Case Study: Psychiatric Evaluation Lisa Tremblay
Name: Lisa Tremblay
Age: 33 years old
T- 100.0 P- 108 R 20 180/110 Ht 5’6 Wt 146lbs
Background: Lisa is in a Naples, FL detox facility thinking about long term rehab. She is
considering treatment for her Hep C+ but needs to get clean first. She has been abusing opiates,
approximately $100 daily. She admits to cannabis 1–2 times weekly (“I have a medical card”),
and 1/2 gallon of vodka daily. She has past drug paraphernalia possession arrest. Her admission
labs. abnormal for ALT 168 AST 200 ALK 250; bilirubin 2.5, albumin 3.0; her GGT is 59; UDS
positive for opiates, THC. Positive for alcohol or other drugs. BAL .308; other labs within
normal ranges. She reports sexual abuse as child ages 6-9 perpetrator being her father who went
to prison for the abuse and drug charges. She is estranged from him. Mother lives in Maine, hx
of agoraphobia and benzodiazepine abuse. Older brother has not contact with family in last 10
years, hx of opioid use. Sleeps 5-6 hrs., appetite decreased, prefers to get high instead of eating.
Incorporate the following into your responses in the template:
Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
Objective: What observations did you make during the psychiatric assessment?
Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
Case Study: Psychiatric Evaluation Lisa Tremblay
Lisa's alcohol and opiate addiction is the main issue raised in the case study. She is considering treatment for her Hep C+ but needs to get clean first. She has been spending about $100 each day on her opiate abuse. She admits to using cannabis once or twice a week ("I have a medical certificate") and drinking half a gallon of vodka every day. Lisa, 33 years old, presently resides at a detox center in Naples, Florida. She has to become clean before contemplating therapy for her Hep C+. Every day, Lisa has been misusing opiates, spending about $100. She also acknowledges using cannabis once or twice a week and consuming half a gallon of vodka daily. Her admission test results are abnormal for ALT (168), AST (200), ALK (250), bilirubin (2.5), albumin (3.0), GGT (59), and opiates and THC (UDS positive). Lisa tests positive for drugs or alcohol. BAL.308; all other labs fall below acceptable limits. She claims that her father, who was jailed for the abuse and drug crimes, sexually abused her between 6 and 9. He and she are no longer close. She has a mother who resides in Maine and who has abused benzodiazepines in the past. Her elder brother, who has a history of opiate usage, hasn't spoken to the family in ten years. Lisa has a reduced appetite and sleeps 5 to 6 hours each night. She would instead get high than eat. She is allergic to azithromycin. Lisa's symptoms are having a variety of effects on how she lives her life. She is spending a lot of money on drugs daily due to her drug usage, which is probably affecting her capacity to pay for other vital costs. She is also sleeping less due to her drug usage, which may affect her capacity to operate throughout the day. Her medication usage also affects her appetite, resulting in malnutrition and weight loss. The fact that she is using drugs to feel euphoric rather than hungry might affect her capacity to make healthy eating decisions.
Lisa, a 33-year-old woman at a detox center in Naples, Florida, is considering going to long-term rehab. She has a history of opiate abuse and tests positive for alcohol, THC, and opiates. She also has Hep C+, according to the diagnosis. ALT, AST, ALK, bilirubin, and albumin are all abnormal at Lisa's admission labs; her GGT is 59. Her UDS results for opiates and THC are also positive. Positive for drugs or alcohol. Other labs within normal ranges; BAL.308 Additionally, she has a diminished appetite and chooses to get high rather than eat. Lisa also claims that her father, who is currently in jail on cruelty and drug-related charges, sexually molested her when she was a youngster. He and she are no longer close. She has a mother who resides in Maine and who has abused benzodiazepines in the past. Her elder brother, who has a history of opiate usage, hasn't spoken to the family in ten years.
The patient is confused and bewildered, according to the results of the mental state assessment. She is also nervous and worried. She speaks slurred and makes little eye contact. Her pupils are dilated, and she is sweating. She has a horrible feeling of balance and is trembling as well.
1) Opioid Use Disorder
2) Alcohol Use Disorder
3) Cannabis Use Disorder
Opioid Use Disorder
Patterns of problematic opioid usage causes seriously impair or distress. An opioid use disorder is indicated by ongoing attempts to reduce or manage opioid use, frequent failures to do so, and spending a lot of time on necessary tasks (Dydyk et al., 2022). This occurs during a 12-month time frame. (Dydyk et al., 2022). The diminished ability to recover from opioid use, craving or a strong need to use opioids, and recurring opioid use those results in failure to perform significant role commitments at work, school, or home all serve as additional indicators that the disease exists (American Psychiatric Association, 2022). Therefore, based on the evidence of the manifestation and evidence from the information provided in the case study, the evidence ruled out Opioid Use Disorder as a significant disorder.
