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Focus on explaining concepts clearly and supporting them with examples.
Key Explanation
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Original Question
Extract the information from the provided patient case below and reflect on this case, and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient, and why or why not. What did you learn from this case? What would you do differently? Also include in your reflection a discussion related to legal/ethical considerations (demonstrating critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.). P.P. is a patient who came to the clinic for a mental health assessment. Patient stated, “I have a history of taking medications and then stopping them, but I don’t think I need them. I really feel the medications squash who I am.” She is alert and oriented x 4. Hyperverbal and gets easily irritated. Reports being hypersexual. Many sexual partners. P.P. is grandiose and thinks that she is going to work with famous actors, and her personal paintings will make her very famous because they are really good. P.P. was first hospitalized as a teenager after going 4 to 5 days without sleeping and hearing things. She was hospitalized for mental health issues 4 times, and the most recent admission was last spring. P.P. denies detox or residential rehab. She admitted to overdosing once on Benadryl, and no other suicide attempts. Depression, anxiety, and bipolar disorder were reasons for past hospitalization. P.P. took Zoloft, but she experienced racing thoughts, insomnia, and it made her feel high. Risperdal and Seroquel made her gain weight. Klonopin slowed her down. Another unnamed medication squashed her creativity. She smokes 1 pack of cigarettes a day. Started alcohol at age 19, and no other use since. Used marijuana once and became paranoid, no use since. Never used cocaine, caffeine, inhalants, or methamphetamines. No hallucinogenic, PCP, or mushroom. No opioids, ecstasy, bath salts, or Molly. No blackouts or seizures from alcohol. No DUI or legal issues. She was arrested once by police for dancing around and playing her guitar, then got sent to a psychiatric hospital; the patient thinks that her mother made up a story that led to the patient’s hospitalization. Family history: Mother had bipolar, father went to prison for drugs, and never heard from him in 10 years. Brother maybe “schizo” but never received psychiatric treatment. Mother attempted suicide. The patient tried to overdose once and does not have a history of self-cutting. Raised by her mother and older brother. P.P. currently lives with her boyfriend, but the patient enjoys having sex with multiple partners. The patient has never been married and has no children. Currently works part-time at her aunt’s bookstore. P.P. has a conflict with her mother due to the patient’s promiscuity. Patient is a high school graduate and currently attends cosmetology school for Botox. She denies a history of sexual or emotional abuse. Medical issues: hypothyroidism, polycystic ovaries, last menstrual period was a month ago, regular menses, and not pregnant. 4 to 5 times a year, has episodes of low energy, no motivation, no interest in creativity, and stays in bed all the time. When not taking meds, the patient has a lot of energy, can go 4 to 5 days without sleep, talks too much, and friends tell her she is scattered. Has sex with multiple partners. Denies worrying or panic symptoms. Denies OCD behavior. Presently denies A/V hallucinations, but she experienced hearing voices in the past telling her how good of a painter she is. Currently not able to eat because she is too busy, sleeps 5 to 6 hours of sleep when not manic, but the patient sleeps only 3 hours when manic.
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