Video Case Study

Video Case Study

Module Assignments:

Change the directions to read as follows:

For this assignment, you will watch an assigned video clip that depicts a patient needing psychiatric/mental health treatment. You then will complete a treatment plan for this patient, following the attached formatting.

You are required to follow APA 7, which includes, a title page, your typed treatment plan, and a references page. Each video case that is assessed should result in a treatment plan that is a minimum of 2 pages in length, in addition to the title page and references page. This is a treatment plan, not a research paper. Follow the rubric guidelines for grading criteria.

Just like in practice, there are times when all the preferred information may not be available, yet you still will need to formulate a treatment plan for the patient. Your treatment plan must include in-text citations and proper APA 7 formatting.

The following reference materials are required to be utilized and referenced:

• DSM-5
• Course Textbook
• Drug guide of your choice (text or online)
• 1 scholarly peer reviewed journal article, dated within the last 5 years, that supports your treatment plan. UptoDate is a wonderful site, but it is not considered a scholarly peer reviewed journal article.

The APA 7 style of writing is required. This includes (but is not limited to):

• Proper grammar and composition, capitalization and sentence structure
• APA 7 approved font (such as 12-point Times New Roman)
• Double spaced paper with 1” margins
• Paragraphs are to be left margin justified only
• Paragraph indentions
• Heading Levels (see APA p. 47-48)
• References that are formatted as per APA 7. See chapter 9 of the APA 7.

How to properly cite and reference the DSM-5.

For electronic versions:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

https:doi.org/10.1176/appi.books.9780890425596

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For printed version:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

American Psychiatric Association.

Basic in-text citation for the DSM-5:   (American Psychiatric Association, 2013).

Treatment Plan: What to include and how to format the treatment plan

Your Treatment plan should include the following categories:

1. Title page
2. Content of treatment plan (The title of your treatment plan should be on line 1 of page 2).
   1. Video # or Discussion Board Prompt #
   2. Brief description of the patient
   3. Brief explanation of the presenting symptoms
   4. Any known medical history, allergies, etc.
   5. Your psychiatric diagnosis (supported by the DSM-5).
   6. List 3 of the differential diagnosis from the DSM-5, and briefly state why that was chosen as a differential diagnosis, and not as the main diagnosis. (See course materials on Differential Diagnosis) (supported by the DSM-5).
   7. Suicide and/or homicidal risk assessment (this includes ideation, intent, plan, means, etc.).
   8. What psychiatric tools or scales you used (or that you would use) to help support your diagnosis (include citations).
   9. Medications being ordered
      1. Include name of medication(s) and what the med is used for (include citation)
      2. Include the route, dosage, frequency (include citation)

• Include black box warnings or what the pt needs to know/foods to avoid, etc. (include citation)

1. Non-pharmacological treatments that are being ordered (include citation that supports these).
2. Any labs or medical tests that need to be completed to rule out organic causes, for medication monitoring, and so forth (include citation). (include a short line stating why each lab/test is being ordered)
3. Questions that you would ask to further solidify your diagnosis (brief list)
4. Any further directives/resources for the patient (this would include, follow up with primary doctor to monitor HTN or diabetes; directives to follow-up with other members of the comprehensive treatment team; safety plan if you are sending the pt home and they have suicidal or homicidal thoughts; return for medication assessment in x number of weeks, etc. This also includes support group and hotline phone numbers for things like SI and SUD).

3. References Page – include all citations used in the paper, formatted per APA 7, double spaced and in alphabetical order. References are to include the DSM-5, the course textbook, a drug book of your choice (text or online), and 1 scholarly journal article reference within the last 5 years, for each of the videos or discussion board prompts being assessed.

Note:

                Direct quotations should be kept to a minimum and properly cited as per the APA 7. It is imperative that you synthesize the course information into your own words, using minimal direct quotations from scholarly journal articles to support your treatment plan. Academic integrity is essential as proper citations give credence and reliability to your treatment plan.

