Subjective:CCHPI(Include psychiatric ROS rule out)Past Psychiatric History (chief complain

Subjective:CCHPI(Include psychiatric ROS rule out)Past Psychiatric History (chief complaint): I would like to learn to live my life by myself. I depend on my kids a lot because in our customs when the parents get old and have hard walking and caring for themselves, the children help.: A 40-year-old female (mother) from Iran and her five children: three girls (Sheela is 24-year-old, Sharleen 23-year-old (currently present in the family therapy), and Shireen 21-year-old and two boys (Armin Jr., 18-year-old and Sam, 15-year-old). They are Iranian descent and have been in individual and family therapy for 18 months. Pattie, the mother, presented the clinic secondary to problems after her daughter was finally reunited in the home with the family after ten years. The family was happy initially, but after a few weeks, Shireen told her mother and siblings about her father’s emotional, physical, and sexual abuse. She felt abandoned by her mother. Pattie needed surgery on both her feet after an injury, leaving her disabled and with chronic pain. The surgery and disability have increased tension and stress in the home. Pattie lives with her two sons, and her daughter lives alone. Shireen recently moved out from their mother’s house and married someone the family does not know and now has little contact with family. Mother sees Sheela daily. Pattie has been felt alone, depressed, hopeless, and helpless and wants her daughters to stay and spend time with her. A psychiatric provider has been referred for medication management. : General Statement: The mother and her children began therapy one year and a half ago. The daughter Shireen is back living with the family after 12 years of separation. Shireen told the family her biological father had sexually abused her. She has emotional from experiencing trauma with blame, guilt, shame, and increasing pressure by the family.Caregivers (if applicable): NoneHospitalizations: Mother denies any past psychiatric history and denies past psychiatric hospitalization. The client denies any history of substance abuse. The mother denies any suicide or homicide attempts. The client has had past bilateral feet surgeries due to arthritis, hammer toe, and severe plantar fasciitis with no relief for two years. The client was hospitalized overnight for each foot surgery.Medication trials: Lexapro 10 mg each morning for the depression with minimal relief. Pattie feels helpless and hopeless three to four times a week. Lexapro 20 mg by mouth daily four weeks ago. The patient reports no side effects from the Lexapro. Psychotherapy or Previous Psychiatric Diagnosis: The family has been in individual and family therapy over the last eighteen months. Shireen came in for one time, and she stopped attending and refuses to continue to follow at present. The family has come to therapy together five times. The stress factor is Pattie had foot surgery in the last six months, and she cannot work related to the disabled condition of her feet that arthritis has caused. Substance Current Use and History: Denies smoking or drinking alcohol.Family Psychiatric/Substance Use History: Pattie denies any illegal substances. She is not aware that her family has any abused drugs or alcohol problems. Her husband drinks alcohol daily. However, he has not received alcoholism treatment. Pattie denies any previous psychiatric treatment in herself or her family. Psychosocial History: Pattie was born in Iran and raised by her parents. She is an only child. At 14, Pattie’s parents arranged to marry Armin, a prominent automobile company supervisor in Iran. Pattie moved to Tehran, and Pattie gave birth to five children. Pattie stayed at home and raised the children while her husband worked and provided for the family. When her two daughters, Sheela, and Sharleen, were 11 and 12 years old, her primary doctor discovered they had medical conditions that needed treatment in the United States. Pattie came to the United States with four children. She left behind one of her daughters, Shireen. Her husband, Amir, would later come with Shireen. After years passed, Pattie did not want to return to Iran. She struggled with leaving Shireen behind and was afraid she could not return to the United Stated for her other children if she returned to Iran. During the marriage to Amir, Pattie had been abused by her husband emotionally, physically, and sexually. Pattie worked hard to bring Shireen to the United States; it took several years. She was finally able to get her daughter Shireen who was eighteen. After a few weeks, Shireen came to United Stated, Shireen began to tell her about her father’s emotional, physical, and sexual abuse. Pattie was traumatized to hear the information. Shireen was angry and blamed her mother for leaving her behind in Iran with her father. Pattie looked for help with therapy to work through the shame and guilt of the trauma. Medical History:Current Medications: Lexapro 20 mg each morning for depression and anxiety.Tramadol 100 mg PO three times a day as needed for the severe painIbuprofen 800 mg by mouth twice a day as needed for mild or moderate pain.Trazodone 50 mg or 100 mg PO PRN at night for sleep.Allergies: