relaFonships. Both parents are deceased, and he was an only child. By the end of the assessment, the
paFent has calmed considerably. He denies any thoughts of harming himself or anyone else (including his wife).
“Oh…I was just pissed off…” He reports he just wanted to vent his frustraFon and insists he does not need
hospitalizaFon.
The patient was involuntarily admitted to your inpatient psychiatric unit and
placed on suicide precautions. On his second day of inpatient stay, the
patient admits to you that he had been drinking most every night instead of
just the weekends like he originally reported. He also tells you “I did something else but you’re just gonna have to figure that out!” and stormed
out of the room. He refused to provide a urine drug screen, but the
remainder of his admission lab work was unremarkable.
Questions – separate your answers by question number
1. Now that he has admiUed to addiFonal alcohol and another substance that he won’t tell you
about, you have to include risk for withdrawal symptoms in your treatment plan. From the
DSM-5 pick one other substance he might be talking about and prepare a table that idenFfies
what withdrawal symptoms you are looking for from alcohol and whichever other substance
that you pick
2. Create a treatment plan for withdrawal symptoms from both substances that he is using
(alcohol plus the one you pick.) Include his medical comorbidity (diabetes, HTN, and COPD) if
you think it will impact your treatment plan