Case Study Presentation Essay Discussion Paper
Present History
V.D. is a 14-year-old Caucasian male who came to the clinic with his mother for a follow-up visit. V.D. is currently in an intensive outpatient therapy program for substance abuse and comes to see a PMHNP for medical management. V.D.’s mother reports having caught him drinking and smoking again ten days prior after he broke up with his girlfriend of 11 months. Before that, it was stated that he has gone over two months without abusing any substances.
V.D. lives with his mother and older brother. His father passed away two years earlier. He is involved in his church’s youth group, and he is working towards becoming an Eagle Scout. After his father passed away both V.D. and his other brother started using alcohol and cannabis Case Study Presentation Essay Discussion Paper.
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V.D. denies any concerns with appetite, depression, anxiety, or mood swings at this time. However, his mother reports he has been more withdrawn and anxious to go places. V.D. denies any hallucinations, homicidal or suicidal intentions, or plans. V.D. has been diagnosed with Major Depressive Disorder, Anxiety Disorder, Attention Deficit Hyperactivity Disorder, Chronic Motor or Vocal Tic Disorder, Cannabis Abuse Disorder, and Alcohol Abuse Disorder. His current prescribed medications include 15mg of Lexapro daily for anxiety and depression, Wellbutrin 150mg for depression, and Focalin XR 10mg daily for focus and concentration. He denies having any side effects from his current medications
V.D.’s mother suffers from Anxiety Disorder as well as Bipolar I Disorder. His brother also suffers from ADHD and Substance Abuse. It is unclear if his father had any medical or psychological history at this time.
V.D. has a blood pressure of 110/75, heartrate of 70, and respiration rate of 18. He is 68 inches and weighs 180 pounds. He was appropriately dressed in shorts and a white tank top and appears his stated age. He presents with a normal gait and adequate hygiene. He was alert and oriented to person, place, time, and situation. His cognition appeared grossly intact. His recent and remote memory recall was intact as well. His speech was of normal volume, tone, and rhythm with no noticeable tics at this time. He had a flat affect at this time. His thought process appears to be logical and linear, coherent and goal-oriented. He has good insight as he knows he has a mental illness and believes he needs treatment, however, he has poor judgment as he has continued using substances against all medical advice given to him Case Study Presentation Essay Discussion Paper.
Psychiatric and Mental Health Diagnosis
V.D. has been diagnosed with Major Depressive Disorder, Recurrent Severe without Psychotic Features (F33.2), Attention-Deficit Hyperactivity Disorder (F90.0), Anxiety Disorder, Unspecified (F41.9), Chronic Motor or Vocal Tic Disorder (F95.1), Cannabis Abuse (F12.10) and Alcohol Abuse (F10.188). A few differential diagnoses for V.D. are Post-Traumatic Stress Disorder, Adjustment Disorder, Social Phobia, and Disruptive Mood Dysregulation Disorder.
Major Depressive Disorder
V.D. primary diagnosis is Major Depressive Disorder, which is characterized by at least two-week periods of low moods, and loss of interest or pleasure in activities that normally brought enjoyment (Sheri-Michelle, et al., 2021). V.D. has had recurrent episodes and appears to be suffering from one now following the breakup with his girlfriend. His depression episodes are severe, but he denies ever suffering from any hallucinations.
Attention-Deficit Hyperactivity Disorder
Attention-Deficit Hyperactivity Disorder or ADHD is a very common childhood condition that will often last into adulthood. Classic characteristics of this disorder include trouble focusing, being easily distracted, hyperactivity, and difficulty with schoolwork and projects These symptoms may vary from person to person and change with age and maturity level (Rowland, et al., 2018).
Anxiety Disorder
An Anxiety Disorder occurs when someone has excessive fear, worry, or anxiety that interferes with their day-to-day activities (Jalenques, et al., 2022). V.D.’s current Anxiety Disorder is considered unspecified, but upon talking to him, his anxiety does appear to be associated with social settings. Therefore a Social Phobia diagnosis may be a more accurate diagnosis for him at this time.
Chronic Motor or Vocal Tic Disorder
V.D. has a diagnosis of Chronic Motor or Tic Disorder, however at this time none were noted, and he is not being treated for this condition. This is a condition that can go away for some individuals, and this may not need to be a diagnosis for him anymore at this time Case Study Presentation Essay Discussion Paper.
Substance Abuse Disorder
Since V.D. is being treated elsewhere for his Substance Abuse Disorders it is not considered to be his primary diagnosis at this time for PMHNP. While V.D. was actively using and before he was recommended the intense outpatient treatment it was, but now the focus is on his MDD. Substance Abuse Disorders vary with the substance, but it primarily focuses on when an individual is unable to control the amount they use, and it impacts their day-to-day life. Both marijuana and alcohol use are illegal at the age of 14, so any use is considered a problem at this age.
Post-Traumatic Stress Disorder
Many of V.D.’s mental health concerns and his substance abuse issues started after his father passed away. This could be a very traumatic event for a child and could easily be a differential diagnosis for V.D. PTSD is when one suffers from psychological symptoms such as flashbacks, nightmares, and more following a traumatic event. PTSD has many different symptoms and can show itself differently in all individuals, especially children. One classification of PTSD is symptoms must have occurred after a traumatic event (Haselgruber, et al., 2019),
Disruptive Mood Dysregulation Disorder
Disruptive Mood Dysregulation Disorder (DMDD) is a newer disorder classified for children, who suffer from extreme episodes of irritability, anger, or intense outburst. This can be followed by low periods of depression (Bruno, et al., 2019). At this time V.D. appears to be in a depressive state, but he may have episodes of anger as well.
