Question

Patient 4: 18-year old male. He is the “life of the party” and has a consistent history of drinking every weekend. He loves to play basketball and is a point guard and team captain. His girlfriend is the head cheerleader. He hasn’t been going out as much as usual on the weekends, and pretty much goes to school, practice and games, then home and to bed. His younger brother is a freshman and they are both on the varsity team this year. He gave his younger brother his good-luck jersey for Friday night’s game. He seems nervous when he’s awake and his girlfriend is concerned because he’s talking to himself a lot. She also mentions that he had been really angry for the past couple of months and now he’s not happy or sad.

To complete your assignment: • Choose one patient scenario.

• Offer three differential diagnoses for what might be troubling your patient.

• Provide rationale with citations for each of your differential diagnoses.

• What would be your first course of action for your patient?

• What safety issues, if any, did you recognize for your patient?

• Summarize the scenario and what you chose as your final diagnosis for your patient and why.

• Make sure that you address psychosocial issues/concerns/contributors, along with content related to substance abuse, should this be appropriate.

• This assignment should take no more than 1–2 pages, not including your title and reference pages.

Answer 1

Patient scenario: He seems nervous when he’s awake and his girlfriend is concerned because he’s talking to himself a lot. She also mentions that he had been really angry for the past couple of months and now he’s not happy or sad.

Offer three differential diagnoses for what might be troubling your patient:

1. Mental health conditions:

Bipolar disorder: emotions range from extremely happy to extremely sad. But changes in mood associated with bipolar disorder generally only occur a few times a year, even in rapid-cycling bipolar disorder.

Cyclothymic disorder: is a mild mood disorder similar to bipolar II disorder. In it, emotions go up and down but are less severe than those associated with bipolar disorder.

Major depressive disorder (MDD): experience extreme sadness for a long period of time. MDD is also sometimes called clinical depression.

Personality disorders: experience rapid changes in mood in a relatively short period of time.

Schizophrenia: extreme changes in mood.

2. Substance use:  significant shifts in mood if you use drugs or drink alcohol. Excessive drug or alcohol use can lead to addiction, which can seriously interfere with life. Substance use disorders can be hard on both the person with the disorder and loved ones.

3. Other health conditions: This includes conditions affecting your lungs, cardiovascular system, and thyroid. Conditions that affect your central nervous system may also cause shifts in mood.

First course of action for your patient:

Detoxification: Detoxification is normally the first step in treatment. This involves clearing a substance from the body and limiting withdrawal reactions. If a person is addicted to more than one substance, they will often need medications to reduce withdrawal symptoms for each.

Safety issues for your patient:

• Learn the warning signs of a manic episode, and get early treatment to avoid disruption in the patient's life.
• At the same time each day, record the mood and any symptoms.
• Administer medicines as instructed to help reduce the number of manic episodes.
• To help prevent a manic episode, avoid triggers such as caffeine, alcohol or drug use, and stress.
• Exercise, eat a balanced diet, get a good night's sleep, and keep a consistent schedule. This can help reduce minor mood swings that can lead to more severe episodes of mania.
• Have an action plan in place so that if the patient do have a manic episode, one can follow the plan and keep him safe.

Summarize the scenario and what you chose as your final diagnosis for your patient and why:

As it is mentioned that  He is the “life of the party” and has a consistent history of drinking every weekend. I have chosen the diagnosis to be substance use: Alcohol

Psychosocial issues related to substance abuse:

Substance use is generally initiated in adolescence or early adulthood and is commonly associated with variety of problems

These problems can be in any area of the client’s functioning: physical, psychological, family, interpersonal, social, academic, occupational, legal or spiritual.

They can lead to physical and psychological dependence, coercing the person to continue taking the drug despite adverse consequences.

Besides profound impairment and loss of physical health, people with alcohol and drug use disorders may suffer severely from psychosocial problems, interpersonal problems, loss of employment, difficulty in participating in education, and legal problems

Social harms associated with psychoactive substance use include interpersonal problems that impact adversely on relationships with family members, friends, colleagues and members of society

Heavy drinking can lead to a decline in the overall academic performance.

Individuals who engage in substance use early are more likely to develop harmful patterns of use, suffer from severe psychological problems, adjustment problems and school dropout