673 WEEK 3 PSYCHIATRIC INTERVIEW

673 WEEK 3 PSYCHIATRIC INTERVIEW: It is anticipated that the initial discussion post should be in the range of 250-300 words. Response posts…

673 WEEK 3 PSYCHIATRIC INTERVIEW

Unit 3 Discussion – Psychiatric Interview

Psychiatric Interview

Instructions

It is anticipated that the initial discussion post should be in the range of 250-300 words. Response posts to peers have no minimum word requirement but must demonstrate topic knowledge and scholarly engagement with peers. Substantive content is imperative for all posts. All discussion prompt elements for the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments unless specified in the instructions. All posts should be supported by a minimum of one scholarly resource, ideally within the last 5 years. Journals and websites must be cited appropriately. Citations and references must adhere to APA format.

Classroom Participation

Students are expected to address the initial discussion question by Wednesday of each week. Participation in the discussion forum requires a minimum of three (3) substantive postings (this includes your initial post and posting to two peers) on three (3) different days. Substantive means that you add something new to the discussion supported with citation(s) and reference(s), you are not just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion, however, should be correlated to the literature.

All discussion boards will be evaluated utilizing rubric criterion inclusive of content, analysis, collaboration, writing, and APA. If you fail to post an initial discussion or initial discussion is late, you will not receive points for content and analysis, you may however post to your peers for partial credit following the guidelines above.

Discussion Prompt [Due Wednesday]

Review the video: https://youtu.be/pF12xCtHWwc

Psychiatric Interview and Mental Status Exam: 

1.      Using the readings, lecture, and references, write a complete SOAP note for this patient in the proper format as if this were a referral for you from the school counselor. 

2.      Post the SOAP note to this discussion board for your peer review. 

3.      Your post should include a comprehensive treatment plan which incorporates both psychosocial interventions as well as a medication plan, if indicated, with collateral information. 

Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.

Please review the rubric to ensure that your response meets the criteria.

