answer discussion

Please answer one page each with separate references.

# 1

 

Youset

Engida Yousef Abegaze

 

Hello Silibaziso Masebe.

        I value your in-depth analysis of the patient’s condition. It details the patient’s past, and the findings of the physical examination conducted as part of the psychiatric assessment. When he reported, “I struggle to sleep at night.” He said he does not want to disturb his parents at night. A 6- to 8-week therapy program called CBT-I can teach you how to fall asleep more quickly and remain asleep longer. Long-term insomnia is typically treated with this as the first line of defense, and it can be highly successful. The patient will learn how to unwind and go off to sleep more quickly through relaxation or meditation treatment. Students can develop healthy sleep patterns by receiving sleep education. Most likely he developed generalized anxiety disorder which is one of the most common mental health problems. In addition to fear and worry, generalized anxiety disorder also causes persistent, excessive, and illogical worry about the future. Experiencing depressive symptoms, finding it difficult to carry out daily tasks at school and start using a drug (NCBI, 2022).

3) What non-pharmacological interventions would you have prescribed for the patient and why?

non-pharmaceutical strategy the patient will benefit from behavioral therapy that includes multimodal strategies involving the parents, teachers, and others, as well as parent-led behavioral and classroom interventions. Parents are taught a variety of behavioral techniques to improve the quality of their interactions with their children, encourage good behavior, and discourage bad behavior. Education of Patients It is crucial to teach the patient how to build coping mechanisms, self-esteem, and the ability to recognize when they need support. These abilities can significantly improve the outcome of the patient’s mental health treatment.

·       What would you have done differently? As the patient is a minor, his family will get medication education, and they will both be informed of the medication’s side effects. It is crucial to inform the patient that they should report side effects of their medication right away. The indications and symptoms to watch out for as well as how to treat them will also be explained to the patient and family. The patient must adhere to a routine, exercise, eat healthily, and get enough rest each night. By doing so, the likelihood of mood swings and impulsive conduct can be reduced. Health promotion plan remind the patient to arrive on time for all scheduled appointments, including those for group and individual therapy, medication refills, and education. Insist that their presence is necessary for a successful outcome.

2) What pharmacological interventions would you have prescribed for the patient and why? Low dose Seroquel 25 mg at bedtime help for anxiety and sleep. Check the patient’s understanding and keep an eye out for their needs and safety. Pay attention to the patient’s verbalized understanding and keep an eye out for their needs. The patient follows up remind the patient to arrive on time for all scheduled appointments, including those for group and individual therapy, medication refills, and education. Insist that their presence is necessary for a successful outcome. Verify the patient’s understanding and keep a close eye on their needs and safety. Pay attention to the patient’s verbalized understanding and keep an eye out for their needs (U.S. National Library of Medicine, 2022). 

References

Psychiatric Nursing and Mental Health. APNA. (2021, September 8). Retrieved August 31, 2022, from https://www.apna.org/about-apna/ Psychiatry online. DSM Library. (n.d.). Retrieved October 23, 2022, fromhttps://dsm. psychiatryonline.org

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11thed.). Wolters Kluwer.

 U.S. National Library of Medicine. (n.d.). Home – books – NCBI. National Center for Biotechnology Information. Retrieved October 15, 2022, from https://www.ncbi.nlm.nih.gov/booksLinks to an external site.

 Reply

 

 

#2

 

iscussion Post Response # 1

Hello Mrs. Masebe,

Thank you for a comprehensive, thoughtful, and insightful discussion. I acknowledge the effort put into developing such a robust assessment of the patient and determining probable diagnoses and treatment plans. The patient presented with multiple comorbidities, indicating a severe mental health deterioration. Presenting with ADHD, DMDD, MDD, PTSD, and adjustment disorder with anxiety features is a significant cause of concern with considerable implications for the healthcare provider, the provider, and other caregivers, including teachers. For the patient to arrive at this point, it might indicate neglect on the caregivers’ part. The patient experiences sleeping difficulties and irritable mood. He seems to be improving following the previous interventions, which is a positive take. The patient is also under multiple medications, an undesirable situation for a teenager but necessary to treat the multiple mental health disorders. I believe continuing to combine medication and psychotherapy would be necessary for continuous improvement and prevention of relapse. There are still signs of irritability, drug abuse, and disciplinary issues that should be addressed.

