assign

3 challenging patients

PATIENT 1

The patient is a 45-year-old African American female who came to the clinic for a follow-up visit. The patient appears well groomed, well dressed, and with good hygiene. The patient is alert and oriented times four. The patient has a history of major depressive disorder (DSM-5296.20-296.36). Patient denied thoughts of hurting herself and others. During this visit, she reported that she just had a new baby 3 weeks ago, and her anxiety has increased because she is a single parent and does not know who will keep her baby while she is at work. She stated that she takes hydroxyzine 25mg daily at home. After discussing with my preceptor, we agree to prescribe 4 weeks of CBT to the patient and let her continue her daily dose of hydroxyzine. We will reassess the patient at the end of the 4 weeks of therapy.

Patient 2

BG is an 18-year-old Caucasian female who came to the clinic with his parents. Patient was sent to home by his school principal. Since BG moved to a new school, she has been very agitated. She has a tendency of being violent and destroys school property. She was diagnosed two years ago with mood disruptive disorder (309.9F43.20), and ADHD. Patient has past medical history of diabetes type 1, take metformin 250mg, and ability 5mg. She is well groomed, alert, and oriented, and appears very calm. Patient reported that she voluntarily stopped taking her medications for the past two weeks. My preceptor and I agreed to renew patient ability 5mg daily. We also prescribe family therapy and will reassess patient in 4 weeks.

Patient 3

Pt is a 19-year-old African American adolescent who has Hx of anxiety, and depressive symptoms DSM-5 300.02 (F41.1). Patient-reported that she lost her child two years ago, and since then she is having a mood swings. One day she feels sad, and the day after she feels happy. She has been unable to sleep, and the therapist she sees went on a 6 months’ vacation. She is well groomed and pleasant. She denies Hx of suicidal ideation, and intentions of killing others. The patient has Hx of anxiety and depressive disorder. She is currently taking Cymbalta 30 mg daily, and Adderall 15 mg daily. With the agreement of my preceptor patient should continue her present medication, add exercise, do activities that bring her happiness in her life, and do cognitive behavioral therapy for 4 weeks. We will reassess the patient in 4 weeks.