This is a 25 year old African American female still grieving the loss of her mother who presents with fatigue, lack of appetite, sleep disturbances, suicidal ideations, and anhedonia.
Plan:
1. Suicidal Ideations: The patient revealed that she has thought about committing suicide once a week for the past 2-3 weeks. The patient has not created a plan to commit suicide, though. She states that what prevents her from committing suicide is that she does not want to put those around her through that. Possible causes for these thoughts are depression, bipolar disorder, substance abuse, depression secondary to hypothyroidism. With respect to assessment for depression or bipolar disorder, I would like to refer the patient to a psychiatrist
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2. Sleep Disturbances: The patient’s history also revealed issues falling asleep. Since the onset of these sleeping issues came about around the same time as the fatigue, the sleep disturbances may be contributing to the fatigue and it is important to see if fatigue remains in absence of the sleeping disturbances. Her sleep disturbances could be due to depression or primary insomnia. Evaluation for depression should be done by a psychiatrist immediately. The patient should keep a sleep diary to track her sleeping patterns, with an eye seeing if her fatigue is better on days where she gets better sleep. Given the patient’s fatigue, anhedonia, and affect cognitive-based therapy for her sleeping issues, although, the preferred way to treat primary insomnia, does not seem appropriate. Instead, for now, the patient should be prescribed a melatonin receptor agonist (Ramelteon) to assist her in getting to sleep, until the psychiatrist makes their evaluation, which may lead to reassessment of treatment.
Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008 Oct 15. 4(5):487-504.
3. Lack of appetite: Based on the history taken from the patient, she has a lack of appetite, going so far as to consuming just a grilled chicken sandwich and water over the course of an entire day. The lack of appetite came around the same time as her fatigue and may play a role in it. Her
She just feels like she is always at the same level, never feeling happy, but never feeling super sad. She has no suicidal or homicidal ideations now or in the past. She has never been previously evaluated for depression. She admits to feeling very tired, even if she gets enough sleep. She has previously been evaluated by a physician in New York, though not for depression, more for the fatigue, and reportedly the investigation including laboratory studies with thyroid, a metabolic panel everything looked normal. She says that in addition to this symptom, she has had constipation that she has been dealing with for the last couple of years, which she has not again has not discussed with the physician, but more tries to deal with on her own. No blood in her stool, no abdominal pain associated with it. She also has had a five-pound weight gain in the last year as well, despite no changes in her appetite or diet. She does have a family history of thyroid disease in her paternal grandmother and is interested in evaluating that
The client’s primary care physician is Dr. Damian Covington. The client does not currently have a psychiatrist.
Using the symptoms check list, the client recalls feeling the following daily: overly sad, uncontrollable crying, easily irritated, difficulty concentrating and making decisions, loss of interest in things she once
Medical: Wellness Coach asked Mr. Hallet how was his day and he said he was doing well. He also express that he been taking his medication but the sleep pills is causing to have irregular patterns of sleep. Mr. Hallet has been falling to sleep everywhere even while traveling on public transportation. He also stated that the sleep pills are causing him to even fall asleep during the work hours. Wellness Coach and Family Counselor Clair Arzon discuss with Mr. Hallet that maybe creating sleep pattern will then decrease the irregular sleeping. He express that he has tried everything. Family Counselor Ms. Arzon inform Mr. Hallet to try not taking the sleeping pills for a few days to see how his sleep habits will be. If he gets sleepy then to take walks or drink water to help keep Mr. Hallet up during the day and when bedtime come try turning the TV off therefore you can relax.
