Mr. C is a 35-year-old Hispanic male with a long-standing history of . He was admitted to an inpatient psychiatric facility following a severe suicide attempt. He stated that he had been feeling progressively more depressed during the past three months and had been having an increase in suicidal thoughts over the past week. He felt tired most of the time and had problems concentrating. He felt hopeless about his life, found his job and personal life unfulfilling, and worried a lot about his critical financial situation. He was unable to think about reasons to continue living even though he has an extensive family living close by and several children from other partners. A few days prior to his admission, he went to a local casino for the first time in a few years and lost a significant amount of money. He then went back home, drank eight beers, and slit his wrists. He was found by a friend who stopped by the patient’s house to ask him to pay back some money he’d loaned the patient.
The patient was brought to the hospital by ambulance, was medically stabilized, and was sent to the psychiatric unit. He reported passive suicidal ideation but felt safe in the hospital. Denied any homicidal ideation, thought, or plan, as well as any psychotic symptoms. Denied recent use of illicit drugs but admitted to having weed once every six months and drinking two beers and a couple shots of whiskey per day on a regular basis. Denied any past history of withdrawal symptoms.
Psych Hx: Some elementary school problems with bullying and resulting encounters with school counselor. Also showed increasing problems with lying and stealing as a youngster. Recommended mental health counseling, but parents never followed up.
One previous suicide attempt at age 27 resulting in three-day hospital stay. Intermittently compliant with outpatient treatment. Stopped taking escitalopram 20mg several months ago because of sexual side effects.
Substances: Extensive abuse of cocaine since age 16. Drinking since age 14-15, mostly beer and whiskey. Has tried rehab several times but relapses shortly afterwards. No history of withdrawal. Currently doesn’t see his alcohol use as a problem and denies using any cocaine for the past two years, saying “it costs too much.”
Legal: Two DUIs. Served six months for robbing a convenience store. Frequent arguments and fights which have necessitated police involvement but no arrests. Denies significant problems with gambling except for most recent event, during which he lost a lot of money.
Family Psych Hx: Mother diagnosed with bipolar and somatization ; father has history of alcoholism.
Social Hx: Third of four boys. Parents divorced when he was 5 years old. Inconsistent contact with father after that. Remembers father as drunk and physically abusive much of the time. Some trouble in school; kicked out after cheating incident. Never returned and only finished 11th grade. Never married, but many relationships, often short-lived, with three children that he knows of. Little contact with any of them. Works as truck driver. Has moved to several different places, often as a result of “trouble with paying back debts.”
Medical Hx: Overweight, denies any medical issues. ED visit following accidental overdose of cocaine. Thought he was having an MI.
• Total Cholesterol: 220
• Triglycerides: 172
• SGOT (AST): 48
• SGPT (ALT): 36
• HGB: 16.5gm/dl
• HCT: 45%
• Na: 134
• K: 3.2
• Free T4: 1.1
• TSH: 3.2
During his hospital stay, the patient presented as rather calm and charming with other patients. Always agreeable but gave little history about himself. Would not participate in divulging personal details of his life or talk about ways in which he might change in order to live a happier life. Seemed to always redirect the conversation to irrelevant subjects unrelated to his treatment. Mood and affect improved significantly over the course of his stay.
Based on the case history, answer the following questions. Use APA format with a minimum of three evidence-based journal articles to support your answers and reference accordingly. Your of this case should be in depth and demonstrate advanced understanding of the psychodynamic, psychobiological, and psychosocial factors relevant in this case. Format your paper so that it is clearly noted which questions are being addressed. Per APA, please use headings.
- What is your diagnostic formulation? How does the diagnosis(es) meet DSM criteria?
- What are your rule-outs (differentials)?
- What screening/assessment tools would you use (if any) and why?
- Discuss the etiology of your major psychiatric diagnosis(es) and the psychological underpinnings.
- Discuss the epidemiology associated with your diagnostic formulation.
- Discuss medical concerns (if any) and suggested interventions.
- What would be your therapeutic interventions while the patient is in the hospital? Outpatient? Include both psychotherapeutic and psychopharmacologic interventions. Be specific and evidence based when determining your treatment strategies.
- Discuss key points that might be considered when interviewing this patient considering his diagnosis(es).
- What should you keep in mind about counter-transference issues that might come up with this type of client? How would you manage your feelings and minimize impact on the therapeutic process?
- Give the prognostic factors associated with your diagnostic formulation.
- Discuss the risk assessment for this gentleman.
- As a resource for nursing staff, what factors would you keep in mind when consulting with them around the care of this ?