Fluent Essays

file attached below. Peer reviewed articles within 5 years of publication. Please see the instructions below. msn_675_db_2.docx Unformatted Attachment Preview DB1: 1. According to the DSM what is the difference between agoraphobia and social anxiety? 350 words without references included. 2-3 references peer review articles within 5 years of publications in the U.S.A. Case study: (200 words to reply and 2-3 references). 2. 26 y/o malemod4 History of Present Illness: A 26-year-old man is transferred from the medical emergency department to psychiatry after receiving sutures to multiple lacerations on both wrists. The patient was initially brought to the emergency department by a friend who found him in the bathtub, bleeding from his wrists. When the patient is asked to move into an exam room to be interviewed, the examiner notes that he 1st unties and reties his shoes 3 times. When the interviewer finally begins, the patient reports that in recent months he has become disturbed “by his life and the way things are going.” He describes feeling” ugly” and” worthless” and is” tired of dealing with everything”. When asked about his suicide attempt, he states,” the past few days have been really bad… Its all coming apart now.” He then begins to cry uncontrollably. When the patient regains composure, that he is a writer who has recently signed a deal to publish novel. He was scheduled to the photographed for the book jacket cover earlier today and feels” overwhelmed” by the idea of being photographed and having the photo publicly released. When asked why he felt overwhelmed, he points to the skin around his mouth, where multiple small lesions in various stages of healing are appreciated. The patient describes an ongoing concern about the thickness of his mustache, despite being clean shaven. He reports shaving 3to 4 times every day and then using tweezers between shaves to prevent more growth. He endorses feeling this way for the past year,” ever since I got my nose fixed.” The patient also admits to repeatedly checking for hair growth in the mirror and feeling that people in the street are constantly looking at his mustache. The patient notes that he lives alone, works from home, and has few friends. He rarely leaves the house because he does not want” to be around people”. He also appears anxious to end the interview and interrupts the examiner to ask if he can go to the bathroom. When asked why, he seems embarrassed but admits to wanting to check his skin and wash his hands. Past Psychiatric history: The patient denies any previous psychiatric treatment. He has never been hospitalized or taken psychiatric medication. He was once referred for depressive symptoms but never followed up. Past medical history: The patient admits to seeing a dermatologist for” skin problems” and has a history of 2 rhinoplasties in the past 5 years. Mental status exam: The patient is a good- looking man who appears his stated age. He is disheveled in appearance but clean shaven. He has limited eye contact, and his speech is slow and quiet. The patient keeps his hand over his mouth throughout the interview and moves it only slightly to speak. When his hand is moved, the lesions around his lips can be seen, and some appear infected. He reports that his mood is “really bad”, and his affect is constricted to the dysphoric range. He cries openly and at times uncontrollably. His thought process is linear and goal directed. He describes feeling that people on the street are looking at him and talking about his skin but denies other disturbance in thought content. He denies homicidal ideation but still endorses suicidal ideation. When asked about a plan, he replies, “well something better than cutting my wrists”. He denies auditory and visual hallucinations. He is alert and orients, with good attention and intact memory and concentration. His insight and judgment appear poor. What is this man’s primary diagnosis? Please explain why? Body Dysmorphic Disorder (BDD) Any other diagnosis? OCD What are the Differential diagnosis? Major depressive disorder (MDD), Social phobia, panic disorder, Somatoform disorder, agoraphobia, and anxiety disorder What is your treatment plan? Prescribe Selective Serotonin reuptake inhibitor (SSRI) therapy such as fluoxetine, fluvoxamine, escitalopram, and citalopram in the treatment of body dysmorphic disorder. Order blood work such CBC, thyroid function levels, and chem 7. Also, order EKG before starting on SSRI. and cognitive behavior therapy (CBT) DB2: 350 words without references included. 2-3 references peer review articles within 5 years of publications in the U.S.A. 1. What is the difference between depersonalization and derealization? 2. Case study: (200 words to reply and 2-3 references). Hx Present Illness: A 16 y/o girl is brought to the ER by her soccer coach and a few teammates. Her coach told the doctor that during a routine practice that afternoon, the girl suddenly collapsed on the field. Her friends mentioned that following previous practices she c/o feeling sort of dizzy but never mentioned passing out. Her friends explained that she has been spending less time with them lately; often going straight home after practice instead of going out for a snack with her teammates, as she used to do. The pt. states that she had a weird pain in her chest, felt dizzy and then just passed out. She describes several episodes of chest pain lately and apparently has been feeling more dizzy than usual. These feelings occur throughout the day and not associated only with physical exercise. When the girls mother arrived at the ER, she was visibly frantic. What happened? I told you were practicing too much--its no wonder you passed out.--You play soccer more than 4 hrs a day. Mother corroborates the absence of any past physical or psychiatric Hx but states that the pt has not been herself lately--spending most of the weekend lying in bed instead of going out with her friends. I know she is not sleeping well-just last night I found her looking through the frig at 3 am. Physical Exam: Pt is a slight girl , 65 inches tall, weighing 135 lbs. Resting pulse 48 beats/min in a regular rhythm. B/P 115/60 seated and 120/67 standing. She appears well nourished and hydrated. She is clearly anxious and states that she feels nervous being in the hospital. The HEENT exam is significant for enlarged parotid glands bilaterally. The remainder of the physical is unremarkable. LABS: Sodium-138; K-2.7; Cl-82; Bicarb-35; Venous blood gasses=7.5 pH. All other labs WNL. with exception of Mg = 1.0. The ekg showed prominent U-waves and a prolonged QT interval. What is her Diagnosis? What are the differential diagnosis? How does the medical workup confirm it? What is your plan of care? 3. Case Study 3: 200 words to reply and 2-3 references). A man walked into Cincinnati District One police station. He states that he didn’t remember a thing about his life prior to finding himself in the Cincinnati Greyhound station that morning. The officer on duty reports to you, the NP on duty at the free clinic who receives the officer’s telephone call, that he also cannot remember his name. The man is dressed in what appears to be an Italian designer suit, custom made shoes and a monogrammed cuffed shirt, TJG. In reviewing the contents of the wallet the man and officer note that he has pictures of himself a woman and 3 children who appear under the age of five. His driver’s license shows the name of Thomas Joseph Gassler and a Cleveland Ohio address. No other contents in the wallet provide additional information. The officer initiates a computer search for the man’s family and then drives him to the Emergency Room of University Hospital. While recording the history you note that the man is pleasant, well-spoken, excellent grammar and sentence structure, though troubled by his memory loss. He denies delusions or hallucinations and his thinking and logic seen intact. Except for his recent memory loss his mental status exam is WNL. What is your tentative diagnosis? What other information is essential to confirm your diagnosis? From a therapeutic standpoint what kinds of core issues would be addressed in therapy? What is your Dx? Axis 1 Axis 2 Axis 3 Axis 4 Axis 5 What is your treatment plan? Would you start any medications? If so What? Would you order labs? If so: What labs and why? ... Purchase answer to see full attachment