Clinical Log

1

Cases and Reflection

Name

Affiliation

Course Name

Instructor

Due Date

Cases and Reflection

Introduction

I worked with patients in a mental health private practice in California. The patients arrived in a welcoming waiting room before I attended to them. I would interview the patient using the history of present illness (HPI) and make a recommendation based on the information collected. The semi-structured nature of the questions allowed me to collect comprehensive patient data. My preceptor guided me on approaching an interview with a patient and how to leverage information from relatives.

Clinical Log #1

A baby-clinic referred a 26-year-old woman who came to the practice with her husband. She recently emigrated from Peru two years ago and delivered a baby girl two months ago. Since she moved to America, she has struggled with financial pressure. Her English is limited, and her husband acts as the interpreter. Her spouse indicated that the patient is unhappy and lacks the motivation to do anything. The spouse reported that the patient would rarely get out of bed or look after the baby and indicate that she experienced pains in her stomach. There was nothing abnormal with the patient and there was no history of mental health care.

Given that there was no psychiatric history and the patient was not on any medication, I had to change my approach to see if I could get any psychiatric history from the patient. I consulted with my preceptor about the possibility of using a more culturally sensitive assessment. Notably, I shared my concern that the patient could be suffering from postnatal depression.

My next step was to confirm the patient's diagnosis. My preceptor advised me that a full assessment for the diagnosis may take longer due to cultural diversity. Further, he suggested that it would be helpful to use an independent translator during the assessment. During the early stages, I asked questions about the patient's health as well as that of her baby to create a rapport and allow for the investigation of mental distress. The assessment reveals that the patient does not like her child and does not take care of her health, confirming the diagnosis. The treatment plan involved the use of sertraline as well as psychotherapy and was acceptable to the patient.

Clinical Log #2

A 38-years-old male patient who works as a plumber came into the practice with persistent worries. His general practitioners referred him to the mental health practices after admitting that he was under considerable stress during a consultation seeking to overcome his sleep problem. He expressed that he is crippled by the worries that he has not properly installed pipes, and the patient may experience a problem with the plumbing system, and water may destroy his client’s properties. He informed me that he worried that he worries that he may have given the wrong change to the client if they paid him in cash or overcharged them. He noted that he often imagined that worst scenarios are likely to unfold, which results in headaches, sick feeling, butterflies, and heart palpitations. Fred has no psychiatric or medical history of note.

I asked the patient to describe whether he was anxious over the past two weeks or was unable to control his worrying. Then I asked him to describe how worrying had affected his daily function. The patient described feeling unable to control his anxiety. After reassurance, the client further described feeling overwhelmed. My preceptor advised me to use the Generalized Anxiety Disorder 7-item (GAD) and ask the client to report how long he has experienced the symptoms. The result from GAD-7 and his review of background information revealed that the patient had a generalized anxiety disorder. I recommended talk therapy to the client after seeking advice from the preceptor. Though reluctant, the patient agreed to receive talk therapy to overcome his generalized anxiety.

Clinical Log #3

A 37-year-old female with chronic kidney disease was referred to the mental health practice by their general practitioner. Her current medication regime includes dietary restriction and inhibitors. She noted that she had overall poor health. She complain about back pains and abdominal problems. A review of mental health history showed that benzodiazepines were indicated by her general practitioner.

When asking the patient to describe her symptoms, she described them using a flat, monotonous voice with a hint of nervousness. Her descriptions were full of vague phrases that were not adequately described. Nevertheless, she believes that her symptoms can be attributed to her present kidney disease. The case was complex for me, and I had to ask for assistance from the preceptor. Notably, the patient’s use of vague words made it hard for me to establish her diagnosis. Notably, the preceptor told me to look for non-verbal cues from the patient during the assessment. I noticed that the patient fidgeted frequently and had restless movements. She did not make eye contact with me. The preceptor also indicated that I should focus on how the patient described her feelings and an accurate description of her symptoms. The patient described that her headaches were tight but were not a consequence of routine activities. I administered a GAD-7 given her restless movement and used the Patient Health Questionnaire-9 (PHQ-9) owing to her flat, monotonous voice.

I suspected that the patient had depression and other associated impairments. However, given her chronic kidney disease, the case was too complex for me. I had to leave the diagnosis to the preceptor, who noted that the patient had multi-morbidities, and there was a need to explore how her mental impairments were related to her kidney disease.

Reflection

My strength was the ability to communicate effectively with patients during the assessment. I realized that I created a rapport with the patient that I could leverage to gather information about their condition. Also, I was adept at using various assessment tools to determine the problem with the patients. My weakness was that I was not well versed in the impact of cultural diversity on the assessment process. Further, I was not adequately prepared to deal with patients who could not provide the required details to make an accurate diagnosis.

The relationship with my preceptor was fulfilling. In some of the cases, I would interact with him throughout the assessment, while in others, I would only interact with him before and after patient assessment.