The patient is undoubtedly experiencing adjustment issues after moving to a new area and getting bullied at school. Bullying is associated with an increased risk of depression and anxiety. More should be done to help the client adjust to the new environment, including cognitive behavioral therapy, mindfulness, and supportive and educational-based interventions (Evans et al., 2020). Family therapy and parental management training are integral in establishing a supportive environment to help the client build confidence and adapt to the new environment (Johns Hopkins Medicine, 2021). If I were to work with the client, I would inquire more from the school’s counselor regarding the patient and involve him or her in developing a comprehensive treatment and management plan. The school counselor has more information about the school environment and would help establish an environment that bolsters growth and helps the student adjust. Involving the school would also help address the issue of bullying. I agree with the pharmacological interventions selected for this client, although they appear many for a teenager. I would focus on psychotherapy and supportive and educational-based interventions as the first line of treatment. I would not add to the prescribed medication but would engage the parent to ensure medication adherence and progress reporting.   

References

Evans, K., Spiby, H., & Morrell, J. C. (2020). Non-pharmacological interventions to reduce the symptoms of mild to moderate anxiety in pregnant women. A systematic review and narrative synthesis of women’s views on the acceptability of and satisfaction with interventions. Archives of women’s mental health23(1), 11–28. https://doi.org/10.1007/s00737-018-0936-9

Johns Hopkins Medicine. (2021, August 8). Adjustment Disorders. Johns Hopkins Medicine, based in Baltimore, Maryland. https://www.hopkinsmedicine.org/health/conditions-and-diseases/adjustment-disorders

 

 

 

# 3

Response 1

 Hello Blessing Ohwaga, 

 I like how informative your post on conduct disorder was. I agree with you that for this teenage patient conduct disorder is the most likely diagnosis. However , a differentially diagnosis for this patient can be borderline personality disorder. According to Guile et al , borderline personality disorder can be diagnosed as young as eleven years old (2018). Boderline personality disorder is marked by having high impulsivity , instability in their interpersonal relationship and intense inappropriate anger(Guile et al , 2018). Thus based on the patient’s prone to violence and rage with his lack of interpersonal relationship we can pose borderline personality disorder as a potential diagnosis for this patient .

The golden standard of treatment for children or adolescence with conduct disorder is cognitive behavioral therapy . However, another potential therapy for these types of patients is Parent Management Training–Oregon model (PMT–O). According to Gatti et al , PMT-O is 20 sessions where the patient parents learn how to avoid coercive practices and improve their parenting style(2019). These therapy session essentially teach the parent to use a rational system of rewards and minor punishments , to teach the parents how to have clears codes of behaviors that their child must adhere to and to help the parents teach the children how to solve everyday problems(Gatti et al ,2019). These are important tools for a parent to have because there is link between parent conducts and child behavior . Thus by improving the parents parenting style we can help the child improve their behaviors as well .

Reference

 

 

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answer discussion

Please answer one page each with separate references.

# 1

 

Youset

Engida Yousef Abegaze

 

Hello Silibaziso Masebe.

        I value your in-depth analysis of the patient’s condition. It details the patient’s past, and the findings of the physical examination conducted as part of the psychiatric assessment. When he reported, “I struggle to sleep at night.” He said he does not want to disturb his parents at night. A 6- to 8-week therapy program called CBT-I can teach you how to fall asleep more quickly and remain asleep longer. Long-term insomnia is typically treated with this as the first line of defense, and it can be highly successful. The patient will learn how to unwind and go off to sleep more quickly through relaxation or meditation treatment. Students can develop healthy sleep patterns by receiving sleep education. Most likely he developed generalized anxiety disorder which is one of the most common mental health problems. In addition to fear and worry, generalized anxiety disorder also causes persistent, excessive, and illogical worry about the future. Experiencing depressive symptoms, finding it difficult to carry out daily tasks at school and start using a drug (NCBI, 2022).