No known drug, seasonal, food allergiesReproductive Hx:Pattie is to pregnancy and birth gravidity five parity five. The patient reports no abortion or miscarriages. The patient has been abstaining from sexual activities since she got to the United States. The patient denies any sexually transmitted disease. Pt stated she began menses at the age of fourteen. The menses have been regular every month without any significant issues.ROS: See the medical providerVital signs: T-98.9, P: 86. Hight: 63 inches (5′ 3″), Weight: 108.4 kg, 239 lbs., BMI 42.0 General: Alert and oriented person, place, and time. Calm and cooperative with examination. No weight changes recently. No fever, chills, weakness, or fatigue was noted. Head: Symmetry, Normocephalic, and atraumaticEye: Lids are normal. Gaze aligned appropriately, extraocular movements intact. Conjunctive normal, pupils are equal, round, and reactive to the right, PERRLA.Ears: symmetry. Tympanic membrane and external ears normal. No decreased hearing was noted. Neck: No JVD, Full ROM. Cardiovascular: Rate and Rhythm normal rate and regular rhythm. Heart sounds: No murmur noted.Lungs: Pulmonary effort is normal?no respiratory distress. Breath sounds normal breath sounds?no wheezing or rales.Abdomen: Round and large. Bowel sounds are present in all four quadrants. No tenderness.Genital/Rectal: No abnormal. Menses are regular monthly.Musculoskeletal: Normal ROM. Muscle weakness due to physical inactivity. Gait; slow and unsteady gait due to pain. Neurological: Negative for dizziness, No headaches. Skin: No clubbing or cyanosis. The skin color is pink and noted no open area.Toes: Arthritis, Hammertoes, great toes, bilateral incisions healed.Objective:Diagnostic results: CBC: within normal range.Assessment:Mental Status Examination: A 40-year-old Iranian female, appearing stated age. Appearance is dressed in casual clothing, groomed. Behavior normal posture and within normal limits. Patient with good eye contact. Speech is normal in rate rhythm, volume. Thought processes are logical and goal directed. Thought content is normal?no hallucination, flight of ideas, or delusional. The patient’s mood is depressed and anxious. Affect is blunted at times, and the patient denies being suicidal or homicidal at present. The patient’s memory is intact. Insight is good, and judgment with good concentration. The patient has no legal problems, arrests, and no pending charges. Eye contact is fair throughout the interview.Differential DiagnosisAdjustment disorder with depressed moodPattie’s children are getting older, and she feels isolated. She claims that she feels hopeless and helpless when she is lonely. She wants her children to stay with her since she has difficulty adjusting to them not being at home as often. She has also had surgery in the last four months and is adjusting to not being as autonomous as she once was due to mobility and chronic pain difficulties. Pattie is experiencing sadness and hopelessness because of three identifiable stressors: recent surgeries, children moving out of the house, and grief and guilt over her daughter’s View the Mother and Daughter: A Cultural Tale video prior tragedy. The patient fits the criteria (APA, 2013). In adjustment disorder, the stressor can be of any severity of type rather than the required by PTSD criteria. An adjustment disorder is diagnosed when the symptom pattern of PTSD occurs in response to a stressor that does not meet PTSD View the Mother and Daughter: A Cultural Tale video.Depressive disorders due to grief, PTSDPatti had depressive periods to her surgeries, has been in treatment for the past 18 months and has experienced terrible events such as abuse and loss throughout her life. It is critical to determine if the medical problem is linked to depression. Depression existed before medical disease, the medical condition exacerbates depression, and the symptoms resolved after the medical condition began (APA, 2013). Patients with posttraumatic stress disorder should receive cognitive-behavioral treatment, cognitive therapy, and eye movement desensitization and reprocess, according to a panel of psychiatric health professionals (EMDR). Celexa, Prozac, Paxil, Lexapro, Zoloft, and Effexor (Summary of the Clinical Practice, 2019). Not all psychopathology in individuals exposed to an extreme stressor should be attributed to PTSD. The diagnosis involves that trauma exposure precedes the onset or exacerbation of patient symptoms. The symptom response pattern to the severe stressor meets the criteria for another mental disorder, and these diagnoses should be given instead or in addition to PTSD (APA, 2013). Depressive Disorder relates to chronic pain.Pattie got more depressed following her surgeries, with thoughts of pessimism, and her desire for her daughter grew (“Mother and Daughter: A Cultural Tale,” directed by Anonymous, 2003). Pattie’s independence declined, and she became disinterested in things that harmed her mobility. Chronic pain has been linked to several recent research.Changes in the family dynamic might lead to family strife. Individuals can feel sad because of the family load and have more trouble controlling their discomfort (Boone & Kim, 2019). Pattie does not fulfill the diagnostic criteria for this