Unit 3 Psychiatric Review. Due 5-22-24. 600w initial and 600w replay. Replay to 2 students. 1200 words total. 4 references. Initial Response Instructions: Psychiatric Interview and Mental Status Exam:

Criteria

Clinical Notes

Subjective

Patient Name: Cory

Chief complaint: Grades have been
getting worse and patient has difficulty listening to teachers.

Patient admits not to like any
particular subjects especially math’s. He finds history more appealing but
still cannot concentrate well in class because he is somehow distracted by
something.

Patient admits to not playing any
sports and says that whilst he participated in basketball and baseball in
high school he thinks he can’t find time now and with his performance in
school, the mother would allow sports.

Admits to forgetting his homework
frequently either because he forgot a notebook, the pen, or some needed
material

He feels that he is disappointing
his mother but admits he can do very little to change that because he feels
he has no control over it

Patient admits to having a not-close
relationship with his father or his other sibling (sister)

Patient admits to enjoying video
games because they are fun and distracts him from the normal life. He likes
outdoor activities but engages in them so that he can be a bit active and
‘mum doesn’t think he isn’t doing anything’

Admits to limited sleeping time due
to video games but sees no connection to his school performance and
concentration issues

(UMass Nursing 690M, 2016)

Objective

MSE exam findings: Patient can
effectively repeat the three words in the order provided.

Patient can remember the three words
and repeat them again few minutes later.

Patient can spell the provided word
appropriately (UMass Nursing 690M, 2016)

Mental status exam

Orientation: Alert and oriented x 3

Appearance: The patient was appropriately dressed, and appeared his stated age.

Speech and language: The patient’s speech was slightly fast.

Attitude: The patient was cooperative and calm

Mood: Anxious

Concentration: Impaired concentration

Thought processes and associations: Logical and coherent

Suicidal/homicidal ideations: The patient had no homicidal or suicidal ideations.

Memory: Intact

Insight: Altered

Judgement: Poor

Assessment

Differential diagnosis:

1. Attention deficit hyperactivity
disorder (ADHD), Unspecified Type. ICD-Code F90. 9

2. Anxiety Disorder, Unspecified.
ICD-Code F41. 9

3. Obsessive-compulsive disorder,
unspecified ICD-Code F42. 9 (Carr et al., 2016)

Primary diagnosis:

Attention deficit hyperactivity
disorder (ADHD), Unspecified Type. ICD-Code F90. 9 (Carr et al., 2016)

As evidenced by manifestation of
more than five symptoms for over five months including but not limited to
lacking attention to detail, difficulty in sustaining attention, easily
distracted, poor organization/forgetfulness, and restlessness (American
Academy of Family Physicians, 2019)

Obstacles to treatment:

Patient has a problem with
forgetfulness which could affect medication adherence.

The absence of a close relation for
psychological support and to help in self-organization and self-management
such as a sibling limits chances for optimal outcomes (Nimmo-Smith et al.,
2020)

Plan

Patient will be prescribed for
Adderall XR (amphetamine) 20mg Tab PO QD as starting dosage. The
intention to begin with extended release (XR) is informed by the patient’s
lacking organization and forgetfulness. The medication will be maintained for
four weeks during which a review will be conducted.

Cognitive Behavioral Therapy (CBT):
The intention of CBT in ADHD is to train the brain to respond more
appropriately to the primary roles of the patient’s life (Nimmo-Smith et al.,
2020). In the patient’s case herein, the ADHD is affecting his studies and
the role of CBT is to enable him shed off the negative elements influencing
his behaviors and lifestyle (Nimmo-Smith et al., 2020). The CBT will be
sustained for four weeks with a maximum of two sessions each week. Patient
will be seen again in two weeks.