3) What non-pharmacological interventions would you have prescribed for the patient and why?

non-pharmaceutical strategy the patient will benefit from behavioral therapy that includes multimodal strategies involving the parents, teachers, and others, as well as parent-led behavioral and classroom interventions. Parents are taught a variety of behavioral techniques to improve the quality of their interactions with their children, encourage good behavior, and discourage bad behavior. Education of Patients It is crucial to teach the patient how to build coping mechanisms, self-esteem, and the ability to recognize when they need support. These abilities can significantly improve the outcome of the patient’s mental health treatment.

·       What would you have done differently? As the patient is a minor, his family will get medication education, and they will both be informed of the medication’s side effects. It is crucial to inform the patient that they should report side effects of their medication right away. The indications and symptoms to watch out for as well as how to treat them will also be explained to the patient and family. The patient must adhere to a routine, exercise, eat healthily, and get enough rest each night. By doing so, the likelihood of mood swings and impulsive conduct can be reduced. Health promotion plan remind the patient to arrive on time for all scheduled appointments, including those for group and individual therapy, medication refills, and education. Insist that their presence is necessary for a successful outcome.

2) What pharmacological interventions would you have prescribed for the patient and why? Low dose Seroquel 25 mg at bedtime help for anxiety and sleep. Check the patient’s understanding and keep an eye out for their needs and safety. Pay attention to the patient’s verbalized understanding and keep an eye out for their needs. The patient follows up remind the patient to arrive on time for all scheduled appointments, including those for group and individual therapy, medication refills, and education. Insist that their presence is necessary for a successful outcome. Verify the patient’s understanding and keep a close eye on their needs and safety. Pay attention to the patient’s verbalized understanding and keep an eye out for their needs (U.S. National Library of Medicine, 2022). 

References

Psychiatric Nursing and Mental Health. APNA. (2021, September 8). Retrieved August 31, 2022, from https://www.apna.org/about-apna/ Psychiatry online. DSM Library. (n.d.). Retrieved October 23, 2022, fromhttps://dsm. psychiatryonline.org

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11thed.). Wolters Kluwer.

 U.S. National Library of Medicine. (n.d.). Home – books – NCBI. National Center for Biotechnology Information. Retrieved October 15, 2022, from https://www.ncbi.nlm.nih.gov/booksLinks to an external site.

 Reply

 

 

#2

 

iscussion Post Response # 1

Hello Mrs. Masebe,

Thank you for a comprehensive, thoughtful, and insightful discussion. I acknowledge the effort put into developing such a robust assessment of the patient and determining probable diagnoses and treatment plans. The patient presented with multiple comorbidities, indicating a severe mental health deterioration. Presenting with ADHD, DMDD, MDD, PTSD, and adjustment disorder with anxiety features is a significant cause of concern with considerable implications for the healthcare provider, the provider, and other caregivers, including teachers. For the patient to arrive at this point, it might indicate neglect on the caregivers’ part. The patient experiences sleeping difficulties and irritable mood. He seems to be improving following the previous interventions, which is a positive take. The patient is also under multiple medications, an undesirable situation for a teenager but necessary to treat the multiple mental health disorders. I believe continuing to combine medication and psychotherapy would be necessary for continuous improvement and prevention of relapse. There are still signs of irritability, drug abuse, and disciplinary issues that should be addressed.

The patient is undoubtedly experiencing adjustment issues after moving to a new area and getting bullied at school. Bullying is associated with an increased risk of depression and anxiety. More should be done to help the client adjust to the new environment, including cognitive behavioral therapy, mindfulness, and supportive and educational-based interventions (Evans et al., 2020). Family therapy and parental management training are integral in establishing a supportive environment to help the client build confidence and adapt to the new environment (Johns Hopkins Medicine, 2021). If I were to work with the client, I would inquire more from the school’s counselor regarding the patient and involve him or her in developing a comprehensive treatment and management plan. The school counselor has more information about the school environment and would help establish an environment that bolsters growth and helps the student adjust. Involving the school would also help address the issue of bullying. I agree with the pharmacological interventions selected for this client, although they appear many for a teenager. I would focus on psychotherapy and supportive and educational-based interventions as the first line of treatment. I would not add to the prescribed medication but would engage the parent to ensure medication adherence and progress reporting.   

