PRAC 6645 WEEK 9 Assignment 1 : Clinical Hour and Patient Logs
Walden University PRAC 6645 WEEK 9 Assignment 1 : Clinical Hour and Patient Logs-Step-By-Step Guide
This guide will demonstrate how to complete the Walden University PRAC 6645 WEEK 9 Assignment 1 : Clinical Hour and Patient Logs assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for PRAC 6645 WEEK 9 Assignment 1 : Clinical Hour and Patient Logs
Whether one passes or fails an academic assignment such as the Walden University PRAC 6645 WEEK 9 Assignment 1 : Clinical Hour and Patient Logs depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for PRAC 6645 WEEK 9 Assignment 1 : Clinical Hour and Patient Logs
The introduction for the Walden University PRAC 6645 WEEK 9 Assignment 1 : Clinical Hour and Patient Logs is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
How to Write the Body for PRAC 6645 WEEK 9 Assignment 1 : Clinical Hour and Patient Logs
After the introduction, move into the main part of the PRAC 6645 WEEK 9 Assignment 1 : Clinical Hour and Patient Logs assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for PRAC 6645 WEEK 9 Assignment 1 : Clinical Hour and Patient Logs
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for PRAC 6645 WEEK 9 Assignment 1 : Clinical Hour and Patient Logs
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for PRAC 6645 WEEK 9 Assignment 1 : Clinical Hour and Patient Logs
Clinical Logs
Post-traumatic Stress Disorder
Name: K.P
Age: 39 years
Diagnosis: Post-traumatic stress disorder
S: K.P is a 39-year-old male client who came to the unit today for his regular follow-up visits for post-traumatic stress disorder. He was diagnosed five months ago with the disorder and has been undergoing treatment. His mental health problems started following his involvement in a road accident. He had come for the first visit with complaints that included flashbacks and nightmares about the accident. He also avoided any stimuli that related to the accident. K.P further reported being easily irritated,
experiencing difficulties in sleeping and concentration. Therefore, they brought him to the unit where he was diagnosed with post-traumatic stress disorder and initiated on treatment.
O: The client was well groomed for the occasion. His orientation to self, others, environment, and events were intact. His self-reported mood was normal. His level of judgment was intact. He denied suicidal thoughts, plans or attempts, illusions, delusions, and hallucinations.
A: The client is responding positively to the treatment. He is also tolerating the medications, as evidenced by the minimal side effects of the antidepressants.
P: The client was advised to continue with the treatments and scheduled for a follow-up visit after one month
Generalized Anxiety Disorder
Name: H.S
Age: 29 years
Diagnosis: Generalized anxiety disorder
S: H.S is a 32-year old client that came to the unit for her sixth visit after being diagnosed with generalized anxiety
disorder seven months ago. The diagnosed was reached after she raised several complaints that included excessive worry and anxiety about her performance in her workplace. She also had persistent, excessive fear of an impending doom. She had reported that the excessive fear and worry were beyond her control. The accompanying symptoms that the client reported included chest pain, shortness of breath, tremors, and sweating. The symptoms could not be attributed causes such as medication use, substance abuse and medical condition. H.S noted that the symptoms of excessive worry and anxiety were affecting negatively her productivity at workplace. As a result, she was diagnosed with generalized anxiety disorder and initiated on group psychotherapy treatment.
O: The client appeared well groomed for the occasion. She was oriented to self, others, time and events. She was alert during the assessment and maintained normal eye contact. She reported control over her anxiety. She denied illusions, delusions, and hallucinations. She also denied suicidal thoughts, attempts and plans.
A: The client has developed effective coping strategies for managing her anxiety disorder.
P: Psychotherapy sessions were terminated with consent from the client, since the treatment objectives had been achieved.
Post-traumatic Stress Disorder
Name: T.Y
Age: 32 years
Diagnosis: Post-traumatic stress disorder
S: T.Y is a 32-year old female that came to the unit today for her second visit after being diagnosed with post-traumatic stress disorder. She was diagnosed with it after she started feeling low since her husband died through a road accident six months ago. T.Y reported that she always experiences flashbacks and nightmares related to the accident. She also tries so much to avoid any situation that is related to the events that led to the accident, as it arouses the depressive symptoms. Her productivity in both social and occupational roles had reduced significantly. T.Y could not attribute to the above symptoms to any cause such as medication use, substance abuse or medical condition. As a result, she was diagnosed with post-traumatic stress disorder and initiated on treatment.
