Description
Respond at least 2 times each to all colleagues who presented this week (should be 2-3 presenters each week). Need 2 references to each response.The goal is for the discussion forum to function as robust clinical conferences on the patients. Provide a response to discussion prompts that your colleagues provided in their video presentations.You may also provide additional information, alternative points of view, research to support treatment, or patient education strategies you might use with the relevant patient.Responses exhibit synthesis, critical thinking, and application to practice settings…. Responses provide clear, concise opinions and ideas that are supported by at least two scholarly sources…. Responses demonstrate synthesis and understanding of Learning Objectives…. Communication is professional and respectful to colleagues…. Presenters’ prompts/questions posed in the case presentations are thoroughly addressed…. Responses are effectively written in standard, edited English.Meets requirements for participation by responding at least twice to each colleague who presented this week.
Unformatted Attachment Preview
Respond at least 2 times each to all colleagues who presented this week (should be 2-3
presenters each week).
The goal is for the discussion forum to function as robust clinical conferences on the
patients. Provide a response to discussion prompts that your colleagues provided in their
video presentations.
You may also provide additional information, alternative points of view,
research to support treatment, or patient education strategies you might
use with the relevant patient.
Responses exhibit synthesis, critical thinking, and application to practice
settings…. Responses provide clear, concise opinions and ideas that are
supported by at least two scholarly sources…. Responses demonstrate
synthesis and understanding of Learning Objectives…. Communication is
professional and respectful to colleagues…. Presenters’ prompts/questions
posed in the case presentations are thoroughly addressed…. Responses are
effectively written in standard, edited English.
Meets requirements for participation by responding at least twice to each
colleague who presented this week.
Week (#7): LS Case Study
Brandy Hopson
College of Nursing-PMHNP, Walden University
PRAC 6675: PMHNP Care Across the Lifespan II
Demesia Brown
January 10, 2024
NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric
Evaluation Template
Subjective:
CC (chief complaint): “It’s helping the voices.”
HPI: Patient is a 14-year-old AAF who presents for her second medication management
follow up since her initial evaluation. She has diagnoses with Attentiondeficit/hyperactivity disorder (combined type), major depressive disorder, Tourette’s
disorder, and Bipolar I (current or most recent episode depressed, with psychotic
features.) She initially developed tics that progressed to Tourette’s. Symptoms of
depression began several years ago, during elementary school. She began to
experience untriggered bouts of sadness, having a hard time focusing at school and
home, constant worrying about “other things than what I need to do such as random
objects or people.” She has a hard time with organization and her mother reports that
her room is a mess. She reports having auditory and visual hallucinations. She reports
that no matter what she does she cannot make them stop which makes her get
confused with reality. Patient reports that the command hallucinations can be hard to
control even if she knows it is wrong. Some of the visual hallucinations in the past
consisted of seeing people from TV shows that she had watched or seeing shadows.
She struggles academically and socially. She is currently taking Seroquel, Lexapro,
benztropine, Adderall, clonidine, and Abilify. She reports that since starting Seroquel
she has seen a decrease in command hallucinations. Clonidine helps with the tics. She
denies suicidal ideations but does feel hopeless. Previously tried Risperdal but she did
not tolerate it well.
Substance Current Use: None
Medical History: None
•
•
•
•
•
Current Medications: quetiapine 25 mg tablet 1 tablet by mouth every night,
Lexapro 10 mg tablet 1 tablet by mouth every night, benztropine 0.5 mg tablet 1
tablet by mouth once a day, dextroamphetamine-amphetamine ER 10 mg 1
capsule by mouth every morning, clonidine HCl 0.1 mg tablet 1 tablet by mouth
twice a day, aripiprazole 5 mg tablet 1 tablet by mouth
Allergies: No Known Allergies
Reproductive Hx: She started her menstrual cycle at 12 years old. She is not on
birth control and denies being sexually active. She is not pregnant and does not
have any children.
