NRNP 6645 Assignment: Family Assessment
NRNP 6645 Assignment: Family Assessment
Subjective:
CC (chief complaint): There is chaos in my household.
HPI:
In the video, Patti, a 40-year-old female, is accompanied by her daughter Sharleen, 23-year-old. Patti first presented to the counseling clinic with complaints of chaos in her home. She moved to the United States 12 years ago alongside her four children. However, the family left one daughter, Shirleen- 21 years, back in Iran. Patti obtained a visa for Shirleen two years ago, but since she joined the family in the U.S., there has been constant chaos. The chaos was triggered by Shirleen’s reports that their father abused her physically and sexually and would abandon her in the house. As a result, there have been unending fights, screams, yelling, and cursing in the home. Patti reports that Shirleen constantly blames her mother for leaving her back in Iran, where she faced abuse from her father.
Patti states that the chaos worsened when her daughters tried to detach from her since she still practices Iran traditions. The daughters wish to be independent of their mother and identify their individuality. Patti reports more tension and anxiety in her family since she became disabled from a failed surgery. Her condi
NRNP 6645 Assignment Family Assessment
tion left her helpless and hopeless, and she feels that her children are uncontrollable. Patti perceives that she is no longer in control of her family, and her children no longer need her. She has had frequent arguments with her daughters since she wishes to spend more time with them. However, the daughters want to be independent of her, which leaves her feeling depressed. Sharleen and Patti deny having delusions, hallucinations, phobias, obsessive thoughts, or suicidal thoughts or ideations.
Past Psychiatric History:
- General Statement: Patti has a history of depression.
- Caregivers (if applicable): None
- Hospitalizations: None
- Medication trials: None
- Psychotherapy or Previous Psychiatric Diagnosis: Patti has been referred to a psychiatrist to manage the depressive symptoms. She is currently on psychotherapy.
Substance Current Use and History: Information on substance use is not provided. The information can be
NRNP 6645 Assignment Family Assessment
obtained by asking if Patti and Sharleen have a history of smoking, taking alcohol, or using drug substances. The substance use history is important to determine the client’s risk of a substance use disorder, depression, and psychotic disorders.
Family Psychiatric/Substance Use History: The history is not addressed. The information would be obtained by asking Patti and Sharleen if they have any family member who has a history of psychiatric illness or substance use disorder. The history is essential in establishing mental disorders the clients are at risk of from genetic factors such as psychotic, alcohol, and substance abuse disorders.
Psychosocial History:
Patti and her family moved from Iran to the U.S. 12 years ago. Her 3rd born daughter, Shirleen, immigrated to the U.S. two years ago. Patti has five children, three daughters aged 24, 23, and 21, and two sons aged 18 and 15 years. She lives with her sons since her daughters moved out. Patti was a caregiver before the failed surgery that left her disabled. The 1st born, Sheela, is working and studying. The 2nd born, Sharleen, is into promotional jobs and is currently working on having a real estate license. Shirleen, the 3rd born, is married and is living with her husband. The 4th born old son is currently in high school. They have a cousin who moved to the U.S. with them, but he now lives in L.A. Patti’s husband remarried twice after he was left Iran.
Medical History: Patti had two surgeries on her feet. One surgery failed and left her disabled with persistent pain. Sheela had a medical problem during childhood.
- Current Medications: No current medications.
- Allergies: No history of drug/food allergies
- Reproductive Hx: No history of reproductive disorders
Objective:
A physical exam was not performed in this video. However, it would be essential to help identify any abnormalities associated with mental disorders.
Diagnostic results: No diagnostic tests at this point.
Assessment:
Mental Status Examination:
Patti and Sharleen are well-groomed and appropriately dressed. Their speech is clear, but Sharleen’s speech volume and rate vary in the interview. They demonstrate a logical and coherent thought process. The clients exhibited no hallucinations, delusions, or obsessions. They were both oriented to person, place, and time. Patti’s and Sharleen’s short-term and long-term memory were intact.
Differential Diagnoses:
Major Depressive Disorder
MDD presents with a depressed/low mood, diminished interest/pleasure, or both. MDD is diagnosed when a patient presents with a depressed mood or diminished pleasure and at least five of the following manifestations: Increased/decreased appetite; Weight loss/gain; Sleep disturbances; fatigue/low energy levels; agitation, guilt; indecisiveness; reduced capacity to think and concentrate; suicidal thoughts or ideations (Tolentino & Schmidt, 2018). MDD is a differential diagnosis based on Patti’s history of depressive symptoms and being referred to a psychiatrist for depression treatment. Patti’s symptoms consistent with MDD include a depressive mood, feelings of tearfulness, sadness, and emptiness for most of the time, feelings of helplessness and worthlessness.
