Discussion Board and Case Study

Discussion Board and Case Study

Answer the below 2 questions 1 paragraph max 1 reference

Question 1: Please include the time consideration for differentiating adjustment disorders from PTSD.

Question 2: What is the difference between an Oppositional defiant disorder and Conduct disorder?

Please refer to  the following for the case study that is included below. Thank you

• Any differential diagnoses
• Your diagnosis and reasoning
• Any additional questions you would have asked
• Medication recommendations along with your rationale. Note possible side effects or issues  to address if attempting to obtain consent.
• Any labs and why they may be indicated
• Screener scales or diagnostic tools that may be beneficial
• Additional resources to give  (Therapy modalities, support groups, activities, etc.)

Discussion Board and Case Study

Case Study

33 Y/O Male

History of Present Illness:

A 33 year old male is brought to the psychiatric department by police after he attacked another man in a bar and threatened to “rip (your) throat out with (my) bare hands”.  The pt. apparently returned from the restroom in the bar to find the man putting an arm around his girlfriend.

The pt. states that he immediately became ‘ENRAGED” and began to scream obscenities.  The shouting quickly escalated into a full blown bar brawl, and the police intervened when the patient wrapped his hands around the man’s throat and pinned him against the bar.

The pt. admits to numerous incidents of this nature and has found himself in fights several times each year since late adolescence.  Two months ago, he was arrested for smashing a car window with a baseball bat when the man “cut him off” on the highway.

He was also fired from several jobs in his late 20’s due to his “hot temper” with coworkers who were trying to “slight him”.  The pt. believes that his actions are sometimes unreasonable, but the combination of heightened energy, racing thoughts, and anger makes his urges nearly impossible to resist.

The pts. girlfriend states that he is a fun loving and charming man between episodes but starts arguments with her approximately twice a week.  She claims that during his verbal attacks he will often make demeaning and devaluing remarks about her.

On several occasions he has broken her personal belongings during trivial arguments.  The pt. acknowledges that he regrets these episodes, but they usually subside within a half hour and provide an instant sense of relief.

Past Psychiatric History:

No psychiatric history or past use of psychiatric medications is reported.  The pt. denies symptoms of a mood disorder.  He admits to 1 or 2 alcoholic drinks per week and a history of marijuana experimentation in his late teens.

Mental Status Exam:

The pt. appears well built and sharply dressed and looks his stated age.  He is awake, alert and oriented in all spheres.  Behavior is appropriate, and eye contact is good.  Speech is clear and coherent with normal rate, rhythm, and volume.

Mood is euthymic, and affect is full.  Thought process is logical and goal directed.  Thought content does not include delusions, ideas of reference, paranoid ideation, suicidal, or homicidal ideation.  Impulse control is poor, as noted by his recent violent outbursts.  Insight is limited because he does not recognize the maladaptive nature of his behavior.  Judgment is impaired, as evidenced by his inability to behave in asocially accepted ways.  Reliability is fair.

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Labs:

Na = 141, K=4.2, Chloride=106, carbon dioxide =23, blood urea nitrogen=9, creatinine=0.6, glucose=91.

Blood alcohol level and urine tox are negative.

Diagnostic Testing:

CT of the head shows no sign of mass, lesion or bleeding.  Electroencephalogram is unremarkable without signs of slowing or seizure foci.

Physical Exam:

The man appears healthy, and the exam is within normal limits without remarkable findings.

Include:

• Any differential diagnoses
• Your diagnosis and reasoning
• Any additional questions you would have asked
• Medication recommendations along with your rationale. Note possible side effects or issues to address if attempting to obtain consent.
• Any labs and why they may be indicated
• Screener scales or diagnostic tools that may be beneficial
• Additional resources to give  (Therapy modalities, support groups, activities, etc.)

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