Family Hx: Depression and anxiety on maternal side. Unknown psychiatric
history on her father’s side. Grandmother has hypertension. No substance
abuse, learning disabilities, other psychiatric hx, or medical hx.
Social Hx: 8th grader who lives with her mother. Her father left the family and
remarried in 2021 without telling the patient what was going on. She reports
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having her mother as a support system. She denies any history of abuse. No
religious preferences.
ROS:
•
•
•
•
•
•
•
•
•
•
•
•
GENERAL: No weight loss, fever, chills, weakness, or fatigue. All systems WNL
HEENT: No visual loss, blurred vision, double vision, or yellow sclerae. Ears,
Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.
All systems WNL
SKIN: No rash or itching. All systems WNL
CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No
palpitations or edema. All systems WNL
RESPIRATORY: No shortness of breath, cough, or sputum. All systems WNL
GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No
abdominal pain or blood. All systems WNL
GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color. All
systems WNL
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia,
numbness, or tingling in the extremities. No change in bowel or bladder control.
All systems WNL
MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness. All
systems WNL
HEMATOLOGIC: No anemia, bleeding, or bruising. All systems WNL
LYMPHATICS: No enlarged nodes. No history of splenectomy. All systems WNL
ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No
polyuria or polydipsia. All systems WNL.
Objective:
Diagnostic results: None
Assessment:
Mental Status Examination: She is a 14-year-old African American female who appears
appropriate for her age. She openly participates in her session and answers all
questions thoroughly. She appears well groomed and appropriately dressed. Patient
exhibited a ritual of whistling, hand clapping, foot tapping, and motor tics several times
during the session. Patient reports that it is worse when she has high emotions, good or
bad. Her speech is within normal limits. Her thought process is logical, and goal
directed. She appears to be in a euthymic mood with normal affect. She is alert and
oriented X4. Her concentration, remote memory, and recent memory is good and intact.
She denies having any suicidal ideations or homicidal ideations. She reports having
auditory and visual hallucinations daily. “They’re always talking about something, they
just watch me, multiple voices.” No issues with sleep or appetite noted.
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Evaluation Template
Diagnostic Impression:
Major Depressive Disorder: The client reports symptoms of sadness, constant worry,
difficulty focusing, auditory hallucinations, and visual hallucinations. She reports
improvement in her symptoms of depression with the addition of Lexapro. Scientists
observed that the drug reaction to two anti‐depressant drugs was largely influenced by
the genotype of the specific patient. These findings could aid clinicians in predicting the
clinical receptiveness in patients with major depressive disorder and recommend the
serotonin transporter which is the principal primary goal for many classes of
antidepressants, including selective serotonin reuptake inhibitors and SSRI
antidepressant treatment to achieve a better therapeutic outcome (Gulfishan, Etal,
2022).
Bipolar I Disorder with psychotic features- The client reports symptoms of sadness,
constant worry, difficulty focusing, auditory hallucinations, and visual hallucinations. She
reports that the addition of Seroquel has created a decrease in her hallucinations.
Seroquel is a part of the second-generation segment of drugs and was accounted for
the largest share in 2015 and are anticipated to further expand during the forecast
period despite the adverse effects that have been reported in some second-generation
drugs (PR Newswire, 2017).
Rule out: Generalized Anxiety Disorder- The client reports symptoms of sadness,
constant worry, difficulty focusing, auditory hallucinations, and visual hallucinations. She
has seen improvement in her symptoms of constant worrying since starting Lexapro. In
a study completed by Peters, Knorr, Et al, (2019), it was concluded that a potential
beneficial effect of escitalopram on neuroticism may be driven by reductions in anxiety.
There was a significant improvement in symptoms of anxiety with the use of Lexapro
versus a placebo medication.
Reflections: I agree with my preceptor’s and my assessment and treatment plan. The
current regime of medication has been improving the client’s symptoms. The client has
restarted therapy and is beginning to utilize coping skills. I would not do anything
differently from the current treatment plan. The client and her mother reported that she
has followed up with her pediatrician within the past year. They report that everything
including her labs were WNL.