O: The client appeared appropriately dressed for the occasion. Her speech was of normal rate and volume. Her self-reported mood was normal. She declined illusions, delusions, and hallucinations. She also declined suicidal thoughts, plans, and attempts. Her thoughts were future oriented.
A: The client is demonstrating moderate improvement in symptoms of depression. She is also tolerating treatment.
P: The client was advised to continue with the prescribed treatment and psychotherapy sessions. She was scheduled for the next follow-up visit after four weeks.
Post-traumatic Stress Disorder
Name: A.D
Age: 42 years
Diagnosis: Post-traumatic stress disorder
S: A.D is a 42-year-old female client who came to the unit with complaints of feeling mentally depressed after the death of her spouse. She reported that she always experiences flashbacks of the events that led to the death of her husband. She also experienced nightmares and avoidance of any stimuli or events that led to his death. Those close to A.D reported that she experienced abnormal behaviors that included the presence of exaggerated negative thoughts about the world, negative affect, decline in interest in activities, and self-isolation. The family members had noted that the client was becoming easily irritated, experiencing difficulties in sleeping and concentration. Based on the above, A.D was diagnosed with post-traumatic stress disorder and initiated on treatment.
O: The client was well groomed for the occasion. Her orientation to self, others, environment, and events were intact. Her mood was depressed. Her level of judgment was intact. She denied suicidal thoughts, plans or attempts, illusions, delusions, and hallucinations.
A: The client is experiencing moderate symptoms of post-traumatic stress disorder.
P: The client was initiated on antidepressants and group psychotherapy. Antidepressants were prescribed to help the client improve her mood. Group psychotherapy aimed at helping the client cope with the distressing symptoms of post-traumatic stress disorder. She was scheduled for the next follow-up visit after four weeks.
Depression
Name: C.D
Age: 28 years
Diagnosis: Depression
S: C.D is a client who came to the psychiatric department today for her follow-up visit after being diagnosed with major depression three months ago. She was diagnosed with major depression due to the symptoms that included persistent feelings of guilt and worthlessness. She also reported feeling depressed in most days almost throughout the day. She also complained of lack of energy to engage in her activities of the daily living and professional work. She noted that her appetite had increased significantly. She also experienced difficulties in concentrating and making decisions. She also reported insomnia for the last two months prior to the first hospital visit. She had however denied suicidal thoughts, plans, or attempts. C.D was diagnosed with major depression and has been undergoing treatment in the unit.
O: The client was dressed appropriately for the occasion. Her orientation to self, others, time and events were intact. Her self-reported was normal. Her speech was normal in terms of rate and volume. She denied illusions, delusions, and hallucinations. She also denied suicidal thoughts, attempts, and plans.
A: The client is responding well to the treatment. The symptoms of major depression have improved as expected in the treatment plan.
P: The client was advised to continue using the current treatments. She was scheduled for a follow-up visit after four weeks. She was to be discontinued on psychotherapy sessions should she demonstrated continued improvements in symptoms in her next visit.
Depression
Name: J.D
Age: 34 years
Diagnosis: Depression
S: J.D is a 34-year-old client that came to the unit today for his follow-up visit after being diagnosed with depression three months ago. She has been on antidepressants and psychotherapy. J.D’s diagnosis with depression as reached after he came initially to the department with complaints of persistent feelings of depressed mood always and lack of pleasure and interest. She also reported that she was finding it hard to concentrate in her social and occupational roles. She also felt worthless and experienced insomnia. J.D also complained of suicidal thoughts and attempts. She however did not have any plans of committing suicide by the time she came to the department for her first visit. The symptoms of depression had affected significantly her functioning and productivity. A further assessment had revealed that the symptoms were not due to a medical condition, medication, or substance use. As a result, she was diagnosed with major depression and initiated on antidepressants and psychotherapy sessions.