disorder, but she enjoys spending time with her children, friends, and three dogs. An individual’s suffering is influenced by relationship dynamics, interactions, and symptoms that cause pain. People might be affected positively or negatively depending on how much emotional support they receive. Tankha et al. (2020) report people in pain and their partners.A prominent and persistent period of depressed mood or markedly diminished interest or pleasure in all activities predominates in the clinical picture. Diminishing in social, occupational, or other significant areas of functioning or The significant reasons are clinically significant distress.If the mood disturbance is reasoning a general medical condition, the clinician must first establish the presence of a known medical condition (APA, 2013).A treatment plan that includes psychotherapy interventionsCase formulation and Treatment Plan: psychotherapeutic group interventions that into necessary the family’s culture and current situation Diagnostic studies:Place an order for a thyroid panel. Thyroid hormones (THs) play critical roles in modulating the overall metabolism of the body, protein synthesis, fat metabolism, neuronal and bone growth, and cardiovascular and renal functions (Mondal & Mugesh, 2017). Patients with thyroid disorders are more likely to develop depressive symptoms, and conversely, depression may be accompanied by various subtle thyroid abnormalities. The study aimed to estimate the prevalence of thyroid dysfunction in depression (Kafle et al., 2020). Thyroid-related symptoms, including depressive symptoms, fatigue, and body mass index (Bekkering et al., 2019). Vitamin D levels check for depression and anxiety. The objective of this study was to study the protective effects of vitamin D (Vit D) on depression-like, anxiety and  behaviors induced by unpredictable chronic mild stress and brain tissue oxidative damage criteria and neuroinflammation in rats. The current research results revealed that Vit D improved UCMS-induced anxiety and depression by decreasing brain oxidative stress and inhibiting neuroinflammation (Bakhtiari-Dovvombaygi et al., 2021).ReferralsDirect with a community behavioral health outpatient clinic to get treatments such as medication management from a psychiatric professional and group and art therapy from a specialist at the clinic?Informed to a pain consult to examine treatment for chronic pain in both feet. Coordinate with a primary care provider for ongoing medical management. Physical therapy referral is recommended to promote mobility and avoid decompensation. Recommend a dietitian for help with weight management, increase self-esteem, and encourage community involvement.Therapeutic interventions:Discourse the risks, benefits, side effects, pharmaceutical options, and the target symptoms with the patient. Gastrointestinal, decreased appetite, nausea, diarrhea, constipation, dry mouth insomnia, increased suicidal ideation, and constipation is some of the side effects of Lexapro that have been studied (Stahl et al., 2021). Reviewed the importance of not stopping any medication without consulting a doctor and notifying the doctor if any side effects occur.Any medication combination was strongly discouraged. Mixing drugs, including over-the-counter, herbal supplements, alcohol, and illegal substances, have been discussed as potentially harmful. The necessity of abstaining from alcohol and illicit substances, which can harm a patient’s mental health, depression, sleep cycle, and physical health, was discussed.Make an appointment with a psychiatric provider in one weekMake an appointment with a primary provider in five days.She has phone numbers for her children, the crisis line, emergency services, and the nearest emergency department if she has feelings of self-harm, suicide, or homicidal ideas, which she confirmed with a patient. The patient’s concerns were addressed. The patient expressed her understanding of the talk and verbal agreement with the treatment plan. The patient freely signed the treatment plan.ReflectionsThe family psychotherapeutic session was conflicting with the patient and children. Pattie’s suffering from depression due to many contributing factors. However, the family is trying to heal and move forward. The family got worst and went on the tension of cultural difference. It is a struggling family issue. The children have their own lives and want to have an independent and productive life. It is essential to respect the family’s beliefs and differences?the goal is to find the solution for both mother and her adult children. Treatment consists of cognitive-behavioral therapy, interpersonal therapy, and psychodynamic therapy, staying active and getting physical exercise, getting better sleep, avoiding unhealthy coping mechanisms, and reducing stress. ————————————–=========—Please, revise the underlined sections and I am not sure Include a psychotherapy genogram for the family. Note: For any item you are unable to address from the video, explain how you would gather this information and why it is important for diagnosis and treatment planning.Thank you. Health Science Science Nursing NRNP 6645 Share QuestionEmailCopy link Comments (0)

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