Post-traumatic stress disorder (PTSD)
PTSD occurs after one experience the traumatic event directly, witnesses a traumatic event as it occurs to others, or learns that a traumatic event happened to a loved one (Miao et al., 2018). Based on the video, the family members exhibit symptoms of PTSD. Shirleen’s PTSD symptoms result from directly experiencing physical and sexual abuse and abandonment. For the rest of the family, the symptoms result from finding out the traumatic events that occurred to Shirleen.
PTSD symptoms apparent in Shirleen include irritable behavior, emotional distress, and reckless behavior of eloping with a son to her mother’s friend. Sharleen’s PTSD features include avoiding conversations related to her sister’s traumatic event and a negative emotional state that developed when she learned of Shirleen’s traumatic event (Miao et al., 2018). Patti also exhibits PTSD features such as a negative emotional state and changes in cognition and mood.
Dependent Personality Disorder:
Dependent personality disorder (DPD) manifests with a persistent and exaggerated need to be taken care of, contributing to being submissive and clinging to behaviors. Individuals with DPD do not believe they can take care of themselves (Maccaferri et al., 2020). As a result, they use submissiveness to convince others to care for them. In the video, Patti exhibits a constant and excessive need to be taken care of by her daughters. She believes that her daughters should spend time with her since she is disabled. Her clinging behaviors have exacerbated the chaos in her family (Maccaferri et al., 2020). Besides, the belief that her children must be there for her has resulted in feelings of loneliness, helplessness, and depression.
Reflections:
The family assignment was a bit challenging since the family members presented in the video presented with different complaints. Patti complains of her daughters being out of her control, while her daughter Sharleen complains that Patti is clinging and should let them live independently. However, symptoms of changes in mood, emotional distress, and irritable behavior are common in the family and can be attributed to the traumatic events that occurred to Shirleen. If I were to conduct a session again, I would assess each member for PTSD symptoms.
Case Formulation and Treatment Plan:
Patti presents with features consistent with MDD, PTSD, and Dependent personality disorder. The rest of the family also exhibit features of PTSD, attributed to learning the traumatic events that occurred to Shirleen perpetrated by their father. At this point, Patti will be requested to fill the PHQ-9 questionnaire to help in confirming the MDD diagnosis and assess the degree of her depressive symptoms (Tolentino & Schmidt, 2018). Besides, she will fill the Dependent Personality Questionnaire (DPQ) to help diagnose DPD.
Treatment Plan
- MDD: Start Patti on cognitive behavioral therapy (CBT) once a week. CBT centers on helping clients become conscious of how negative automatic thoughts, expectations, attitudes, and beliefs result in sadness and anxiety (Health Quality Ontario, 2017). Individuals then understand how the thinking patterns, which may have developed to cope with difficult or painful experiences, can be identified and modified to reduce distress.
- PTSD: Start Patti’s family on Family Trauma-focused cognitive-behavioral therapy (TF-CBT) once a week. TF-CBT focuses on the thoughts, feelings, and memories related to the traumatic event (Watkins et al., 2018). It comprises behavioral techniques, like exposure, and cognitive techniques, like cognitive restructuring.
- DPD: Initiate Patti on Clarification-Oriented Psychotherapy (COP). COP is an integrated type of therapy developed for individuals with personality disorders. It centers on tacking the fundamental internal determinants to interaction maneuvers, including emotions, schemes, cognitions, and patterns (Maccaferri et al., 2020).
References
Health Quality Ontario (2017). Psychotherapy for Major Depressive Disorder and Generalized Anxiety Disorder: A Health Technology Assessment. Ontario health technology assessment series, 17(15), 1–167.
Maccaferri, G. E., Dunker-Scheuner, D., De Roten, Y., Despland, J. N., Sachse, R., & Kramer, U. (2020). Psychotherapy of dependent personality disorder: the relationship of patient-therapist interactions to outcome. Psychiatry, 83(2), 179-194. https://doi.org/10.1080/00332747.2019.1675376
Miao, X. R., Chen, Q. B., Wei, K., Tao, K. M., & Lu, Z. J. (2018). Post-traumatic stress disorder: from diagnosis to prevention. Military Medical Research, 5(1), 32. https://doi.org/10.1186/s40779-018-0179-0
Tolentino, J. C., & Schmidt, S. L. (2018). DSM-5 criteria and depression severity: implications for clinical practice. Frontiers in psychiatry, 9, 450. https://doi.org/10.3389/fpsyt.2018.00450
Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in behavioral neuroscience, 12, 258. https://doi.org/10.3389/fnbeh.2018.00258