Case Formulation and Treatment Plan:
Patient and mother both have received education on risk and benefits of medications,
watching for potential side effects of the medications, and to monitor for suicidal
thoughts (black box warning). Other side effects to monitor for are weight gain, dry
mouth, tiredness, difficulty sleeping, headaches, dependency, increased heart rate, and
nausea. Patient denies being sexually active and advised on the importance of not
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getting pregnant due to risk of medications on pregnancy and the fetus. Encourage to
begin birth control if she becomes sexually active. Advised patient on the importance of
notifying the provider of any changes in medications, including over the counter
medications, and the risk of drug interaction. Discussed the risk of mixing illicit drugs or
alcohol with medications and the effects on her overall mental health. Both mother and
patient verbalized understanding to call 911, go to the nearest emergency room, or
psychiatric hospital should suicidal ideations or homicidal ideations occur.
Continue medications as prescribed:
quetiapine 25 mg tablet 1 tablet by mouth every night to treat symptoms of auditory and
visual hallucinations
Lexapro 10 mg tablet 1 tablet by mouth every night to treat depression and anxiety
symptoms
benztropine 0.5 mg tablet 1 tablet by mouth once a day to decrease motor symptoms
and tics
dextroamphetamine-amphetamine ER 10 mg 1 capsule by mouth every morning to help
with focus,
clonidine HCl 0.1 mg tablet 1 tablet by mouth twice a day to decrease motor symptoms,
tics, and focus
aripiprazole 5 mg tablet 1 tablet by mouth for mood stabilization
Continue therapy with current therapist. The patient has been referred to start
psychotherapy and has completed three sessions. She verbalizes coping strategies that
she is learning and implementing. She reports using deep breathing, counting, and
stopping to look, listen, and feel for what is reality and what is not. She reports that her
coping skills have been helping.
Mother and patient allowed the space to ask any questions or voice any concerns.
Denied having any questions or concerns. Notified to contact the office should any
questions or concerns arise. They both verbalized understanding and agreed to the
current treatment plan in place.
Should any changes in health status occur to follow up with the pediatrician. The patient
recently had her yearly exam and labs. Everything was within normal limits.
Return to clinic in 3 weeks. Continued treatment is medically necessary to address
chronic symptoms, improve functioning, and prevent the need for a higher level of care.
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Evaluation Template
1. What other diagnosis would you consider and why?
2. If you would consider an alternative diagnosis, what measures would you
consider to make that diagnosis?
3. What other medication additions would you implement and why?
4. What other questions would you have for the patient or mother that may not have
been addressed?
PRECEPTOR VERFICIATION:
I confirm the patient used for this assignment is a patient that was seen and managed by the student at
their Meditrek approved clinical site during this quarter course of learning.
Preceptor signature: ________________________________________________________
Date: ________________________
References
Gulfishan, S., Halder, S., Kar, R., Srivastava, S., & Gupta, R. (2022). Association of
serotonin transporter gene polymorphism with efficacy of the antidepressant
drugs sertraline and mirtazapine in newly diagnosed patients with major
depressive disorders. Human Psychopharmacology, 37(4), e2833.
https://doi.org/10.1002/hup.2833
Peters, E. M., Knorr, U., Vinberg, M., Kessing, L. V., & Bowen, R. (2019). A
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Evaluation Template
randomized placebo-controlled trial examining the effects of escitalopram on
neuroticism and state anxiety in a nonclinical sample. Human
Psychopharmacology, 34(5), e2711. https://doi.org/10.1002/hup.2711
PR Newswire. (2017, July 17). Antipsychotic Drugs Market By Drug Class (Haldo,
Navane, Invega, Latuda, Seroquel, Risperdal, Zyprexa, Geodon, Abilify), By
Application (Schizophrenia, Bipolar disorder, Dementia, Unipolar Depression)
And Segment Forecasts, 2014 – 2025. PR Newswire US.
