NRNP/PRAC 6645 Assignment: Comprehensive Psychiatric

NRNP/PRAC 6645 Assignment: Comprehensive Psychiatric

NRNP/PRAC 6645 Assignment: Comprehensive Psychiatric

Evaluation Note Template

CC (chief complaint): Patti says: “There is chaos at my household.”

HPI: Sandi (the therapist) reports that when Patti came for the first time, she mentioned that there was chaos in her household, which started when one of her daughters (Sharleen) joined the rest of the family in the US. Patti came with her four children to the US 12 years ago from Iran but left Sharleen in her home country when she was barely ten. Two years ago, the family got a visa for Sharleen, and since then, there has been chaos in their home. Two weeks after Sharleen joined the family, she began telling them that their father physically and sexually abused her and abandoned her in the house. The chaos exploded after the family learned of this incident. The family lived peacefully, but after learning this, they started constantly fighting, yelling, screaming, and cursing each other.

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Sandi further examined the cause of the family chaos and established that Patti follows archaic ways of living. Her daughters are trying to separate from her, grow independently, and find their individuality. Patti’s daughters insist that she should learn to live independently. However, Patti believes that her daughters should be taking care of her. This is because, in their custom, children take care of their aged parents, but in the US, children live their life and are not available for their parents. Patti states that she feels depressed and unable to move and needs her daughters to visit and spend a night with her.

Past Psychiatric History:

• General Statement:
• Caregivers (if applicable): None
• Hospitalizations: None
• Medication trials: None
• Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History: No substance use history has been provided. However, the PMHNP needs to ask the family members if there is anyone who takes alcohol, smokes, or uses drugs to establish the risk of substance use disorders or associated comorbidities.

Family Psychiatric/Substance Use History: The family history of psychiatric disorders or substance use is not provided in the video. The PMHNP can ask the family if they have close relatives with psychiatric or substance use disorders to identify hereditary risks.

Psychosocial History: Patti and her children lived in Iran 12 years ago. She was married but left her husband in Iran, but he hesitated to join them in the US. Patti was a caregiver before she underwent surgery that left her disabled. The firstborn daughter is working and studying; The second-born does promotional jobs and will soon have a real estate license; The third-born is married and lives with her husband. The fourth-born is in high school. Patti has a cousin who lives in LA, but she does not have contact with them.

Medical History: No history of chronic illnesses in the family.

• Current Medications: None
• Allergies: None

• Reproductive Hx: None

ROS:

• GENERAL: No fever, body weakness, or malaise.
• HEENT: No head injury, visual changes, ear pain/discharge, rhinorrhea, sneezing, or sore throat.
• SKIN: No skin rashes, bruises, or discoloration.
• CARDIOVASCULAR: No palpitations, chest pain, or dyspnea.
• RESPIRATORY: No cough, wheezing, or shortness of breath.
• GASTROINTESTINAL: No GI distress.
• GENITOURINARY: No urinary symptoms or pelvic pain.
• NEUROLOGICAL: No neurological symptoms.
• MUSCULOSKELETAL: No limitations in movement.
• HEMATOLOGIC: No bruising or bleeding.
• LYMPHATICS: No lymph node enlargement.
• ENDOCRINOLOGIC: No endocrine symptoms.

Physical exam: Not applicable

Diagnostic results: No lab tests were ordered.

Assessment

Mental Status Examination:

The family members are neat and well-groomed. Speech is clear with normal volume and rate. Oriented to person, place, and time. The thought process is coherent and goal-directed. No delusions or hallucinations were noted. Memory is intact, and they demonstrate good judgment.

Differential Diagnoses:

Post-traumatic Stress Disorder (PTSD): PTSD develops in individuals who have undergone or witnessed a traumatic event or a series of traumatic events. Symptoms of PTSD include intrusion, avoidance, alterations in cognition and mood, and alterations in arousal and reactivity (Bryant, 2019). Patti and her children developed symptoms of PTSD like altered mood and cognition, negative emotional state, avoidance of conversations, thoughts, and feelings related to Sharleen’s abuse, emotional distress, and irritable and reckless behavior.

Major Depression: The typical symptoms of major depression include a depressed, sad, or tearful mood and/or diminished interest or pleasure in activities (Christensen et al., 2020). Patti presents clinical manifestations of major depression like a depressed mood, tearfulness, and feelings of hopelessness and helplessness. She states that she feels depressed because she feels hopeless and is constantly in a lot of pain, and they cannot help with her pain.

Dependent Personality Disorder (DPD): DPD is characterized by a persistent and excessive need to be cared for. This results in submissive and clinging behavior and fear of separation. The dependent and submissive behaviors aim to bring forth caregiving and are brought about by a self-perception of the inability to function adequately without others’ help (Ekselius, 2018). Patti demonstrates DPD by clinging to her daughters and saying that she feels depressed when they are not around. She also wants them to take care of her due to her disability, but her daughters think it is unnecessary.

Case Formulation and Treatment Plan:

The primary diagnosis for this case is Post-traumatic disorder since the family members exhibit symptoms of PTSD. This can be attributed to the chaos in Patti’s household.

The treatment plan will include: Family Trauma-focused cognitive-behavioral therapy (TF-CBT). This will include one family psychotherapy session per week. TF-CBT aims to help the family members to overcome the distress related to learning about the trauma that occurred to Sharleen, thus enabling them to live harmoniously (Suomi et al., 2019). Health education will focus on stress-coping mechanisms for the family members. This will empower them to handle stress effectively.

Reflections:

The case was challenging since it involved family members presenting with symptoms of PTSD and Patti having depression symptoms. I found it challenging to establish if the depressive symptoms were related to Patti learning about the traumatic events that happened to her daughter or if it was due to major depression. In a similar situation, I would have done things differently by using the Posttraumatic Stress Disorder Checklist (PCL-5) for each family member to assess the severity of PTSD symptoms (Suomi et al., 2019). Ethical factors of confidentiality should be considered in this case, and the PMHNP should ascertain the family that their information will be kept confidential.

Patti’s Family Genogram

References

Bryant, R. A. (2019). Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges. World Psychiatry, 18(3), 259–269. https://doi.org/10.1002/wps.20656

Christensen, M. C., Wong, C., & Baune, B. T. (2020). Symptoms of Major Depressive Disorder and Their Impact on Psychosocial Functioning in the Different Phases of the Disease: Do the Perspectives of Patients and Healthcare Providers Differ? Frontiers in psychiatry, 11, 280. https://doi.org/10.3389/fpsyt.2020.00280

Ekselius, L. (2018). Personality disorder: a disease in disguise. Upsala journal of medical sciences, 123(4), 194–204. https://doi.org/10.1080/03009734.2018.1526235

Suomi, A., Evans, L., Rodgers, B., Taplin, S., & Cowlishaw, S. (2019). Couple and family therapies for post-traumatic stress disorder (PTSD). The Cochrane database of systematic reviews, 12(12), CD011257. https://doi.org/10.1002/14651858.CD011257.pub2