PRAC 6645 Wk 7 Assignment 2: Comprehensive Psychiatric Evaluation Note and Patient Case Presentation
PRAC 6645 Wk 7 Assignment 2: Comprehensive Psychiatric Evaluation Note and Patient Case Presentation
Subjective:
CC (chief complaint): ‘My child is behaving abnormally. He is violates the rights of others and bullies his peers. He is getting out of control.’
HPI: A.A is a 13-year-old client that came to the unit as a referral by his physician. He was referred for psychiatric assessment because the physician felt that his deviant behaviors were likely to be attributed a mental disorder. The mother of the client reported that A.A has been acting abnormally for the last six months. He has been aggressive and often violates the rights of children of his age. The violation of rights were reported to include aspects such as bullying others, threating to harm, engaging in fights frequently, and used a stick to hit his friend when they disagreed. The mother also reported that A.A was recently accused of stealing a book from his friend in his school. The mother noted that she has tried talking and taking A.A for counseling but they have been unsuccessful. She also noted that the frequency of his involvement in deviant behaviors are getting out of hand. She took him to their family physician, where they were referred to the unit for psychiatric assessment.
Past Psychiatric History:
PRAC 6645 Wk 7 Assignment 2 Comprehensive Psychiatric Evaluation Note and Patient Case Presentation
- General Statement: ‘My child is behaving abnormally. He is violates the rights of others and bullies his peers. He is getting out of control.’
- Caregivers (if applicable): A.A’s mother
- Hospitalizations: The client does not have any history of hospitalizations.
- Medication trials: The client does not have any history of medication use or medication trials.
- Psychotherapy or Previous Psychiatric Diagnosis: The mother reports that she has taken A.A for counseling services, which have not been effective.
Substance Current Use and History: A.A denied any history of substance abuse
Family Psychiatric/Substance Use History: The mother reported that her father died at the age of 65 years with a history of depression. She also reported that her husband’s father lives with Alzheimer’s disease. She denied any history of drugs and substance abuse in the family.
Psychosocial History: A.A is a the first born in a family of three. He lives with his parents in a healthy environment. He has a brother and a sister. He is in junior highschool. He reports that his hobbies includes playing with peers and watching the television. He has no history of childhood trauma or violence. He also has no history of involvement with the legal system.
Medical History:
- Current Medications: A.A is currently not on any medications.
- Allergies: A denied any history of food, drug, or environmental allegies.
- Reproductive Hx: A.A denied any history of increase in urinary urgency and frequency. He is not sexually active.
Objective:
Diagnostic results: Physical examination and history taking are the most effective diagnoses recommended for
PRAC 6645 Wk 7 Assignment 2 Comprehensive Psychiatric Evaluation Note and Patient Case Presentation
A.A. The information obtained from physical examination and history taking can help rule out whether the client has a conduct disorder or is suffering from another rmedical condition. Laboratory investigations such as blood test may be conducted to determine if the client has abnormal biomarkers or changes in the electrolyte levels. Tests such as thyroid function tests may be performed to rule out thyroid disorders, which may have some of the symptoms that the client presented with to the hospital. In rare cases, neuroimaging investigations such as scan of the brain may be performed to determine if the client has any brain pathologies such as changes in the prefrontal and frontal complex, which are contributing to the symptoms.
Assessment:
Mental Status Examination: A.A is a 13-year-old client who appears appropriately dressed for the occasion. He does not show any signs of fatigue or abnormal movements such as tremors and tics. The client is oriented to place, time, events, and space. His insight is intact with absence of depressed mood. The client denies illusions, delusions, and hallucinations. He also denied suicidal thoughts, attempts, and plans. His thought content is future oriented. He also has normal speech in terms of rate and volume.
Differential Diagnoses:
Conduct disorder: Conduct disorder is the primary diagnosis for the client in this case study. According to DSMV, patients with conduct disorder present to the hospital with a number of symptoms. The symptoms involve disruptive and impulsive behaviors. They include repetitive pattern of behaviors that violate societal norms and rights of others for the past 12 months with at least the following symptoms in the last six months. The symptoms include bullying, initiating physical fights, using weapon to harm others, crueal to people and animals, stealing, forcing others into sexual activity, destruction of property, and commiting arson (Rolon-Arroyo et al., 2018). The other symptoms include destroying other people’s properties deliberately, breaking into other peoples’ properties, violation of rules, staying out of night despite prohibition by parents, and running away from home (Fairchild et al., 2019). A.A has the majority of the above symptoms, hence, making conduct disorder his primary diagnosis.