Estimated time to complete: 2 hours

Patient Psychiatric Interview
Patient Initials: T.P Gender: Male Age: years Ethnicity: Non- Hispanic White
Subjective
Chief Complaint (CC):
History of Presenting Illness (HPI): Mr. TP is a … year old male with a history of
Current Medications: The patient is not under any medications prescribed or otherwise.
Allergies: The patient has no known medication, food, animals, or environmental allergens
Past Medical History: Noncontributory because he has had no major illnesses necessitating admission to the hospital and has had no surgical operations or blood transfusions.
Family medical history: No family member’s immediate, close or distant relations have chronic diseases worth mentioning.
Social History: The patient lives with his father and a sister with whom he does relate well and occasionally takes part in outdoor activities if only to please his mother.
Past Psychiatric issues: The patient denies past psychiatric issues necessitating medications or other therapeutic interventions. He also reports that no close family member has psychiatric issues.
Objective
Review of Systems (ROS)
General: The patient is a healthy-looking adolescent who appears appropriately groomed for the visit and occasion. He appears overweight.
Vitals: Temp-37.7 C BP RR 19,BP 126/ 79 Weight 83.5kg Height 5ft 9 inches BMI 28.8
HEENT: Head norm cephalic, no swellings or injuries, or scars. Has normal hair distributed equally across the clap? Negative for headache, no changes in vision. Denies earache, hearing loss or discharge from ears, no nasal discharge, nose bleed, no voice hoarseness, and swallowing without difficulties.
Skin, Hair, and Nails: No skin discoloration, normal skin texture, and kinky hair. Capillary refills less than 3 sec.
Respiratory: Negative for shortness of breath, wheezing, or breathing difficulties.
Cardiovascular: Negative for chest pains, no feet or hand swelling
Gastro-intestinal: Denies nausea, vomiting, or heartburn; belly protuberant and symmetric. Soft and non-tender abdomen.
Genito-urinary: Denies STIs, reports normal emptying of the bladder
Musculoskeletal: Negative for joint or muscle pain
Hematologic: No splenectomy,
Neurologic: Patient is alert and oriented place time and event.
Mental Status Exam
Orientation: AO*4-Patient is alert and oriented to place, time, and situation
Appearance: Appropriately dressed and groomed for the weather and occasion.
Speech and language: Speech is moderately fast, averaging over 150 words a minute
Attitude: Relaxed and composed, and cooperative
Mood: He had an anxious disposition as he constantly kept on fidgeting.
Concentration: slightly impaired concentration
Thought Process and Association: Logical and coherent with clear organization and easy to follow.
Suicidal/ homicidal ideation: Denied both suicide and homicidal intentions
Memory: Determined to be intact
Insight: Slightly altered patient could not make a connection between his falling grades and the connection
Judgment: Slightly impaired as the patient was unable to make a sensible conclusion given a set of information to help in making sound decisions
Lab tests and findings
No lab tests were ordered, so lab results are not applicable.
Psychiatric Screening Measure Results
Administered the NICHQ Vanderbilt Assessment Scales tool with results meeting the DSM-IV criteria for diagnosis of ADHD.
Risk Assessment
The patient denies suicidal or homicidal ideations. His impulsivity, secondary to his ADHD condition, puts him at risk of legal issues as he is exposed to the risk of taking part in criminal activities.
Assessment
Differential diagnosis
Attention Deficit Hyperactive Disorder (ADHD)
General Anxiety Disorder (GAD)
Manic Depressive Disorder (MDD)
Attention Deficit Hyperactive Disorder (ADHD) Unspecified Type F90.9
According to Cabral et al. (2020), a case of ADHD should be considered likely if the patient presents with difficulties sustaining attentiveness, gets easily distracted, is restless and forgetful, and exhibits poor organization skills inappropriate for their age. Many ADHD-specific scales exist, also known as narrow-band scales, due to their focus on ADHD core symptoms. Most importantly, the screening tool/instrument validity rests on the patient’s age, the rating scale used, and the information corroborated by either parent or teacher, where the patient can also be the chief informant. Upon administering the NICHQ, the Vanderbilt Assessment Scales tool was administered, and the results met the DSM-IV criteria for diagnosis of ADHD; a diagnosis of ADHD unspecified type F90.9was confirmed.
General Anxiety Disorder (GAD) Unspecified F41.8
Which symptoms are similar to ADHD, AND WHY IS IT ADHD AND NOT GAD FOR THIS PATIENT.
Manic Depressive Disorder
Which symptoms are similar to ADHD, AND WHY IS IT ADHD AND NOT MDD FOR THIS PATIENT. Patients who have ADHD can also have symptoms that mimic those o MDD like poor memory, inadequate attention, and concentration challenges, thus necessitating the provider to consider confirming the presence of at least six symptoms characteristic of MDD to confirm its presence and determine whether it is comorbid with ADHD (Edrogan et al., 2020). MDD was considered unlikely because the patient did not present an enduring dysphoric mood, and neither was suicidal or homicidal ideations present.
Plan
Pharmacological intervention is initiated with a prescription of Methylphenidate P.O. 5-10 mg daily, increased gradually to achieve a target dose of 40 mg to 90 mg every day (Chamakalayil et al., 2020). This medication has proven efficacy in addressing attention and concentration issues. The drug is also known lower impulsivity in teenagers. The patient is advised to take medicine for the following weeks before coming to the clinic for a follow-up visit to review progress.

To reinforce the efficacy of the medication, non-medication interventions like individual counseling will be utilized. Other helpful interventions will comprise cognitive behavioral therapy, where the patient is expected to receive at least two sessions every week for the next eight weeks that ensue. Incorporating patient and family education will also help ensure medication adherence and overcome obstacles to treatment, like poor relations between the patient with his father and sister (Nimmo-Smith et al., 2020).
Referrals
The provider is expected to monitor the effectiveness of the therapeutic intervention (Ng et al., 2019). If necessary, referral to a specialist on neuropsychological testing to assess the ADHD diagnosis depending on the patient’s response to the prescribed treatment.

References
Cabral, M. D. I., Liu, S., & Soares, N. (2020). Attention-deficit/hyperactivity disorder: diagnostic criteria, epidemiology, risk factors and evaluation in youth. Translational Pediatrics, 9(Suppl 1), S104.
Chamakalayil, S., Strasser, J., Vogel, M., Brand, S., Walter, M., & Dürsteler, K. M. (2021). Methylphenidate for attention-deficit and hyperactivity disorder in adult patients with substance use disorders: good clinical practice. Frontiers in psychiatry, 1593.
Erdoğan, E., Delibaş, D. H., & Baskin, E. P. (2020). Investigation of childhood traumas in inpatient adults with major depression and with or without attention deficit hyperactivity disorder comorbidity. Turkish J Clinical Psychiatry, 23, 56-63.
Ng, R., Heinrich, K., & Hodges, E. K. (2019). Brief Report: Neuropsychological Testing and Informant-Ratings of Children with Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, or Comorbid Diagnosis. Journal of Autism & Developmental Disorders, 49(6), 2589–2596.
Nimmo-Smith, V., Marwood, A., Hank, D., Brandling, J., Greenwood, R., Skinner, L., … & Rai, D. (2020). Non-pharmacological Interventions for Adult ADHD: A Systematic Review. Psychological Medicine, 50(4), 529-541