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Week 7 Assignment 1: Case Study Presentation
Kehinde Tade
College of Nursing-PMHNP, Walden University
PRAC 6675: PMHNP Care Across the Lifespan I
Dr. D. Brown
1/10/24
NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric
Evaluation Template
Subjective:
CC (chief complaint): “Just started classes early at Grand Canyon University. I have difficulty
with focus and concentration.:”
HPI: Patient is a 25-year-old white woman who is here for an appointment because she has been
having persistent, untreated problems with staying organized and focused on what she has to do.
Patient reports that she started classes early at Grand Canyon University. Continues to have
difficulty with focus and concentration. Patient reported that she has completed Chantix
treatment. Reports only vaping a couple of times a week. Reports that smoking decreased
tremendously. Stressors Areas of stress included the following: severe stress due to family,
friends, relationship, and economic concerns, moderate stress due to legal and health concerns,
and mild stress due to occupational and housing concerns. There was no stress reported in the
following areas: educational concerns.
The patient reports no present symptoms of depression and affirms that her pharmaceutical
regimen is effectively controlling her depression. The individual in question admits to
experiencing heightened anxiety as a result of “not being on top of things” and admits to putting
off paying bills and doing job assignments. The patient admitted undergoing treatment for
symptoms of attention deficit hyperactivity disorder (ADHD), explaining that she had always
suffered from these problems but had never considered them odd. According to her, these
symptoms and concerns have persisted since she was a little child. The patient expresses that
these symptoms have greatly affected her career and home life. The patient reports no present
symptoms of depression, suicidal ideation or behavior, hallucinations, self-injury, or any threats
to their safety. The patient reports experiencing nervous thoughts whenever she is unable to
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Evaluation Template
control herself whenever she has an episode of bingeing. Symptoms of anxiety include racing
thoughts, palpitation, trouble concentrating, a racing heart, and profuse perspiration. She
mentions that her hunger levels have remained constant, but she frequently overeats even when
not hungry. She worries that her binge eating is becoming worse and that she is unable to
manage it, which makes her feel ashamed and guilty. Despite the positive effects on her general
health, the patient feels her present concerns are unaddressed by the patient-focused
psychotherapy she is received from her previous therapist (Carlat, 2017).
Substance Current Use: Drinks one cup of caffeinated coffee daily, smokes cigarettes on
occasion, and infrequent alcohol usage..
Medical History: No past surgical history or psychiatric hospitalization, Patient has completed
Chantix treatment.
•
Current Medications: Fluoxetine 40mg capsule combines with 20mg capsule for a total
of 60mg per day in the morning. Bupropion hcl 150mg ER tablet every day in the
morning.Dextroamphetamine-amphetamine 10mg ER day in the morning Buspirone
10mg 3x/week, Bupropion XR to 300mg daily, Naltrexone 50mg daily, and quetiapine
25mg at night for sleep
•
Allergies: absence of medication allergies
Reproductive Hx: The patient is sexually active and has regular periods.
Family History: No Known family history
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ROS:
GENERAL: The patient has not experienced any notable changes in weight, neither gaining nor
losing, and has not had any fever, night sweats, or difficulty in exercising.
• HEENT: Absence of visual impairment, visual distortion, diplopia, or jaundiced sclerae. No
auditory impairment, sneezing, nasal congestion, rhinorrhea, or pharyngitis.
• SKIN: The skin is undamaged and shows no signs of jaundice, redness, or itching.
• CARDIOVASCULAR: Absence of dyspnea, palpitations, angina, or angina-like symptoms,
absence of documented heart murmur, and lack of edema.
• RESPIRATORY: Absence of cough, wheezing, dyspnea, or sputum.
• GASTROINTESTINAL: Absence of vomiting, diarrhea, loss of appetite, stomach discomfort,
or blood. Positive for gastroesophageal reflux disease (GERD).
• GENITOURINARY: The patient does not have any urinary problems or discomfort. They have
no history of abortions, miscarriages, pregnancies, hysterectomy, or polycystic ovary syndrome
(PCOS).