O: The client appeared well groomed for the session. She was alert during the assessment. She reported that her mood had improved significantly following the adopted treatments. She denied illusions, delusions, and hallucinations. Her speech rate and volume were intact. She denied any recent experience of suicidal thoughts, attempts, and intentions.
A: The client is responding well to the treatment.
P: The client was advised to continue with the treatment, as positive improvement in symptoms was being reported. She was scheduled for a follow-up visit after four weeks.
Depression
Name: J.O
Age: 40 years
Diagnosis: Depression
A.A is a 40-year old client that that came today for his fourth follow-up visit for depression. J.O was diagnosed with the disorder five months ago after he came with complaints of feeling worthless in life. He also reported that he always has suicidal thoughts. The client had unsuccessful attempted to commit suicide by consuming organophosphate poison. The client also reported that his mood was highly depressed. He did not want to interact with people and often locked himself indoors. The client also reported that his energy levels were low in most of the days. His appetite had also reduces significantly affecting dietary intake. Due to the above complaints, the client was diagnosed with major depression and initiated on treatment.
O: The client appeared well groomed for the occasion. He maintained normal eye contact during the assessment. His orientation to self, others, place, time and events were intact. He denied hallucinations, illusions, and delusions. His speech was normal in rate and volume. He denied any recent experience of suicidal thoughts, plans or attempts. The judgment is intact with thoughts that are future oriented.
A: The assessment findings show that the symptoms of depression being experienced by the client have improved significantly.
P: The client was advised to continue with the prescribed medications as well as psychotherapy sessions. He was scheduled for a follow-up visit after one month.
Bipolar Disorder
Name: Z.C
Age: 33 years
Diagnosis: Bipolar Disorder
S: Z.C is a 33-year-old client that came to the unit for his fifth follow-up visit for bipolar disorder. He was diagnosed with bipolar disorder after he presented to the unit with complaints that included periods of elevated mood, which was characterized by behaviors that that included over activity, engaging in goal-directed initiatives, excitement, euphoria and delusions. The symptoms alternated with depressive symptoms that included lack of energy, too much sleeping, difficulties in concentrating and making decisions. The symptoms experienced by the client could not be attributed to medical condition, medication use of substance abuse. Additional history taking revealed that the symptoms had distressing effect on the health and wellbeing of the client. As a result, he was diagnosed with bipolar disorder and initiated on treatment.
O: The client appeared appropriately dressed for the occasion. He was oriented to self, place, time and events. His judgment was intact. He denied any recent experience of delusions, hallucinations, illusions, suicidal thoughts, plans, and attempts. His thought process was future oriented. He did not demonstrate any abnormal behaviors during the assessment.
A: The client is responding well to the adopted treatments. He also denies any side or adverse effects to the prescribed medications.
P: The client was advised to continue with the current treatments because of the improvement in symptoms and tolerability of the treatments. He was scheduled for a follow-up visit after one month.
Delusional Disorder
Name: C.H
Age: 30 years
Diagnosis: Delusional Disorder
S: C.H is a 30-year-old client that came to the unit with complaints of abnormal behaviors. The client came with her spouse who reported that C.H has been experiencing abnormal behaviors that he felt needed medical attention. The spouse reported that C.H has been experiencing a mix of mental states where she appeared not knowing who she was. One of the symptoms was having an inflated sense of worth. She perceived that she knew everything in the universe. She also kept talking about her encounters with prominent people in the state. She also talked frequently that she had unique talents in her workplace that were not being exploited. In some cases, C.H felt that her supervisor was jealous of her abilities and was planning to terminate her employment. According to the spouse, the complaints were untrue. As a result, she brought her for psychiatric assessment, where she was diagnosed with delusional disorder. She was initiated on psychotherapy sessions.
O: The patient appeared appropriately dressed for the occasion. She did not demonstrate any symptoms of fatigue or weight loss. She experienced flight of ideas during the assessment. She was delusional. She denied history of illusions and hallucinations. She also denied suicidal thoughts, attempts, or plans.
A: The client is delusional. She does not have an accurate understanding of her self-identity.