DSM-5 & Differential Diagnosis

In order to effectively treat patients, a reliable diagnosis and treatment recommendation is essential. The DSM-5 provides a definition for each mental health disorder along with diagnostic criteria that must be met for each diagnosis. These diagnoses are designed to “help clinicians to determine prognosis, treatment plans, and potential treatment outcomes for their patients” (American Psychiatric Association, 2013, p. 20). Diagnosis are then made after performing a clinical interview with the patient, using DSM-5 descriptions, criteria, and using clinician judgment (American Psychiatric Association, 2013).

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1. All psychiatric disorders have a categorical place in the DSM -5. It includes the symptoms that must be present with specifiers that allow for a more specific diagnosis that help with the development of a treatment plan. (Example: Major depressive disorder with psychotic features).

 

2. Most psychiatric disorders (and psychiatric emergencies) require a thorough suicide risk assessment. If the patient in the DB or video requires a suicide risk assessment you must mention that clearly, as well as giving the side effects of any meds that may make suicidal thinking worse, as well as a safety plan.

 

3. Differential diagnoses: A reliable diagnosis is required to effectively treat the patient and to have positive treatment outcomes. The differentials provide for clinicians and alternate diagnosis that could be considered if it is proven that the patient does meet the criteria for the primary diagnosis that was chosen.

A clinician does not randomly come up with a differential diagnosis on their own. The DSM-5 provides for clinicians, differential diagnosis for each primary diagnosis. They are listed in the DSM-5 at the end of each diagnosis chapter. The differentials are listed in order of prevalence.

For example, of all the patients diagnosed with Bipolar 1, if that diagnosis was proven not to be correct, most often the correct diagnosis is found to be first, major depressive disorder, then second most frequent is the 2^nd differential listed, then the 3^rd most frequent is the 3^rd differential that is listed. So the differentials should be alternate diagnosis that you considered or wrestled with as you were determining the primary diagnosis for the patient.

For example, if you have a patient who appears with a mood disorder, you may be considering depressive disorder or bipolar 1 disorder. Upon examining the diagnostic criteria in the DSM-5 for bipolar 1 (page 123-131) you determine that bipolar 1 is the diagnosis that the patient meets the criteria for.

You must then look to the differential diagnosis that are listed in the DSM-5 (for bipolar 1 the differentials are on page 131-132) and you choose 2 or 3 of them that your patient closely matches the criteria for. You then briefly explain why you chose bipolar 1, as opposed to the differential diagnosis of major depressive disorder (for example).

Transcript from Video Patient Diagnosis is PTSD therefore the treatment plan must be for PTSD

[KRISTINA:] I know you specialize in helping women who have been… you know.

[OFF CAMERA:] Raped?

[KRISTINA:] Yeah, but I don’t see how it could possibly help me.

[OFF CAMERA:] Your family told me that you were very reluctant to come see me… You’ve been afraid to leave the house. Can you tell me why that is?

[She shifts uncomfortably].

[KRISTINA:] I can’t go out.

[OFF CAMERA:] Why can’t you leave your home?

[KRISTINA:] Because I can’t.

[She shifts repeatedly in her chair].

[OFF CAMERA:] You seem uncomfortable now? Is there something wrong with being here?

[KRISTINA:] I just don’t like this room.

[OFF CAMERA:] I’m sorry, what about this room don’t you like?

[KRISTINA:] It’s just… it’s closed off. I can’t get out. [She cries]. We’re up high and the door… you could block the door, I can’t get out.

[OFF CAMERA:] Do you feel threatened by me?

[KRISTINA:] I don’t know. You could… I don’t know you.

[OFF CAMERA:] Do you feel this way when you are in unfamiliar places with unfamiliar people?

[KRISTINA:] Yes. I… I just don’t want to be here.

[OFF CAMERA:] Well, I’m sorry to hear that. But just to make you more comfortable, your family is right outside the door if anything were to happen and I’m in no shape to block the door so if you really wanted to leave. Do you want to leave now?

[OFF CAMERA:] Do you feel safe at home?

[KRISTINA:] Sometimes.

[OFF CAMERA:] When do you feel safe?

[KRISTINA:] When my family is around. When there is someone I know is with me or in the next room. I like hearing the television on, somewhere in the house, just knowing I’m not alone.

[OFF CAMERA:] Are you afraid to be alone?