Alcohol Use Disorder
As anxiety disorder does not entail recurrent alcohol use despite adverse effects, it cannot be diagnosed according to the DSM-5-TR diagnostic criteria for alcohol consumption disorder (American Psychiatric Association, 2022). Likewise, since opioid use disorder does not entail compulsive alcohol consumption, it cannot be diagnosed using the DSM-5-TR diagnostic criteria for alcohol use disorder.
Cannabis Use Disorder
Because alcohol consumption disorder does not feature persistent fear or concern, it cannot be diagnosed using the DSM-5-TR diagnostic criteria for anxiety disorder (American Psychiatric Association, 2022). Since opioid use disorder does not contain chronic fear or worry, it is likewise excluded from the diagnosis under the DSM-5-TR diagnostic criteria for anxiety disorders.
The Critical Thinking Framework
The patient's stated symptoms and the findings of the laboratory tests guided my critical thinking process, which ultimately resulted in the primary diagnosis of opioid use disorder. The patient acknowledged daily opioid usage, a vital sign of opioid use disorder. The patient's test findings also revealed high levels of ALT, AST, and bilirubin, all of which are signs of liver impairment. Additionally, supporting the diagnosis of an opioid use disorder, the patient's urine drug test revealed positive results for opioids.
What can be done differently?
If I were allowed to conduct the session, I would focus more on Lisa's history. Some of Lisa's historical perspectives that I would focus on are Lisa's sexual abuse history and her relationship with her father. Much appears to be unexploited about Lisa's relationship with their father. I would also focus on Lisa's drug involvement and her trauma history. I would also engage Lisa in the identification of her family history and her relationship with the family members the family appears to have played a critical role in her present condition. Lastly, I would engage Lisa in identifying other treatment options and teach her the importance of keeping clean.
To assist Lisa in getting clean and concentrate on health promotion and disease prevention techniques, including creating a good sleep routine, enhancing her diet, and offering her support to prevent relapse (Worrall et al., 2018). Her drug participation will decrease thanks to a healthy diet, and the strategy's long-term effect will be a decrease in addiction. Additionally, it works well to provide Lisa access to tools for reducing distraction and dealing with her experience of sexual assault. Therapy sessions, periodic mental checks, and support groups that enable sharing and problem-solving can all be used as interventions to lessen Lisa's mental load. All the provided interventions have the end objective of improving Lisa’s condition.
When dealing with Lisa, there are a few moral and legal factors to consider. First, when dealing with her and offering therapy, it will be essential to consider her history of sexual abuse. It is crucial to ensure she feels safe and at ease sharing her experiences and can get any assistance or resources she might require. When choosing the appropriate course of treatment for her, it will also be necessary to evaluate her history of substance misuse (Haddad & Geiger, 2021). Additionally, her mental health history will need to be considered while offering therapy.
PMH and other risk factors
Lisa has a substance abuse, mental issue, and traumatic history, and her family background has played a role in the issue. Lisa comes from a family with a history of substance abuse and mental illnesses. Lisa's father was very abusive, and her mother has agoraphobia. In addition, Lisa has an older brother who is estranged from the family and has a history of substance abuse. The family has therefore played a significant role in the condition's manifestation (Newnham et al., 2022). A family, therefore, plays a role in developing some conditions.
American Psychiatric Association. (2022). Psychiatry.org - DSM. Psychiatry.org. https://psychiatry.org/psychiatrists/practice/dsm
Dydyk, A. M., Jain, N. K., & Gupta, M. (2022). Opioid Use Disorder. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553166/#:~:text=Opioid%20use%20disorder%20includes%20dependence
Haddad, L. M., & Geiger, R. A. (2021). Nursing Ethical Considerations. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526054/#:~:text=There%20are%20four%20main%20principles
Newnham, E. A., Chen, Y., Gibbs, L., Dzidic, P. L., Guragain, B., Balsari, S., Mergelsberg, E. L. P., & Leaning, J. (2022). The Mental Health Implications of Domestic Violence During COVID-19. International Journal of Public Health, 66. https://doi.org/10.3389/ijph.2021.1604240
Worrall, H., Yuan, L., Lloyd, C., Worrall, H., Schweizer, R., & Yuan, L. (2018). The effectiveness of support groups: a literature review Publication Details. https://ro.uow.edu.au/cgi/viewcontent.cgi?article=6502&context=smhpapers
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