Discussion Response

 response to question 1 and question 2, discuss what they wrote about their two patients and how it could compare or differ from yours. Use a peer-reviewed article  for each response to substantiate this post (that will be two articles, one for each classmate). 

1. Please respond to the two questions on attachment (reply No 1)

2. Use a peer-reviewed article for each questions. (2016-2020) articles only.

3. No three is my own post. (Discussion attachment) 

4.  Discuss what they wrote about their patients and how it could compare or differ from mine. (Its on discussion attachment).

5. Use a peer-reviewed article  for each response to substantiate this post (that will be two articles, one for each classmate). (2016-2020)

6. Two Paragraph each for Each Questions.

Assignment

Please discuss two of your patients that you have interacted with (it can be for assessment, diagnosing or observing). Discuss medications they were on, the DSM 5 diagnosis given, if their behavior was that of their diagnosis. Discuss a brief conversation you had with them; passive, aggressive, accepting, uncomfortable. After you post your initial reply, please respond to two class members posts. In your response, discuss what they wrote about their two patients and how it could compare or differ from yours. Use a peer-reviewed article  for each response to substantiate this post (that will be two articles, one for each classmate). 

No 1-Katie-

Assessment: Patient J.S. is a 30y/o male diagnosed with schizoaffective disorder, recently released from the hospital. He presented disheveled with poor eye contact and positive symptoms of laughing during the interaction. A discussion took place regarding medication compliance. The patient reported that he would only take Saphris. However, Saphris was no longer working for him, and his previous psychiatrist broke ties with him for noncompliance. The patient has had different practitioners who would no longer work with him. He was angry, tense, defensive, and guarded. Saphris was continued and a discussion was had regarding adding a mood stabilizer. The patient refused but said he would go on an antidepressant. At this point, a discussion ensued regarding the patient directing his own treatment. He was given education regarding his symptoms and what medications could be useful for his symptoms. The patient agreed to start on Tegretol. However, the patient was called to discuss how the medication was working and the patient never picked up the prescription.  It was reiterated that he would be terminated from treatment for non-compliance. The patient reported that he felt that he did not need medication. The risks and benefits were discussed. However, the end result was that he was terminated from care.

Question Two- Khan

Patient is a 42 year old AA male with history of mood disorder and self-history of schizoaffective disorder who was brought in by EMS self-activated for thoughts of suicidal/homicidal with no plan. Patient states he is stressed, depressed, and overwhelmed because of housing problems, stating that he does not like the shelter system. During interview patient is suspicious that people are out to get him. Admits to use crystal meth, alcohol, cocaine and marijuana. Drinks alcohol daily and smokes 15 cigarettes daily. He states he has been noncompliant for two years with his medication regimen of Seroquel, Depakote, and Risperidone, with NKDA. Lab work including CBC, CMP, and UA were completed, with no critical values noted. He will be started on Zyprexa 10mg PO and the benefits, interactions and side effects were discussed and patient verbalizes understanding. Continue to monitor patient on Q15 for aggressive/impulsive behavior. Encourage patient to verbalize needs and concerns to staff.

Clinical One

37 Years old, Caucasian male, single man who lives with his brother. Fully oriented, normal weight well dressed, adequately groomed, oddly related, abnormal movements, hesitant, no abnormalities observed, exhibiting both motor and vocal tics, pt. engaged very well despite initially expressed reluctance to speak with us. He frequently wrote his responses down, seemingly due to difficulty fluidly expressing himself verbally in the setting of vocal tics. He reported feeling: marvelous” Diagnosed with schizoaffective disorder bipolar type and moderate opioid use disorder, and a psychiatric history notable for multiple inpatient hospitalization. He has denied any history of substance abuse, though he has been treated for substance abuse in the past, which he attributed to drug overdose without intent to harm himself. His medical history is notable for type I diabetes, seizure, aortic stenosis, hypertension, asthma, and self-reported history of TBI. He currently taking Risperdal Consta 50 mg IM Q2weeks, Lamictal 200mg BID, and Trazodone 50mg qhs. He became noncompliant with Risperdal Consta injection in January 2020, and therefore was switched to oral Risperdal. Most recently he has been treated with oral Risperdal 2mg qhs, Lamictal 200 mg twice a day, Benadryl 50mg qhs, and Cogentin 0.5mg qhs, as well as methadone 80 mg daily. Mr 11/1/20, G.I was transferred to Bellevue hospital to optimize treatment of both his psychiatric and medical conditions. He currently exhibits symptoms of active psychosis including ongoing paranoid delusions, internal preoccupation, and odd relatedness. In addition, he has been exhibiting various vocal and motor tics, which have been reportedly increased in frequency/severity over past weeks. Mr. G. I verbally complained of abnormal movements have included oral movements reported to be involuntary. Patient has been prescribed Cogentin and Benadryl.

Diagnoses: Schizoaffective disorder, Bipolar type and Opioid use disorder

Medication: Lamictal 200mg oral BID, Risperidone 2 mg oral qhs, Cogentin 0.5mg qhs, Lantus 22 units sq qhs, Methadone 80 mg daily, Diphenhydramine 50mg oral qhs, Docusate 100 mg two tabs.

Plan:

Increase to Risperdal 3 mg qhs for psychosis as well as hopeful benefit for motor/vocal tics.

-Continue Lamictal 200mg twice a day for mood regulation.

-Continue Benadryl 50mg qhs for insomnia and EPS

-Discontinue Cogentin 0.5mg qhs given patient already given Benadryl

-Monitor for adverse effects of medications including EPS and metabolic syndrome

-Monitor closely for medication compliance.

-Continue to work with patient to build rapport and insight into symptoms/treatment with goal of hopefully switching back to Risperdal Consta IM