• NEUROLOGICAL: Absence of headache, syncope, paralysis, ataxia, weakness, numbness,
convulsions, dizziness, or alterations in bowel or bladder control.
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• MUSCULOSKELETAL: Absence of myalgia or asthenia, absence of arthralgia or dorsalgia,
absence of rigidity.
• HEMATOLOGIC: Absence of hemorrhaging, anemia, or ecchymosis.
• LYMPHATICS: There are no swollen lymph nodes and no record of spleen removal.
• ENDOCRINOLOGIC: There are no documented cases of excessive perspiration, sensitivity to
cold or heat, or excessive urination or thirst.
Objective:
Diagnostic results:
Vital signs BP 117/76, RR- 18, HR- 78, O2 97, weight 160lbs, HT, 5’7.
The diagnostic results were based on the various rating scales:
The Binge Eating Scale (BES) yielded a score of 31 out of 46, suggesting the presence of severe
binge-eating habits (Cotter & Kelly, 2016).
The Adult ADHD Self-Report Scale (ASRS) indicates that the individual scored 6 out of 6 in
part A and 7 out of 12 in part B. A score of at least 4-6 in both parts A and B suggests the
presence of ADHD. (World Health Organization and others, no date)
Differential Diagnosis: 1. Bipolar Disorder 2. Adjustment Disorder with Depressed Mood 3.
Anxiety
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Assessment:
Mental Status Examination:
The patient seems to be in good spirits and is willing to cooperate, so there is no immediate
cause for concern. She has complete awareness of time, location, and people. According to her
age, the weather, and the season, the patient is clothed correctly. Throughout the interview, she
kept good eye contact, and her psychomotor activity seemed normal; she did not exhibit any
unusual or involuntary motions. With a stated mood of “good” and no signs of mood
dysregulation or elevation, her affect is euthymic. Dialogue is delivered at a typical pace,
rhythm, loudness, and tone. Both the substance and the method of her thoughts are specific,
rational, and goal-oriented. For both current and past occurrences, the patient’s memory remains
unimpaired. She claims she has never had delusional ideas, hallucinations, or thoughts of selfharm or harm against others. During the interview, her attention span and concentration were
expected, suggesting that her cognition is generally intact. You have vital insight and intelligent
judgment. According to Carlat (2017), the patient not only understands and can express her
requirements but is also highly motivated, engaged, and compliant with her treatment plan.
Diagnostic Impression:
Bipolar Disorder – According to McIntyre et al. (2020), a subtype of bipolar illness known as
bipolar II disorder occurs when a person has hypomanic and sad periods rather than a “full”
manic episode. A person is considered to have bipolar II disorder if they experience at least one
episode of significant depression and one episode of hypomania, with intervals of stable mood
and behavior in between. The symptoms include a lack of focus, excessive pleasure-seeking,
grandiosity, difficulty sleeping, hypersomnia, excessive goal-focused activity, exhaustion,
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difficulty concentrating, thoughts of death or suicide occurring frequently, changes in appetite
(both up and down), restlessness, feelings of worthlessness, extreme sadness, and increased or
decreased appetite. The case study patient has a history of unexplained depressive episodes;
nonetheless, she has reported that her present pharmaceutical regimen has been effective in
managing her symptoms. Since it is a recent diagnosis that she has been treated for and is still
being treated for, along with her current symptoms and complaints, it was placed as the third
differential diagnosis. Hence, it was ruled out.
Major depressive mood disorder- (World Health Organization, 2019) Major depressive
disorder, undefined, recurrent episode: Criterion A, as asserted by (APA, 2018), indicates, .
During two weeks, at least 5 out of 9 symptoms must be present, and these symptoms must
indicate a shift from how the person was functioning before. Additionally, one of the five
symptoms must be either a low mood or anhedonia, which is a lack of interest or pleasure.
(American Psychiatric Association, 2018): Subjective reports or observations from others point
to a generally downbeat mood throughout most of the day, almost daily (American Psychiatric
Association, 2018).