R.A. is a 12-year-old female who was admitted to Presbyterian Kaseman Mental Health facility on February 26, 2016. She was initially brought into the emergency department by her mother for cutting (self-mutilation). Patient had sent long text messages to mother with thoughts of wanting to die, the world would be better without her, feeling lost, and has memories that she had declined to talk about. She described feeling overwhelmed, not able to focus, depressed, anxious and that her thoughts were continuously racing prior to be admitted. Patient lives with her mother and pregnant sister and has a history of self-mutilation and marijuana use. The patient’s Axis I diagnosis on admission was major depressive disorder (MDD),
Ms. Simons is a 47 year old female who presented to the ED experiencing symptoms of psychosis and suicidal ideation without a plan. At the time of the assessment Ms. Simons reports experiencing depressive symptoms that has worsen over the course of the past week. She reports her best friend died around this time in 2014 and she was the one that found her body. Ms. Simons reports the anniversary of the death of her best friend as the primary stressors contributing to her distress. She express depressive symptoms as: feelings of hopelessness, sadness, tearfulness, isolation, insomnia (2-3 hours of sleep) over course of the past few weeks, and irritability. Ms. Simons states, "I had a knife in my hand today and had a plan to stab myself in the
Insomnia is the most common sleep disorder. It can have a devastating impact on one’s emotion, physical, occupation and social life. While it occasionally can be seen in the clinical setting as a primary diagnosis, it most often presents as a comorbidity to a medical or psychiatric issue;
It would be appreciated if you could arrange an appointment with Sam, 24-year-old PhD student who reports sleep onset insomnia, sleep fragmentation and poor quality sleep. Sam has undergone a couple of sleep studies that have not identified any specific disorder aside from a raised arousal index that that led to another sleep study and commencing him in Lyrica and melatonin. Sam has found these medications somewhat beneficial, but continues to report some sleep disruption and daytime fatigue. Your assessment would be appreciated.
Medication non-adherence, also called medication noncompliance, is a concern in virtually every medical condition. Overall, approximately 24% of patients do not adhere to their medication regimen. This non-adherence rate skyrockets when the condition is chronic, and is even higher when the illness is a severe mental illness (American Pharmacists Association, 2013). Bipolar disorder is a severe mental illness that has one of the highest non-adherence rates, up to 65% (American Pharmacists Association, 2013). The reasons for this non-adherence are multi-faceted. Some reasons are common to all non-adherence, and others are specifically related to the nature of bipolar disorder itself. Medication compliance is of utmost importance in the
Chief Complaint (CC): Difficulty sleeping History of Present Illness (HPI): S. M. was 73-year-old Caucasian female seen in the office for CC of difficulty sleeping for the last three months. She stated that she could fall asleep, although has difficulty staying asleep. This occurs most nights and states the frequency is 5 out of 7 days of the week. She has been getting 2-5 hours of sleep during the night and usually wakes up at least once during the night.
Insomnia is one of the sleep-wake disorders and affects millions on a daily basis. Individuals affected by insomnia can have trouble falling asleep, staying asleep, and/or having non-restorative sleep. According to the American Psychiatric Association, insomnia symptoms are reported by one-third of all adults and 10-15% of those adults experience daytime impairments related to insomnia while 6-10% of them actually meet the criteria for insomnia disorder (2013, p. 364-365). The occurrence of insomnia is more prevalent in women, older adults, shift workers, those of lower socioeconomic status, and “those with poor physical and mental” (Morin, 2010). It can result from several causes, some of which include life stressors such as divorce and job loss, other psychological or medical disorders, environmental changes, and age. Cognitive-behavioral therapy (CBT), medication, or a combination of the two is used in treating insomnia.
Patient refers she sleeps “like a baby”. She denies the need of any sleeping pill. She sleeps 7 to 8 hours, does not regularly gets up in the middle of the night. She verbalizes usually wake up in the morning well rested. Patient refers to be a very independent, confident and social active person.
She reports suicidal and homicidal ideations in the past. She denies any such ideations currently. She currently feels hopeless, helpless, full of guilt and worthless. Her energy levels are low. She reports that she does not like sexual activity.
ST came to the clinic with a complaint of insomnia. In the treatment plan for insomnia, the aim is not only to help the individual achieve a restful sleep but, to find out the cause of insomnia. Since anxiety and depression are two of the most common causes of chronic insomnia (Robinson, Smith & Segal, 2016). Firstly, I will evaluate ST for anxiety and depression. For anxiety, I could use the Generalized Anxiety Disorder (GAD-7). This is a 7-question screening tool that identifies whether a complete assessment for anxiety is indicated (CIHS, N.D). For depression I will use Patient Health Questionnaire (PHQ-9) which is the most common screening tool used to identify possible diagnosis of depression and the severity in at-risk population
When asked to conduct an exploration paper regarding a specific disorder including treatment, complicated issues, opinions, and reactions, my disorder of choice is Idiopathic Hypersomnia (IH). IH by definition according to MedlinePlus is “a sleep disorder in which a person is excessively sleepy (hypersomnia) during the day and has great difficulty being awakened from sleep. Idiopathic means there is not a clear cause.” The interesting thing about IH is that it is closely related to a similar sleep disorder called narcolepsy, but lacks the research and information of other sleep disorders (hence the term idiopathic). This sleep disorder came to existence around 1966 when William Dement suggested that those with excessive