References

Evans, K., Spiby, H., & Morrell, J. C. (2020). Non-pharmacological interventions to reduce the symptoms of mild to moderate anxiety in pregnant women. A systematic review and narrative synthesis of women’s views on the acceptability of and satisfaction with interventions. Archives of women’s mental health23(1), 11–28. https://doi.org/10.1007/s00737-018-0936-9

Johns Hopkins Medicine. (2021, August 8). Adjustment Disorders. Johns Hopkins Medicine, based in Baltimore, Maryland. https://www.hopkinsmedicine.org/health/conditions-and-diseases/adjustment-disorders

 

 

 

# 3

Response 1

 Hello Blessing Ohwaga, 

 I like how informative your post on conduct disorder was. I agree with you that for this teenage patient conduct disorder is the most likely diagnosis. However , a differentially diagnosis for this patient can be borderline personality disorder. According to Guile et al , borderline personality disorder can be diagnosed as young as eleven years old (2018). Boderline personality disorder is marked by having high impulsivity , instability in their interpersonal relationship and intense inappropriate anger(Guile et al , 2018). Thus based on the patient’s prone to violence and rage with his lack of interpersonal relationship we can pose borderline personality disorder as a potential diagnosis for this patient .

The golden standard of treatment for children or adolescence with conduct disorder is cognitive behavioral therapy . However, another potential therapy for these types of patients is Parent Management Training–Oregon model (PMT–O). According to Gatti et al , PMT-O is 20 sessions where the patient parents learn how to avoid coercive practices and improve their parenting style(2019). These therapy session essentially teach the parent to use a rational system of rewards and minor punishments , to teach the parents how to have clears codes of behaviors that their child must adhere to and to help the parents teach the children how to solve everyday problems(Gatti et al ,2019). These are important tools for a parent to have because there is link between parent conducts and child behavior . Thus by improving the parents parenting style we can help the child improve their behaviors as well .

Reference

 

 

answer discussion

please answer each separately with references for each.  I put it in the Additional material box as a file:

# 1

 

Youset

Engida Yousef Abegaze

 

Hello Silibaziso Masebe.

        I value your in-depth analysis of the patient’s condition. It details the patient’s past, and the findings of the physical examination conducted as part of the psychiatric assessment. When he reported, “I struggle to sleep at night.” He said he does not want to disturb his parents at night. A 6- to 8-week therapy program called CBT-I can teach you how to fall asleep more quickly and remain asleep longer. Long-term insomnia is typically treated with this as the first line of defense, and it can be highly successful. The patient will learn how to unwind and go off to sleep more quickly through relaxation or meditation treatment. Students can develop healthy sleep patterns by receiving sleep education. Most likely he developed generalized anxiety disorder which is one of the most common mental health problems. In addition to fear and worry, generalized anxiety disorder also causes persistent, excessive, and illogical worry about the future. Experiencing depressive symptoms, finding it difficult to carry out daily tasks at school and start using a drug (NCBI, 2022).

3) What non-pharmacological interventions would you have prescribed for the patient and why?

non-pharmaceutical strategy the patient will benefit from behavioral therapy that includes multimodal strategies involving the parents, teachers, and others, as well as parent-led behavioral and classroom interventions. Parents are taught a variety of behavioral techniques to improve the quality of their interactions with their children, encourage good behavior, and discourage bad behavior. Education of Patients It is crucial to teach the patient how to build coping mechanisms, self-esteem, and the ability to recognize when they need support. These abilities can significantly improve the outcome of the patient’s mental health treatment.

·       What would you have done differently? As the patient is a minor, his family will get medication education, and they will both be informed of the medication’s side effects. It is crucial to inform the patient that they should report side effects of their medication right away. The indications and symptoms to watch out for as well as how to treat them will also be explained to the patient and family. The patient must adhere to a routine, exercise, eat healthily, and get enough rest each night. By doing so, the likelihood of mood swings and impulsive conduct can be reduced. Health promotion plan remind the patient to arrive on time for all scheduled appointments, including those for group and individual therapy, medication refills, and education. Insist that their presence is necessary for a successful outcome.