[KRISTINA:] Yes.

[OFF CAMERA:] What do you feel could happen?

[KRISTINA:] It… [She Cries]. That…

[OFF CAMERA:] Do you think it could happen again?

[She nods].

[OFF CAMERA:] From what I understand, the perpetrator, the man is in jail.

[KRISTINA:] I can’t. [She cries]. I see him. I feel it. It hurts. [Her voice quivers]. I don’t know. I… he could be, some one else… it could happen again. Please just can… can you please just ask me about something else.

[OFF CAMERA:] Okay. How have you been sleeping lately?

[KRISTINA:] I don’t sleep very well.

[OFF CAMERA:] Nightmares?

[KRISTINA:] Nightmares.

[OFF CAMERA:] What are your nightmares about?

[KRISTINA:] About him. [She cries]. That night. Everything that happened. I see every detail, it just replays in my mind, over and over and over. I can’t escape it. I wake up screaming, and even when I’m awake its still there, the presence of it, his breathe on my neck [She holds back tears as her voice quivers] and his hands on my skin. I can’t breathe. I can’t… I want it to go away, I want it to stop… But then there’s Josh.

[OFF CAMERA:] And who’s Josh?

[KRISTINA:] Josh is my boyfriend.

[OFF CAMERA:] And how do you feel with him?

[KRISTINA:] Wonderful… he’s truly wonderful. I don’t know what I’d do without him.

[OFF CAMERA:] What does he do when you have these nightmares?

[KRISTINA:] He wakes up too, of course. He usually holds me while I cry, gets me some water and some Advil. He stays with me until I can get to sleep, which usually doesn’t happen again, or won’t be for awhile. I just don’t know why he hasn’t left me though…

[OFF CAMERA:] Why do you feel he would want to leave you?

[She pauses].

[KRISTINA:] At first I wondered why he’d ever want me again. I dunno, it’s hard to… I hate to say it. It’s hard to express or to think it but… I… I just felt… tainted, poisoned… I have this guilt. If that makes sense?

[OFF CAMERA:] Of course, of course it makes sense. Most people have a horrible guilt over acts like these. But it’s really important for you to remember, you had no control over this. That this was just a random act of violence.

[KRISTINA:] But now… but now I’m just a terrible girlfriend.

[OFF CAMERA:] Why do you feel that way?

[KRISTINA:] I mean look at me. I need therapy. [She holds back tears]. I can’t go out of the house. I’m afraid to walk out the front door. I needed my dad, mom, sister, and boyfriend to get me into the car to come here. When I’m at home, I know I’m irritable, I cry a lot, and I just can’t function. And then there’s of course… I mean, our love life.

[OFF CAMERA:] So are you and Josh having difficulties with your relationship?

[KRISTINA:] I can’t have sex with him. He wants to but I can’t.

[OFF CAMERA:] What is it that happens?

[KRISTINA:] Every time he wants to… have sex, just the situation… it brings me right back to that moment! [She cries] It’s awful. He took away this act of love from me and… he made it vile.

[OFF CAMERA:] So any sex triggers that incident.

Yes.

[KRISTINA:] And I know he just wants to go to the movies, or dinner, have a normal relationship.

[OFF CAMERA:] And the same fears arise when he wants to go out with you?

[KRISTINA:] Movie theatres are dark and I just keep thinking someone is in the bathroom waiting for me, or he’ll be down an alley somewhere.

[OFF CAMERA:] And “he” is…

[KRISTINA:] Yes.

[OFF CAMERA:] Does Josh seem to mind that you can’t go out to dinner with him or a movie lately?

[KRISTINA:] No. I think he understands.

[OFF CAMERA:] What about work? What do you do?

[KRISTINA:] I did work at a clothing store. I sold clothing at a small boutique.

[OFF CAMERA:] You used that in the past tense. Do you still work there?

[KRISTINA:] Not since before… I want to. It’s not like I quit or I’m lazy.

[OFF CAMERA:] No, no, I am not saying that or thinking that. Please. Go ahead.

[KRISTINA:] I just can’t do it! I want my life back. I feel like it was stolen, everything was stolen.

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