Assignment 2: Practicum – Week 6 Journal Entry
Assignment 2: Practicum – Week 6 Journal Entry
Assignment 2: Practicum – Week 6 Journal Entry
The main purpose of this paper is to develop a diagnosis for the patient receiving psychotherapy, evaluating therapeutic approaches for the patient and finally analyzing the legal and ethical implications of counseling the patient. The treatment plan will utilize the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5).
Demographics
The patient is a 12 years old African American male who is under CPS care under a residential program. He is a student in 7th grade receiving special education.
Presenting Problems
CC: The patient stated, “I told my doctor, I was wanting to kill myself. I wrapped a towel around my neck, and I ran out into traffic.”
History of Present Illness
The patient claims that he has been suffering from depression and anxiety ever since he was removed from his biological mother’s house in February 2019 by the CPS due to physical abuse and neglect by his biological mother. The patient’s biological father died from a heart attack when he was only 5 years old. Ever since he has been feeling sad and depressed. He presents with symptoms of sad mood, depression, irritability, anhedonia, feeling of hopelessness and helplessness with intermittent suicidal ideation. He, however, denies homicidal ideation. He is contracting for safety in the hospital. He claims that he was placed in a foster home after being removed from his biological mother’s house, but his behavior was not tolerated by the foster family, and hence was placed in a residential program. Nonetheless, he likes the residential program and would like to go back. He also complains of PTSD-like symptoms as a result of physical abuse by his mother and sexual trauma by his sister’s ex-boyfriend. He also reports of experiencing flashbacks and nightmares, and extreme anxiety with trauma reminder. He claims that he has been hearing the devil’s voice call his names, but currently denies. However, he does not appear to be internally stimulated. He has been having behavioral difficulties. He has also been labile with an irritable mood. At times, he is physically aggressive. He, however, confirms compliance with his current medications. He denies having any side effects. There are no evidence reports of mania, psychosis, hypomania, somatization, eating disorder, phobia, and OCD. He denies having access to guns.
Past Psychiatric History
The patient was brought to the same hospital last year as a result of suicidal ideation. He has also been at the neighboring hospitals for a couple of months for the same problem. He, however, denies making any suicidal attempts.
Medical History
The patient is overweight. He also has asthma. He reports having diabetes but denies having any insulin-dependent diabetes. He is currently on 500mg metformin twice daily for the management of his diabetes.
DSM-5 Diagnosis
The patient is diagnosed with bipolar and depression without psychotic features. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5), a patient is diagnosed with bipolar and depression when he or she has been in a currently major depressive episode and there have previously had at least maniac episode or mixed episode (American Psychiatric Association, 2017). The mood disorders experienced should also not be accounted for by schizoaffective disorder and not superimposed on the schizophreniform disorder, schizophrenia or psychotic disorder. However, the patient must also display specified psychotic features. The patient in this case study has displayed symptoms of depression in the past, and PTSD like symptoms in addition to suicidal thoughts, which is a feature of psychosis. The patient also lacks insight, experiences hallucination, and paranoia. The patient meets the DSM-5 criteria for the diagnosis.
Individualized Plan
The care plan for this patient will include management for both bipolar depression and psychosis. Antipsychotics will mainly be used for the management of psychotic symptoms. He will be started on buspirone 5 mg tablets orally twice daily for the management of anxiety. He will also take clonidine 0.1mg tablets orally at bet time for management of the bipolar disorder and episodes of depression with psychotic features (Stahl, 2018). For more effectiveness, fluoxetine 60 mg tablets will also be administered orally once daily for the management of the same together with Lurasidone 120mg tablets every night at bedtime. Finally, he will take topiramate 50mg for the management of symptoms of bipolar depression and psychotic features. His symptoms of depression, nightmares, and flashback, including hallucination, are expected to be reduced after 4 weeks when he will come for follow up visit. He has proven to be compliant to the same medications in the past with minimal side effects. The patient will also be enrolled in psychotherapy where he will be able to learn about his condition as much as possible, find ways of managing his stress, and advised to join a support group to help with his condition (Cakir et al., 2016). He will also get support to help him prevent behaviors that arise with time such as excessive alcohol consumption.
Legal and Ethical Implications of Counseling
Caring for patients with mental disorders is quite challenging as a result of varied legal and ethical implications. The healthcare provider must make sure that the patients are maximumly involved in treatment choices. It is ethically required that the healthcare provider explains to the patient the available treatment options, their strengths, and side effects before picking on a specific drug regimen for the management of the patient’s condition. The nurse must also uphold the patient’s informed consent agreement, which is however challenging when it comes to the patient with psychotic features (Cakir et al., 2016). In as much as it is not required of his family members to be informed about the patient’s condition without his approval, in this case, the patient needs to be monitored since he displayed symptoms of suicidal thoughts and hence the family members or caregivers will have to be made aware of the patient’s condition and how to help him manage his symptoms for safety and health promotion. Lastly, it is important for the nurse to familiarize with the patient’s cultural beliefs so as to come up with appropriate interventions to enhance patient-centered care plan.
Time Log
List the objective(s) met and briefly describe the activities you completed during each time period. If you are not on-site for a specific week, enter “Not on site” for that week in the Total Hours for This Time Frame column. Journal entries are due in Weeks 4, 8, and 11; include your Time Log with all hours logged (for current and previous weeks) each time you submit a journal entry.
You are encouraged to complete your practicum hours on a regular schedule, so you will complete the required hours by the END of WEEK 11.
| Time Log | |||||
| Week
|
Dates | Times
|
Total Hours for This Time Frame |
Activities/Comments | Learning Objective(s) Addressed |
| 5 | 2 hours | Admission of the patient, monitoring and evaluating the patient’s compliance to treatment, managing medications and psychotherapy. | Utilization of the Cage and Beck depression inventory, and administration of a mini mental state examination. | ||
| 5 | 2 hours | Admission of the patient, monitoring and evaluating the patient’s compliance to treatment, managing medications and psychotherapy. | Performance of both the initial and intake assessment and administration of a mini mental state examination. | ||
| 5 | 2 hours | Admission of the patient, evaluating the effectiveness of prescribed medication, making necessary interventions, enhancing CBT. | Appropriate CBT interventions, evaluation of drug monitoring for compliance and adherence, administration of a full mental status examination. | ||
| Total Hours Completed: 6 |
References
Cakir, S., Tasdelen, D. R., Ozyildirim, I., Ince, E., & Sar, V. (August 07, 2016). Childhood trauma and treatment outcome in bipolar disorder. Journal of Trauma & Dissociation, 17, 4, 397-409.
American Psychiatric Association. & American Psychiatric Association. (2017). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA: American Psychiatric Association.
Stahl, Stephen. (2018). Prescribers Guide: Antipsychotics. Stahl’s essential psychopharmacology. Place of publication not identified: CAMBRIDGE University PR.