2) What pharmacological interventions would you have prescribed for the patient and why? Low dose Seroquel 25 mg at bedtime help for anxiety and sleep. Check the patient’s understanding and keep an eye out for their needs and safety. Pay attention to the patient’s verbalized understanding and keep an eye out for their needs. The patient follows up remind the patient to arrive on time for all scheduled appointments, including those for group and individual therapy, medication refills, and education. Insist that their presence is necessary for a successful outcome. Verify the patient’s understanding and keep a close eye on their needs and safety. Pay attention to the patient’s verbalized understanding and keep an eye out for their needs (U.S. National Library of Medicine, 2022). 

References

Psychiatric Nursing and Mental Health. APNA. (2021, September 8). Retrieved August 31, 2022, from https://www.apna.org/about-apna/ Psychiatry online. DSM Library. (n.d.). Retrieved October 23, 2022, fromhttps://dsm. psychiatryonline.org

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11thed.). Wolters Kluwer.

 U.S. National Library of Medicine. (n.d.). Home – books – NCBI. National Center for Biotechnology Information. Retrieved October 15, 2022, from https://www.ncbi.nlm.nih.gov/booksLinks to an external site.

 Reply

 

 

#2

 

iscussion Post Response # 1

Hello Mrs. Masebe,

Thank you for a comprehensive, thoughtful, and insightful discussion. I acknowledge the effort put into developing such a robust assessment of the patient and determining probable diagnoses and treatment plans. The patient presented with multiple comorbidities, indicating a severe mental health deterioration. Presenting with ADHD, DMDD, MDD, PTSD, and adjustment disorder with anxiety features is a significant cause of concern with considerable implications for the healthcare provider, the provider, and other caregivers, including teachers. For the patient to arrive at this point, it might indicate neglect on the caregivers’ part. The patient experiences sleeping difficulties and irritable mood. He seems to be improving following the previous interventions, which is a positive take. The patient is also under multiple medications, an undesirable situation for a teenager but necessary to treat the multiple mental health disorders. I believe continuing to combine medication and psychotherapy would be necessary for continuous improvement and prevention of relapse. There are still signs of irritability, drug abuse, and disciplinary issues that should be addressed.

The patient is undoubtedly experiencing adjustment issues after moving to a new area and getting bullied at school. Bullying is associated with an increased risk of depression and anxiety. More should be done to help the client adjust to the new environment, including cognitive behavioral therapy, mindfulness, and supportive and educational-based interventions (Evans et al., 2020). Family therapy and parental management training are integral in establishing a supportive environment to help the client build confidence and adapt to the new environment (Johns Hopkins Medicine, 2021). If I were to work with the client, I would inquire more from the school’s counselor regarding the patient and involve him or her in developing a comprehensive treatment and management plan. The school counselor has more information about the school environment and would help establish an environment that bolsters growth and helps the student adjust. Involving the school would also help address the issue of bullying. I agree with the pharmacological interventions selected for this client, although they appear many for a teenager. I would focus on psychotherapy and supportive and educational-based interventions as the first line of treatment. I would not add to the prescribed medication but would engage the parent to ensure medication adherence and progress reporting.   

References

Evans, K., Spiby, H., & Morrell, J. C. (2020). Non-pharmacological interventions to reduce the symptoms of mild to moderate anxiety in pregnant women. A systematic review and narrative synthesis of women’s views on the acceptability of and satisfaction with interventions. Archives of women’s mental health23(1), 11–28. https://doi.org/10.1007/s00737-018-0936-9

Johns Hopkins Medicine. (2021, August 8). Adjustment Disorders. Johns Hopkins Medicine, based in Baltimore, Maryland. https://www.hopkinsmedicine.org/health/conditions-and-diseases/adjustment-disorders

 

 

 

# 3

Response 1

 Hello Blessing Ohwaga, 

 I like how informative your post on conduct disorder was. I agree with you that for this teenage patient conduct disorder is the most likely diagnosis. However , a differentially diagnosis for this patient can be borderline personality disorder. According to Guile et al , borderline personality disorder can be diagnosed as young as eleven years old (2018). Boderline personality disorder is marked by having high impulsivity , instability in their interpersonal relationship and intense inappropriate anger(Guile et al , 2018). Thus based on the patient’s prone to violence and rage with his lack of interpersonal relationship we can pose borderline personality disorder as a potential diagnosis for this patient .