P: The client was initiated in the group psychotherapy treatment. The aim was to transform her thought processes. She was scheduled for a follow-up visit after four weeks.
Insomnia
Name: J.F
Age: 28 years
Diagnosis: Insomnia
S: J.F is a 28-year-old male that came today to the clinic for his regular assessment. Today was his fourth visit to the unit for psychotherapy sessions. He was diagnosed with insomnia five months ago after he started experiencing persistent difficulties in sleeping. He recalled that he experienced lack of sleep in most of the days for four months prior to coming for his first visit to the unit. J.F noted that he could remain awake mostly throughout the night and getting minimal sleep. In some cases, he slept well but experienced night awakenings that were followed by difficulties in getting back to sleep. He was worried that his sleep problem was affecting his ability to perform optimally in his workplace, as he appeared tired and sleepy during the day. He denied any history of medication use, which could have contributed to the sleep problems. He also denied medical conditions or substance abuse, which could have been associated with the development of the symptoms. He was diagnosed with insomnia and has been undergoing psychotherapy treatments in the facility.
O: The client appeared dressed appropriately for the occasion. There were no signs of fatigue or weight loss. The client appeared oriented to self, others, time, place and events. He denied illusions and delusions. He also denied suicidal thoughts, plans and attempts. His thought process was future oriented.
A: The client has demonstrated optimum improvement in symptom of insomnia. He has developed the desired coping skills.
P: The psychotherapy sessions were terminated, as the treatment outcomes had been achieved. He was informed to visit the clinic should he experience relapse of symptoms of insomnia.
Sample Answer 2 for PRAC 6645 WEEK 9 Assignment 1 : Clinical Hour and Patient Logs
Enuresis Disorder
Name: T.K
Age: 14 years
Gender: Male
Diagnosis: Enuresis Disorder
S: T.K. is a 14-year-old male patient who showed up at the clinic for a psychiatric visit. The parents explain that their son has all his development stages and milestones intact. However, he frequently wets his bed at night. The patient has to put on pull-ups at night, which he hates so much. He usually feels embarrassed when he wakes up in the morning. Therefore, he has continually preferred playing alone.
O: The patient appears well-dressed and groomed. He is also alert and oriented, though wearing a mood is sad. He looks uncomfortable discussing the subject of sleep at night. His speech is fluent, and his thought process and memory are intact. Physical exams revealed no cause for bedwetting. He denies suicidal thoughts or thoughts of self-harm.
A: The patient’s symptoms point to nocturnal enuresis disorder. Hence, it needs proper management.
P: The patient needs to start CBT sessions to help identify the underlying factors and equip the patient with the best coping strategies.
Alcohol Use Disorder
Name: H.K
Age: 37years
Gender: Male
Diagnosis: Alcohol use disorder
S: H.K. is a 37-year-old male patient who visited the healthcare facility for a psychiatric follow-up. He had been diagnosed with alcohol use disorder some months before, and therefore, he has been undergoing psychotherapy and pharmacological treatments. The diagnosis came after he started engaging in binge alcohol intake. The patient reports finding it more challenging to abstain from alcohol use. As a consequence, his occupational and social functioning have been affected.
O: The patient is appropriately dressed and groomed. He is also alert and oriented. The patient looks bothered by his inability to control his alcohol use behavior. He has a coherent thought process and intact memory. He denies hallucinations, delusions, or illusions. He has a standard speech.
A: The patient still struggles with alcohol use. Nevertheless, alcohol use disorder is still the diagnosis.
P: The patient must adhere to the psychotherapy plan to help with the symptoms.
Binge Eating Disorder
Name: L.M
Age: 20 years
Gender: Female
Diagnosis: Binge Eating Disorder
S: L.M. is a 20-year-old female patient who visited the facility, indicating that she needs psychiatric help. She has a history of binge eating, which she has so far failed to overcome. She has been experiencing this problem for some time now, indicating that the condition has been ignored. She feels embarrassed after eating large meals and fears that she might become obese.
O: The patient is well-dressed and groomed, alert and oriented. She has a steady speech. She is in a sad mood. The patient has a coherent thought process and intact memory. She denies suicidal thoughts or ideation.