She reported that her current pharmaceutical regimen has been effective in managing her
depressed symptoms; therefore, the diagnosis of MDD, a single episode, is undefined as based
on the American Psychiatric Association, (2018.). Nevertheless, it was included as the third
possible diagnosis since it is a recent illness that she has been and is still treated for and because
her symptoms and concerns are current. Her anxiety symptoms were finally linked to two core
diagnoses, but another possible inclusion—another specified anxiety disorder—was ruled out
due to the very imprecise criteria. Her lack of anxiety daily and her inability to link her
symptoms to any other past or present events or sources of stress led to its exclusion. Disruled
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because the patient states that she is not experiencing any depression symptoms and that her
medicine has effectively treated any past episodes of depression. Based on her medical history,
she probably fits the criteria for this particular differential diagnosis, which is for a single
episode. However, her present symptoms and major complaint do not indicate any signs of
depression (American Psychiatric Association, 2018).
3. Anxiety – Based on the World Health Organization, 2019)and According to the American
Psychiatric Association (2018), the following criteria were missing from the patient’s diagnosis:
Section A. Primary Requirement (American Psychiatric Association, 2018): Anxiety and worry
(aversion), manifesting on a daily basis for a minimum of six months, concerning several events
or activities (e.g., one’s performance at work or school. This possibility was dismissed because
the patient did not exhibit anxiety symptoms on a daily basis or for a minimum of six months,
and they did not mention anything else that could have contributed to their anxiety, such as
events or activities outside of bingeing or attention deficit hyperactivity disorder (ADHD).
According to the American Psychiatric Association (2018), criterion C states that if there are a
minimum of three symptoms that are connected with anxiety and concern. These symptoms must
have been present for at least half of the last six months. Loss of attention or inability to focus:
Although the patient exhibits elements of this symptom, they do not fit the diagnostic criteria for
secondly, they are quickly tired.
Third, alterations to one’s sleep pattern, such as an increase or decrease in the frequency or
quality of disturbed or unrestful slumber (American Psychiatric Association, 2018).The patient
mentions difficulties with occupational and home/life functioning, such as late bill payments and
incomplete job assignments. However, she links these difficulties with binge-eating episodes and
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signs of attention-deficit/hyperactivity disorder, which in turn causes her worry. In the absence
of the other criteria, this would not be enough to diagnose generalized anxiety disorder (GAD) .
Definitive Diagnosis: Attention deficit hyperactivity disorder-The patient’s history, present
symptoms, and scores from the two measuring tools (BES and ASRS) led to the primary
diagnosis of binge-eating disorder and predominantly inattentive type ADHD (American
Psychiatric Association, 2013). Even though the ASRS score showed significant ADHD
symptoms, the patient’s developmental history was incomplete because no one who knew the
patient from childhood onwards—a parent, sibling, teacher, coworker, or friend—could confirm
the patient’s reported symptoms and back up her history (World Health Organization et al., n.d.).
The American Psychiatric Association (2018) identified ADHD as the second primary diagnosis
for this reason.
Reflection
Would have requested laboratory tests to detect any physiological complications that may have
arisen due to an untreated binge-eating disorder over a prolonged period. These complications
may include fatty liver disease or cardiac issues, which are often associated with a history of
binge-eating behaviors If I were prescribing a stimulant for the first time, I would ask for an
updated electrocardiogram (ECG), particularly if the patient has other medical conditions like
obesity, as is the case with this patient. I would also collect baseline measurements of vital signs,
body mass index (BMI), and weight in order to monitor any metabolic changes and ensure that
blood pressure and heart rate are within normal limits (WNL) Administering additional symptom
rating scales to the patient could provide further evidence to eliminate alternative diagnoses or
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identify other potential issues that require further evaluation, such as the Beck’s Depression
Inventory II (BDI-II) and the General Anxiety Disorder-7 (GAD-7) scales .