The golden standard of treatment for children or adolescence with conduct disorder is cognitive behavioral therapy . However, another potential therapy for these types of patients is Parent Management Training–Oregon model (PMT–O). According to Gatti et al , PMT-O is 20 sessions where the patient parents learn how to avoid coercive practices and improve their parenting style(2019). These therapy sessions essentially teach the parent to use a rational system of rewards and minor punishments, to teach the parents how to have clears codes of behaviors that their child must adhere to and to help the parents teach the children how to solve everyday problems(Gatti et al ,2019). These are important tools for a parent to have because there is link between parent conducts and child behavior. Thus by improving the parents parenting style we can help the child improve their behaviors as well.

Reference

 

 

answer discussion

please answer each separately with references for each.  I put it in the Additional material box as a file:

# 1

 

Youset

Engida Yousef Abegaze

 

Hello Silibaziso Masebe.

        I value your in-depth analysis of the patient’s condition. It details the patient’s past, and the findings of the physical examination conducted as part of the psychiatric assessment. When he reported, “I struggle to sleep at night.” He said he does not want to disturb his parents at night. A 6- to 8-week therapy program called CBT-I can teach you how to fall asleep more quickly and remain asleep longer. Long-term insomnia is typically treated with this as the first line of defense, and it can be highly successful. The patient will learn how to unwind and go off to sleep more quickly through relaxation or meditation treatment. Students can develop healthy sleep patterns by receiving sleep education. Most likely he developed generalized anxiety disorder which is one of the most common mental health problems. In addition to fear and worry, generalized anxiety disorder also causes persistent, excessive, and illogical worry about the future. Experiencing depressive symptoms, finding it difficult to carry out daily tasks at school and start using a drug (NCBI, 2022).

3) What non-pharmacological interventions would you have prescribed for the patient and why?

non-pharmaceutical strategy the patient will benefit from behavioral therapy that includes multimodal strategies involving the parents, teachers, and others, as well as parent-led behavioral and classroom interventions. Parents are taught a variety of behavioral techniques to improve the quality of their interactions with their children, encourage good behavior, and discourage bad behavior. Education of Patients It is crucial to teach the patient how to build coping mechanisms, self-esteem, and the ability to recognize when they need support. These abilities can significantly improve the outcome of the patient’s mental health treatment.

·       What would you have done differently? As the patient is a minor, his family will get medication education, and they will both be informed of the medication’s side effects. It is crucial to inform the patient that they should report side effects of their medication right away. The indications and symptoms to watch out for as well as how to treat them will also be explained to the patient and family. The patient must adhere to a routine, exercise, eat healthily, and get enough rest each night. By doing so, the likelihood of mood swings and impulsive conduct can be reduced. Health promotion plan remind the patient to arrive on time for all scheduled appointments, including those for group and individual therapy, medication refills, and education. Insist that their presence is necessary for a successful outcome.

2) What pharmacological interventions would you have prescribed for the patient and why? Low dose Seroquel 25 mg at bedtime help for anxiety and sleep. Check the patient’s understanding and keep an eye out for their needs and safety. Pay attention to the patient’s verbalized understanding and keep an eye out for their needs. The patient follows up remind the patient to arrive on time for all scheduled appointments, including those for group and individual therapy, medication refills, and education. Insist that their presence is necessary for a successful outcome. Verify the patient’s understanding and keep a close eye on their needs and safety. Pay attention to the patient’s verbalized understanding and keep an eye out for their needs (U.S. National Library of Medicine, 2022). 

References

Psychiatric Nursing and Mental Health. APNA. (2021, September 8). Retrieved August 31, 2022, from https://www.apna.org/about-apna/ Psychiatry online. DSM Library. (n.d.). Retrieved October 23, 2022, fromhttps://dsm. psychiatryonline.org

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11thed.). Wolters Kluwer.