A: The patient’s condition is indicative of a binge eating disorder.
P: The patient should start CBT sessions to help deal with the distorted thought patterns.
Bipolar disorder
Name: P.H.
Age: 42 years
Gender: Female
Diagnosis: Bipolar disorder
- P.H. is a forty-five-year-old female patient who came to the facility seeking psychiatric help. The patient reports mood swings, which have worried her for some time. She also reports moments of high energy and low energy, as well as other symptoms such as fatigue, hopelessness, sadness, and joy. In addition, she reports problems with sleep, impulsive behaviors, racing thoughts, and concentration difficulties.
O: The patient is well-groomed and neat. She is also alert and oriented. Her mood is sad, and she looks bothered by the symptoms. She is also having problems with concentration. She has a speech that is pressured and talks a lot. She has an incoherent thought process while short and long-term memory is intact. She denies having suicidal thoughts or ideation.
A: According to the DSM-V criteria, the symptoms indicate she has bipolar disorder.
P: The patient needs to start weekly psychotherapy (CBT sessions). This will help her with the cognitive distortions and also develop coping strategies.
Intermittent explosive disorder (IED)
Name: J.D
Age: 36 years
Gender: Female
Diagnosis: Intermittent explosive disorder (IED)
S: J.D. is a 36-year-old female patient who came to the facility complaining of losing her temper so many times for her liking. She also reports being moody most of the time, particularly at the same time every year. The patient complains of getting bored easily, having sleeping problems, and finding it difficult to keep friends.
O: The patient is well-groomed and dressed. She is also alert and oriented. The patient exhibits pressured speech, and she easily gets agitated and irritable. She looks sad. The patient is positive for delusions. She denies suicidal thoughts or attempts. However, she alludes to the possibility of self-harm and harm to others.
A: From the DSM-V criteria, the patient’s symptoms point to intermittent explosive disorder.
P: The patient needs to commence cognitive behavioral therapy sessions to help her deal with the symptoms and the thought patterns.
Narcissistic Personality Disorder
Name: Z.M.
Age: 37 years
Gender: Male
Diagnosis: Narcissistic Personality Disorder
S: Z.M. is a 37-year-old male patient who came to the clinic the facility following an observation by his workmates that he need a psychiatric evaluation. He claims that he is so handsome and that every female at the workplace is attracted to him. He reports a longstanding pattern of grandiosity and lack of empathy, which has led to strained relationships with his workmates. The patient talks a lot about his huge investments and is forthcoming once.
O: The patient is well-groomed and addressed. He is also alert and oriented. He has a clear speech with no pressure. He exhibits distorted concentration levels. The patient has a distorted thought process but intact memory. The patient denies having hallucinations but is positive for delusions. He also denies suicidal thoughts.
A: According to the DSM-V criteria, the symptoms show narcissistic personality disorder.
P: The patient should start cognitive behavioral therapy sessions to help her with thought patterns.
Attention Deficit Hypersensitivity Disorder (ADHD)
Name: J.P
Age: 13 years
Gender: Male
Diagnosis: ADHD
S: J.P. is a 13-year-old male patient brought to the facility by his mother. The mother points out that her son makes careless mistakes and has continually become forgetful. Sometimes, he must be reminded to complete his school assignments. Reports from school indicate he has a declining performance, continued social isolation, and daydreaming.
O: The patient is well-dressed and groomed. He is alert and oriented. He exhibits a sad mood, struggles to concentrate, has a short attention span, and constantly fidgets. He has a coherent thought process and intact memory. He denies suicidal thoughts or ideations.
A: The patient’s symptoms are indicative of ADHD
P: The patient needs to start weekly family therapy sessions to help with the symptoms.
Generalized Anxiety Disorder (GAD)
Name: L.A
Age: 17 years
Gender: Female
Diagnosis: GAD
S: L. A is a 17-year-old female patient who visited the facility for a psychiatric evaluation. The patient has a history of GAD. Her parents indicate that she has been having suicidal thoughts for the last few weeks after using psychotropic medications. She has also been crying a lot. They report that the prescribed medications have not been as effective as they thought.