In addition to pharmacological treatment, I highly recommend and offer assistance in locating a
therapist who specializes in treating binge-eating disorders and ADHD. Research suggests that
combining psychotropic medication with an evidence-based therapy program leads to
tremendous success in reducing and managing negative symptoms and behaviors.
Furthermore, the patient stated that she had not undergone a primary care physical examination
in some years. Her increased susceptibility to physiological illness processes might worsen her
mental health symptoms and make certain psychotropic medications unsuitable for her (Kates et
al., 2018). I highly recommend that she arrange a follow-up session and ask her primary care
physician to sign a release of information (ROI) to authorize the sharing of relevant health results
(Kates et al., 2018). Adopting an interdisciplinary team approach in healthcare has been shown
to improve patient outcomes, advance healthcare procedures, promote patient safety, and boost
the overall effectiveness of therapy for all patient groups (Lake, 2017).
Case Formulation and Treatment Plan:
Anxiety disorders and Attention-Deficit/Hyperactivity Disorder (ADHD) necessitate a holistic
strategy that may incorporate pharmaceutical and non-pharmacological therapies in the treatment
planning and case formulation phases. Keep in mind that every situation is unique and that each
patient needs a personalized treatment strategy based on their unique set of circumstances. It is
essential to keep in mind that healthcare providers, educators, and families must work together
for the best results while treating ADHD and anxiety disorders, as these conditions are very
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unique. To provide successful care, it is vital to communicate regularly and make modifications
to the treatment plan as needed.
Psychotherapy
ADHD Behavioral Therapy: Cognitive-behavioural therapy (CBT) is a psychotherapeutic
approach that focuses on the connection between thoughts, feelings, and behaviors, this is done
by Targeting the executive functioning and organizational skills of the patient.
Patient also referred to a psychotherapist for binge eating.
Pharmacologic Treatment:
The
pharmaceutical
Drug
Treatments
for
Attention
Deficit/Hyperactivity
Disorder:
Methylphenidate and other amphetamine derivatives are examples of stimulant medications that
can improve concentration and focus. Buspirone 10mg 3x/week
Bupropion XR to 300mg daily, Naltrexone 50mg daily, quetiapine 25mg at night for sleep.Take
note of any changes in appetite or sleepiness that may occur as a side effect. For patients who are
sensitive to stimulants, there are non-stimulant medications such as atomoxetine.
Follow-up
Follow up in 1week
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QUESTIONS
1.What other treatments plan can be provided to this patient?
2.Are there any alternative diagnosis to be considered?
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References
Lake, J. (2017). Urgent need for improved mental health care and a more collaborative model of
care. The Permanente Journal. Retrieved June 17, 2021, from https://doi.org/10.7812/tpp/17-024
Kates, N., Arroll, B., Currie, E., Hanlon, C., Gask, L., Klasen, H., Meadows, G., Rukundo, G.,
Sunderji, N., Ruud, T., & Williams, M. (2018). Improving collaboration between primary care
and mental health services. The World Journal of Biological Psychiatry, 20(10), 748–765.
https://doi.org/10.1080/15622975.2018.1471218
American Psychiatric Association. (2018). Diagnostic and statistical manual of mental disorders
(5th ed.). Arlington, VA, American Psychiatric Publishing.
McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V…. &
Mansur, R. B. (2020). Bipolar disorders. The Lancet, 396(10265), 1841-1856.
World Health Organization. (2019). International statistical classification of diseases and related
health problems (11th ed.). https://www.cdc.gov/nchs/icd/icd10cm.htm
World Health Organization, Adler, L., Kessler, R., & Spencer, T. (n.d.). Adult ADHD self-report
scale (ASRS-v1.1). https://add.org/wp content/uploads/2015/03/adhdquestionnaireASRS111.pdf
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NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric
Evaluation Template
PRECEPTOR VERFICIATION:
I confirm the patient used for this assignment is a patient that was seen and managed by the
student at their Meditrek approved clinical site during this quarter course of learning.
Preceptor signature: ________________________________________________________
Date: ________________________
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