 U.S. National Library of Medicine. (n.d.). Home – books – NCBI. National Center for Biotechnology Information. Retrieved October 15, 2022, from https://www.ncbi.nlm.nih.gov/booksLinks to an external site.

 Reply

 

 

#2

 

iscussion Post Response # 1

Hello Mrs. Masebe,

Thank you for a comprehensive, thoughtful, and insightful discussion. I acknowledge the effort put into developing such a robust assessment of the patient and determining probable diagnoses and treatment plans. The patient presented with multiple comorbidities, indicating a severe mental health deterioration. Presenting with ADHD, DMDD, MDD, PTSD, and adjustment disorder with anxiety features is a significant cause of concern with considerable implications for the healthcare provider, the provider, and other caregivers, including teachers. For the patient to arrive at this point, it might indicate neglect on the caregivers’ part. The patient experiences sleeping difficulties and irritable mood. He seems to be improving following the previous interventions, which is a positive take. The patient is also under multiple medications, an undesirable situation for a teenager but necessary to treat the multiple mental health disorders. I believe continuing to combine medication and psychotherapy would be necessary for continuous improvement and prevention of relapse. There are still signs of irritability, drug abuse, and disciplinary issues that should be addressed.

The patient is undoubtedly experiencing adjustment issues after moving to a new area and getting bullied at school. Bullying is associated with an increased risk of depression and anxiety. More should be done to help the client adjust to the new environment, including cognitive behavioral therapy, mindfulness, and supportive and educational-based interventions (Evans et al., 2020). Family therapy and parental management training are integral in establishing a supportive environment to help the client build confidence and adapt to the new environment (Johns Hopkins Medicine, 2021). If I were to work with the client, I would inquire more from the school’s counselor regarding the patient and involve him or her in developing a comprehensive treatment and management plan. The school counselor has more information about the school environment and would help establish an environment that bolsters growth and helps the student adjust. Involving the school would also help address the issue of bullying. I agree with the pharmacological interventions selected for this client, although they appear many for a teenager. I would focus on psychotherapy and supportive and educational-based interventions as the first line of treatment. I would not add to the prescribed medication but would engage the parent to ensure medication adherence and progress reporting.   

References

Evans, K., Spiby, H., & Morrell, J. C. (2020). Non-pharmacological interventions to reduce the symptoms of mild to moderate anxiety in pregnant women. A systematic review and narrative synthesis of women’s views on the acceptability of and satisfaction with interventions. Archives of women’s mental health23(1), 11–28. https://doi.org/10.1007/s00737-018-0936-9

Johns Hopkins Medicine. (2021, August 8). Adjustment Disorders. Johns Hopkins Medicine, based in Baltimore, Maryland. https://www.hopkinsmedicine.org/health/conditions-and-diseases/adjustment-disorders

 

 

 

# 3

Response 1

 Hello Blessing Ohwaga, 

 I like how informative your post on conduct disorder was. I agree with you that for this teenage patient conduct disorder is the most likely diagnosis. However , a differentially diagnosis for this patient can be borderline personality disorder. According to Guile et al , borderline personality disorder can be diagnosed as young as eleven years old (2018). Boderline personality disorder is marked by having high impulsivity , instability in their interpersonal relationship and intense inappropriate anger(Guile et al , 2018). Thus based on the patient’s prone to violence and rage with his lack of interpersonal relationship we can pose borderline personality disorder as a potential diagnosis for this patient .

The golden standard of treatment for children or adolescence with conduct disorder is cognitive behavioral therapy . However, another potential therapy for these types of patients is Parent Management Training–Oregon model (PMT–O). According to Gatti et al , PMT-O is 20 sessions where the patient parents learn how to avoid coercive practices and improve their parenting style(2019). These therapy sessions essentially teach the parent to use a rational system of rewards and minor punishments, to teach the parents how to have clears codes of behaviors that their child must adhere to and to help the parents teach the children how to solve everyday problems(Gatti et al ,2019). These are important tools for a parent to have because there is link between parent conducts and child behavior. Thus by improving the parents parenting style we can help the child improve their behaviors as well.

Reference