O: The patient is appropriately dressed and groomed. She is also alert and oriented. However, she looks anxious and disturbed. She has a coherent thought process and intact memory. Her speech is also clear. She denies delusions or hallucinations. The patient is positive for suicidal ideation.
A: The patient’s symptoms point to GAD.
P: The patient should start weekly CBT sessions to help the patient identify and challenge the irrational beliefs and thoughts contributing to the symptoms.
Major Depression
Name: F.E
Age: 51 years
Gender: Male
Diagnosis: Major Depression
S: F.E. is a 51-year-old male patient who came to the facility following a referral by their family physician. The patient indicates that he is hopeless and sees no reason to continue living. He states that he perceives himself as a failure as he is not in a position to provide the best for his family. The patient exhibits a depressed mood and has trouble with sleep. He has also displayed other symptoms, such as lack of energy, reduced appetite, inability to concentrate, and complications in decision-making.
O: The patient is appropriately dressed and groomed. He is also alert and oriented. He talks in low tones and volume. He looks depressed and gloomy. He denies hallucinations, delusions, and illusions. His thought content is future-oriented. He reports suicidal thoughts but no action.
A: According to the DSM-V criteria, the patient has a major depressive disorder.
P: The patient should commence weekly CBT sessions.
Body dysmorphic disorder
Name: B.G
Age: 17years
Gender: Male
Diagnosis Body dysmorphic disorder
S: B.G is a 17-year-old male patient who was brought to the facility in the company of their father after an attempted suicide. The patient’s suicidal action has been caused by his obsessive preoccupation with his facial appearance. The patient perceives his face as ugly and thinks a skin graft should help him solve the problem. The patient has a history of acne, and he has been having sleep difficulties caused by a preoccupation with how he looks. He is usually restless in public and crowded places.
O: The patient is well-dressed and groomed. He is alert and oriented. However, he seems bothered by his looks. His skin is of normal elasticity, color, and texture. His speech is clear, but he speaks in an extremely low tone. He finds it difficult to maintain eye contact. He reiterates that he should be offered a skin grafting. He is positive for suicidal ideation and attempts.
A: The patient’s symptoms are indicative of BDD
P: the patient needs to start CBT to help with the distorted thought patterns.
Post-partum Depression
Name: T.A
Age: 31 years
Gender: Female
Diagnosis: Post-Partum Depression
T.A. is a 31-year-old female patient who came to the facility after the her gynecologist referred her to see if she could get a psychiatric assessment. The patient indicates experiencing problems with adjusting as a new mother who recently gave birth. She reports that the baby cries a lot, hence irritating her. The baby’s cries disturb her sleep at night. She feels inadequate since she cannot stop the baby from crying, which bothers her. She has a significantly reduced appetite, and she feels so overwhelmed.
O: The patient is well-dressed and groomed. She is also alert and oriented. She is in a sad mood, looks tired, and is very sleepy. Her speech is fluent. She also has difficulties concentrating. The patient’s short-term and long-term memory is intact. She denies suicidal thoughts or thoughts of harming the baby.
A: The patient has displayed depressive symptoms after giving birth. Therefore, the diagnosis is post-partum depression.
P: The patient should start weekly sessions of CBT sessions to help with depressive symptoms.
Oppositional Defiant Disorder
Name: K.M
Age: 10-years
Gender: male
Diagnosis: Oppositional Defiant Disorder
S: K.M. is a 10-year-old male patient who was accompanied to the facility by his mother. She reports that her son has shown unbecoming behavior; hence, he should be helped. He has continually become disobedient and disrespectful. He is also too aggressive and hates corrections. He doesn’t want to take turns and prefers getting into arguments. He also throws tantrums whenever he is corrected.
O: The patient is well-dressed and groomed. He is also alert and oriented. He is cooperative but questions almost everything. He is also confrontational and argumentative. The patient finds it hard to concentrate and maintain eye contact. His memory is also intact. He denies suicidal thoughts or ideations.
A: The patient’s symptoms are indicative of opposition defiance disorder
P: The patient needs to start family therapy sessions to help with the symptoms