Treatment Plan
Since V.D. is in an intensive outpatient treatment plan for his substance use disorders and still has access to substances at home, inpatient treatment may need to be considered. Proper communication with his care team regarding his outpatient treatment plan should be performed at this time to ensure V.D.’s safety. V.D.’s Lexapro will be increased to 20mg daily to help with his anxiety and depression-like symptoms. He will be instructed to continue taking his Wellbutrin 150mg daily and Focalin XR 10mg daily. To help V.D. when he gets stressed out Hydroxyzine 25mg as needed for anxiety up to three times a day will be added to his medication regime.
The patient and his mother will be educated on the importance of abstaining from any forms of substance abuse. They will also be educated about the risk and benefits of Lexapro, Wellbutrin, Focalin, Hydroxyzine, and the importance of strict adherence to his medication regimen. They will be educated on when to call 911 or the suicide hotline or go to the nearest Emergency Department if he feels he is in a crisis.
He will be instructed to continue his outpatient treatment. The patient will follow up with the psychiatric mental health nurse practitioner in four weeks. Both mother and patient verbalized understanding and agreed with the plan currently Case Study Presentation Essay Discussion Paper.
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Health Promotion and Patient Education
Both V.D. and his mother need to be educated on the importance of abstaining from any illicit substances at this time. V.D. has a history of abusing both cannabis and alcohol, so making sure he does not have access to these things is a must. Educating both V.D. and his mother on the importance of continuing his outpatient intense therapy treatment is extremely important for V.D. as he is recovering from his Substance Abuse Disorder. It is also important to educate V.D. and his family on the importance of taking his medications every day as prescribed, and when to seek help if needed.
Promoting healthy living habits for V.D. would also be extremely beneficial at this time. Besides encouraging him to exercise and eat healthy, getting enough sleep can play a major role in his mental health. An adolescent may need more sleep than adults and encouraging healthy sleep habits would be important for V.D.’s well-being as well (Vlad, et al., 2022)Case Study Presentation Essay Discussion Paper.
Peer Question One
Do you think V.D. is safe at home doing intensive outpatient therapy at this time? If not what would your next step be?
Peer Question Two
If V.D. does not want his mom involved in his care anymore, how would you proceed to move forward?
Research Article
The Article by Mat, et al., talks about the benefits of outpatient treatment for substance abuse in individuals ages 12-17. The article views 455 adolescents who are being treated with intense outpatient therapy and follows them for over one year. They interview the individuals at their intake process and review their process throughout. And have an interview at the one-year mark to finalize the study. The finding of the study was that almost two-thirds of the individuals needed care or received additional care in the final interview (2021). Finding this suggests that intense outpatient therapy may not be the best treatment for many individuals, and more intense inpatient settings may need to be considered more often.
One major flaw with this article is that it did not address the substances used, the severity of each individual’s substance use disorder as well as the exact care they received. Besides ages and receiving outpatient therapy, many other factors were not viewed. Part of the problem that the article stated itself was many individuals were not comfortable fully disclosing all their information, and many individuals also dropped out of the study for one reason or another (Mats, et al., 2021). Overall the study supports more research needs to be done on adolescents with substance use disorders, and the proper treatment for these individuals Case Study Presentation Essay Discussion Paper.
References
Bruno, A., Celebre, L., Torre, G., Pandolfo, G., Mento, C., Cedro, C., & Muscatello, M. R. A. (2019). Focus on Disruptive Mood Dysregulation Disorder: A review of the literature. Psychiatry research, 279, 323-330.
Haselgruber, A., Sölva, K., & Lueger‐Schuster, B. (2019). Validation ofICD‐11PTSDand complexPTSDin foster children using the International Trauma Questionnaire. Acta Psychiatrica Scandinavica, 141(1), 60-73. https://doi.org/10.1111/acps.13100
Jalenques, I., Bourlot, F., Martinez, E., Pereira, B., D’Incan, M., Lauron, S., & Rondepierre, F. (2022). Prevalence and odds of anxiety disorder and anxiety symtoms in children and adults with psoriasis: Systematic review and meta-analysis. Acta Dermato- Venereologica, https://doi.org/10.2340/actadv.v102.1386
Mats, A., Dahlberg, M., & Wennberg, P. (2021). Adolescents with substance abuse problems in outpatient treatment: A one-year prospective follow-up study. Nordic Studies on Alcohol and Drugs, 38(5), 466-479. https://doi- org.americansentinel.idm.oclc.org/10.1177/1455072521995611
Rowland, A., Skipper, B., Rabiner, D., Qeadan, F., Campbell, R., Naftel, A., & Umbach, D. (2018). Attention‐Deficit/Hyperactivity Disorder (ADHD): Interaction between socioeconomic status and parental history of ADHD determines prevalence. Journal Of Child Psychology And Psychiatry, 59(3), 213-222. https://doi.org/10.1111/jcpp.12775
Sheri‐Michelle Koopowitz, Karen Thea Maré, Zar, H. J., Stein, D. J., & Ipser, J. C. (2021). The neurocognitive profile of post‐traumatic stress disorder (PTSD), major depressive disorder (MDD), and PTSD with comorbid MDD. Brain and Behavior, 11(4)https://doi.org/10.1002/brb3.1950
Vlad, S. N., Colosi, I. A., Costache, C., Sevastre-Berghian, A., & Clichici, S. (2022). Time to Sleep?—A Review of the Impact of the COVID-19 Pandemic on Sleep and Mental Health. International Journal of Environmental Research and Public Health, 19(6), 3497. https://doi.org/10.3390/ijerph19063497
Case Study Presentation Essay Discussion Paper