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Can Someone help me analyze the following case-study in terms of: Come out with a diagnosis and the rationale for that diagnosis Differential diagnosis about 3 The screening tool possible to use to guide diagnosis possible treatment education to give to the patient Any other relevant information PATIENT NAME: jj IDENTIFYING INFORMATION: This is a 15-year-10-month-old African­ American adolescent male. INFORMANT: Information obtained from direct interview with the patient and his guardian, who is his maternal half-sister, review of the intake assessment. CHIEF COMPLAINT: Per child, “I feel like I live in two worlds.” HISTORY OF PRESENT ILLNESS: The child reports he has suicidal thoughts that he has been thinking about harming others and has auditory and visual disturbances. He states, “there are voices in m head that say I am going to die.” He has increased agitation and stated, “I feel like there is rage inside me and I just explode.” However, he has not had any aggressive behavior.He is very anxious and has a history of panic attacks and symptoms of generalized anxiety disorder. He also has had features of panic disorder. This child mother died unexpectedly from a pulmonary embolism in April 2017. The patient found his mother deceased and this was a traumatic event for him.Reportedly, his mother had been deceased for some time and Kenton states his motherwas “purple” when he found her. He reported spends a lot of time looking in the mirror to see if he has turned purple. He seeks reassurance that his hands are not turning purple. Further complicating his clinical presentation is that in June 2018 he smoked K2. He states that since that time he has “felt high” and “likeI’m living in my head.” He said, “I haven’t gotten un-high.” The patient resided with his sister from April 2017 to April 2018, after the death of their mother. During that time he had some depressive symptoms, which was previously understood as grieving. He did not have significant agitation, mood instability, mania, hypo mania or psychosis. He then went to live with another family member fromApril throughOctober 2018. Upon returning to his sister’s home in October, she notesdeterioration in her brother’s ability to think logically and an inability to performactivities of daily living. He also avoids sleep for fear of dying. He has had a 20 pound weight loss by restricting his calories. He is preoccupied with his dietary intake of salt and sugar. In the hospital he is constantly asking to have his blood pressure and blood sugar evaluated. His guardian has taken him to multiple medical providers for full diagnostic evaluations. He does see a nephrologist for what I believe is primary hypertension and has been treated for high blood pressure for approximately a year. He has no other medical issues, but continues to have catastrophic worries and preoccupation with his physical health despite being reassured by multiple doctors. Due to his current suicidal ideation with significant deterioration in his cognitions and his ability to function he is appropriate for hospital level of care. PAST PSYCHIATRIC HISTORY: He had an intake appointment at the community mental health center and from that appointment was referred for acute hospitalization. PAST MEDICATION TRIALS: None. ALLERGIES: No known drug allergies, food allergies, or environment. allergies MEDICATIONS ON ADMISSION: Prozac 10 mg q.h.s., which was started by the primary care physician three weeks ago, Vasotec 5 mg at 6:00 p.m MEDICAL HISTORY: Essential Hypertension.He is seen at CMH nephrology every six months. GROWTH & DEVELOPMENT: He was a planned pregnancy. His mother did receive prenatal care. He was carried full-term and delivered vaginally. He was not exposed to illicit substances in utero. His fine and gross motor skills were on time. He did have speech problems and specifics are unavailable as his sister does not have all the information and his mother is deceased. FAMILY HISTORY: He is one of five children born to his biological mother who is deceased. Mother died from a pulmonary embolism. Mother did have depression with a psychotic episode, in 2008 and was hospitalized at Larned State Psychiatric Hospital. This was the only episode of mental health issues that is noted in mother’s history. His biological father is living, but the family knows very little about him. He has four maternal half siblings: three brothers are adults and a sister age 16. His siblings do not have psychiatric or medical issues. There is a maternal medical history of obesity, diabetes, heart disease. Father’s medical and psychiatric history is unknown. SOCIAL HISTORY: He lives at home with his maternal half-sister age31. Her two children are also in the home. Kenton attends Sayer High School. He is a sophomore and failing academically. He has a 5O4 plan for education; the accommodation is an extra set of text books at home. He has had one out-of-school suspensions for fighting, which started after experimenting with K2. Prior to smokingK2 he did not have behavioral issues at school. He endorses having used marijuana, K2 and cigars. He denies using alcohol. He began using marijuana at age 14 and his last use was last spring. He denies being sexually active. He has no history of abuse and neglect. REVIEW OF SYSTEMS: Please refer to his H&P by KU Pediatrics. Vitals: 70″ tall, 151 pounds, BP 138/82, P 54, R 16, T 98.7 CURRENT MENTAL STATUS EXAMINATION: This is a tall, slender African American male. Kenton looks his stated age. His hygiene and grooming is somewhat decreased. His psychomotor activity was slowed. His attention and concentration was distant. His eye contact was fluctuant. His speech was soft and decreased in content. He endorses suicidal thoughts without a plan. He denies homicidal ideation. He endorses auditory and visual disturbances and is currently attending to internal stimuli. He could not describe what he was experiencing. His mood is depressed with a blunted affect and he has a slight fixed smile. He presents with anhedonia and avolition. His Insight and judgment are poor. His use of vocabulary and fund of knowledge appears to be in the average to low average range. His memory is grossly intact as evidenced by recalling recent and remote events. When asked for wishes stated, “I want my mom back alive, I want some money and I want to be a basketball player.”

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