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Psychiatry and Pharmacology Coursework

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Updated: Apr 21st, 2022

Introduction

The patient’s family member should answer the following additional questions: Has the patient experienced incidences of anxiety for the past years? Has the concentration of the patient decreased in the past years? Has the patient’s appetite increased or decreased (Sadock & Sadock, 2011)? Have you noticed signs of reduction of physical movement and slowing down of thoughts of the patient? Has the patient made any suicide attempts?

The patient should answer the following additional questions: What has made you come to the hospital today? What are you most interested in doing? Has the urge of doing what interests you reduced? Do you feel any form of guilt? Do you still feel energetic in your daily chores (American Psychiatric Association, 2013)?

Diagnostic tests

I would recommend the conduction of an electrocardiogram (ECG) test about the previous history of hypertension and mild heart attack. The test will detect incidences of cardiac system abnormalities through measurements of electrical activities of the heart. The female client is under medication for hypertension and diabetes. It is essential to conduct additional testing such as ECG to determine the safety of the medication and other non-invasive procedures to the client. The test will detect heart abnormalities by recording the patient’s heart electrical activity of systolic and diastolic rate on an electrocardiograph. The medical practitioner interprets the electrocardiograph results through comparison from healthy or normal ECGs and notes the deviations. A healthy heart has a characteristic rhythmic shape, and any irregularity from the norm gives a characteristic of the damaged heart muscle (Sadock & Sadock, 2011).

A CT (Computerized Tomography) scan is an essential laboratory test for a psychiatric assessment of psychiatric patients. The female client requires a CT scan to establish the initial steps for her treatment. A CT scan is a brain scan that detects some abnormalities that influence patient diagnosis, and treatment. The recommendation of a CT scan is due to the patient’s increased rate of forgetfulness, slow speech, and her increased rate of agitation and irritation (Sadock & Sadock, 2011). According to her mini-mental status exam, the patient has mild cognitive impairment and the brain scan can determine where some of her disorders such as mood and personality disorders can be reversible. The CT scan can detect the presence of brain lesions and whether these lesions have a major effect on the patient behavioral and personality disorders. The total psychiatric possibilities that can be easily detected through a CT scan on the patient are dementia, mood disorder, schizophrenia, behavior disorder, personality disorder, and anxiety disorder (Appelbaum & Gutheil, 2007).

Renal function tests are also essential laboratory tests for female patients. The rationale for conducting the renal function is the previous history of diabetes and hypertension. High blood pressure causes stretching of blood vessels even those present in the kidneys. Stretching of kidney blood vessels damages kidney functionality leading to a stoppage in the removal of waste products and excess fluids from the body. Type II diabetes has a likelihood of causing nephropathy. Diabetic patients have a high risk of getting damaged glomeruli (American Psychiatric Association, 2013). Damage of glomeruli results in leakage of certain components of protein in the urine, leading to nerve damage and bladder infections. Conducting complete renal function tests will help regulate additional complications that may occur to the patient. Additional complications may lead the patient to have accelerated neurological disorders that may shift to the irreversible stage (Sadock & Sadock, 2011).

Patient Target Symptoms

The patient’s target symptoms are that lead to dementia, mood disorder, schizophrenia, behavior disorder, personality disorder, and anxiety disorder. Dementia is associated with memory loss. The female patient had a dementia disorder considering that she has increased the rate of forgetting to the level of her employer terminating her from her job. Dementia disorder has an effect on communication in the patient considering her change of speech to monotone, deliberate, and slow (Sadock & Sadock, 2011). Moreover, dementia has affected the 69-years old female with her reasoning and judgment considering her increased agitation and irritability. The major mood disorder the patient is experiencing is depression (Katon, 2003). Depression has affected the normal functioning of the patient leading to her wearing disheveled clothing and boycotting her friends and social gatherings. It is the role of the medical practitioner to identify the cause of mood imbalance in the patient through critical analysis of her medical history. According to the medical history, the psychiatric condition of the patient does not have any genetic linkage considering both her parents did not have psychiatric conditions (Appelbaum & Gutheil, 2007).

DSMV Diagnosis and Rationale

According to DSMV diagnostic criteria, the female patient needs medical attention for dementia. The diagnosis will be concerning her cognitive impairment and associated psychiatric disorders. The following cognitive domains will be used in her diagnosis (Appelbaum & Gutheil, 2007). Complex attention, includes information processing speed, executive function, which include working memory and responding to feedback. Learning and memory, which includes recognition memory and semantics. The language includes fluency and receptive language. A perceptual-motor function includes visual-constructional reasoning and perceptual-motor coordination, and social cognition that includes recognition of emotions (American Psychiatric Association, 2013). The rationale for dementia preliminary DSMV diagnosis is the patient’s chance of fluency in communication, memory relapse, and lack of emotional control (Sadock & Sadock, 2011).

Pharmacological Treatment

The female patient requires psychotherapy as an effective medication for depression (Katon, 2003). The patient may need selective serotonin reuptake inhibitors to relieve some depression symptoms. The antidepressant the patient needs to use is Citalopram. The patient needs to take an initial dose of 20mg by mouth daily and later if need be the patient can increase to 40mg PO day for one week. The patient needs close monitoring for the initial dosage for any possibility of renal impairment (Sadock & Sadock, 2011). The increased dosages should be stopped after one week to prevent Q-T interval prolongation in the cardiac system. The female patient has also developed behavioral and psychological symptoms that include sleep disturbances, aggression, restlessness, and delusions. The patient needs drug and non-drug prescriptions to manage these behavioral and psychological symptoms. The simple non-drug treatment involves one-to-one communication with her son and other close family members (American Psychiatric Association, 2013). One-to-one communication significantly reduces aggression and agitation. The patient needs donepezil hydrochloride tablets at an initial dose of 5mg PO day. The tablets will be taken in the evening before retiring. The dosage will then be maintained at 10mg orally once daily for four to six weeks (Appelbaum & Gutheil, 2007).

Patient-Education

I would review with the patient the aspects of her physical health. I would recommend the patient have a comfortable life. I would recommend the family members, especially the son to take good care of her mother. The son should ensure the mother leads an active life with daily stimulating and interesting activities (Appelbaum & Gutheil, 2007). The active life of the patient will help her reduce her intake of drugs, which may be toxic and lead to overworking of kidneys toward eliminating the waste products.

The second area that needs patient education is adherence to drug therapy. The patient needs to follow the medical practitioner’s prescription to avoid complications of drug interactions (Sadock & Sadock, 2011).

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). New York, NY: American Psychiatric Pub.

Appelbaum, P. S., & Gutheil, T. G. (2007). Clinical Handbook of Psychiatry and The Law. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Katon, W. J. (2003). Clinical and Health Services Relationships Between Major Depression, Depressive Symptoms, and General Medical Illness. Biological Psychiatry, 54(3), 216-226.

Sadock, B. J., & Sadock, V. A. (2011). Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. Philadelphia, PA: Lippincott Williams & Wilkins.

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