Attention Deficit Hyperactive Disorder (ADHD): ADHD is the secondary diagnosis that should be considered for A.A. According to DSMV, individuals with ADHD present to the hospital with symptoms that include inattention and hyperactivity or impulsivity. The symptoms of inattention include failing to pay attention to details, not listening when spoked to directly, failing to follow instructions, and dislikes activities that need mental effort. The symptoms of hyperactivity include fidgeting, engaging in inappropriate behaviors for the age, failing to engage in leisure activities, talking excessively, and lack of patience (CDC, 2020). ADHD is the least likely diagnosis for A.A since he has destructive behaviors that violate social norms and rights of others.
Oppositional defiant disorder: The other secondary diagnosis to consider for the client is oppositional deviant disorder. According to DSMV, individuals with oppositional deviant behaviors present with symptoms that include irritable mood, argumentative behaviors, and vindictiveness. The symptoms of irritable mood include losing temper, being easily annoyed, and angry or resentful. The symptoms of argumentative behavior include arguing with authority figures and others, defying requests, and annoying others deliberately. The symptom of vindictiveness includes being spiteful at least two times in the last two months (Burke & Romano-Verthelyi, 2018). Oppositional deviant disorder is the least likely diagnosis for A.A because he engages in activities that harm others and violates the social norms and rules.
Reflections: Conduct disorder is a common problem in children and adolescents. They demonstrate behaviors that contradict the social norms and violate the rights of others in the society. I agee with the diagnosis that was reached in this case study. I also agree with the use of cognitive behavioral therapy to facilitate the management of the symptoms of the disorder. I learnt the importance of comprehensive examination and history taking from this experience. I also learned about the importance of significant others in history taking. One of the things that I would do differently in the future is incorporating family therapy to the treatment to improve the family dynamics of the client (Caldwell et al., 2021).
Case Formulation and Treatment Plan:
A.A has been diagnosed with conduct disorder. Diagnostic investigations were not ordered due to the accuracy of the subjective data that guided the development of the diagnosis. The client was initiated on behavior modification therapy. The therapy aimed at helping him overcome impulsive and intrusive symptoms of the disorder (Fairchild et al., 2019). The client was scheduled for a follow-up visit after four weeks to determine his response to treatment.
References
Burke, J. D., & Romano-Verthelyi, A. M. (2018). 2—Oppositional defiant disorder. In M. M. Martel (Ed.), Developmental Pathways to Disruptive, Impulse-Control and Conduct Disorders (pp. 21–52). Academic Press. https://doi.org/10.1016/B978-0-12-811323-3.00002-X
Caldwell, D. M., Davies, S. R., Thorn, J. C., Palmer, J. C., Caro, P., Hetrick, S. E., Gunnell, D., Anwer, S., López-López, J. A., French, C., Kidger, J., Dawson, S., Churchill, R., Thomas, J., Campbell, R., & Welton, N. J. (2021). School-based interventions to prevent anxiety, depression and conduct disorder in children and young people: A systematic review and network meta-analysis. NIHR Journals Library. http://www.ncbi.nlm.nih.gov/books/NBK572522/
CDC. (2020, September 21). Symptoms and Diagnosis of ADHD | CDC. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/adhd/diagnosis.html
Fairchild, G., Hawes, D. J., Frick, P. J., Copeland, W. E., Odgers, C. L., Franke, B., Freitag, C. M., & De Brito, S. A. (2019). Conduct disorder. Nature Reviews Disease Primers, 5(1), 1–25. https://doi.org/10.1038/s41572-019-0095-y
Rolon-Arroyo, B., Arnold, D. H., Breaux, R. P., & Harvey, E. A. (2018). Reciprocal Relations Between Parenting Behaviors and Conduct Disorder Symptoms in Preschool Children. Child Psychiatry & Human Development, 49(5), 786–799. https://doi.org/10.1007/s10578-018-0794-8