HISTORY OF PRESENT ILLNESS:
A 35-year-old male presents to the psychiatric emergency department for psychiatric evaluation. The client was sent directly from his PCP’s office. That morning, the client and his wife presented to the PCP’s office without an appointment, with a chief complaint of “being overwhelmingly depressed.” The client has developed a plan to die by suicide, which included taking a bottle of Tylenol and drinking “as much vodka as it takes.” The internist performed a thorough evaluation, drew labs, and called 911 to bring the client to the Emergency Department.
When the PMHNP encounters the client, the client is visibly upset and clinging to his wife. The couple explains that they separated a month ago because the client “just couldn’t be a husband anymore.” Over the past four weeks, he has become isolated and has complained of decreased energy, concentration, appetite, and sleep. He lost his job as a house painter four months earlier. The client no longer enjoys taking care of the couple’s two children, ages 4 and 6—a drastic change from the role he has previously enjoyed as a father.
The PMHNP asked the client when he first began feeling down. He states, “When my mother died one and a half years ago.” He says that he has been feeling guilty over the circumstances of her death and wishing he had been closer to her in the years preceding her death. The wife notes with concern: “That was just about the time you started drinking so heavily, as well.” As you question further, you determine that the client has been drinking daily since his mother’s death. He estimates that he drinks six beers a day. He admits that drinking is a problem, and he tried to stop drinking two weeks before this visit. The client says: “My wife kicked me out of the house, I missed my kids, I didn’t have a job…I knew something was wrong.” He notes that in the days after he stopped drinking, he experienced some shakiness and felt “like there were bugs under my skin.” He added that having a beer made these symptoms subside. Last night he became distraught after calling his wife to check on the children and finding they were not home. He sat in his hotel room and thought, “I can’t go on living like this.” He called his wife at 6 a.m. the next day and said he thought he might kill himself. She immediately brought him to the internist’s office.
PAST PSYCHIATRIC HISTORY:
The client has never seen a psychiatric provider or been hospitalized for a psychiatric diagnosis. He recalls having been depressed only once earlier in his life, during his 20s, but he did not seek treatment at that time. Although the client is currently suicidal, he denies any past suicidal thinking and has never made previous suicide attempts.
PAST MEDICAL HISTORY:
MEDICATIONS: Hydrochlorothiazide 25 mg po daily
The client’s father has a history of alcohol dependence, and his mother had hypertension and coronary artery disease before dying of myocardial infarction at age 60. The client denies any Hx of psychiatric illness in his family.
SUBSTANCE ABUSE HX:
The client has been drinking six beers/day for the past year and a half; before that, he was not drinking daily. He has a remote history of similar drinking in his 20s during his first divorce, but he was able to quit “cold turkey” and has never been to any detox facility. He experienced symptoms of withdrawal when he quit, no history of withdrawal seizures. He denies using marijuana, heroin, cocaine, or other substances. He smokes ½ pk per day of cigarettes.
The client describes his childhood as “chaotic.” Reports his father was “unpredictable” because of his drinking. The client graduated from high school and then went to vocational school. He became a house painter and worked sporadically. He was married in his early 20s and has a 17 y/o daughter who is being raised by her mother, his first wife. He married his current wife 8 yrs. ago; the marriage was functioning well until recently.
MENTAL STATUS EXAM:
The client is a white male who appears exhausted and mildly disheveled in a sweatshirt, baseball cap, and jeans. He frequently becomes teary throughout the evaluation and has poor eye contact, although he is cooperative during the interview. His stature is slumped, even seated in the chair, and he often leans forward and hides his face in his hands. His speech is notable for increased latency and paucity of words. His affect is dysphoric, congruent with the context of the discussion, and does not brighten throughout the interview. His thought process is linear and logical, and his thought content is preoccupied with his mother’s death. The client has no overt delusions; he denies ideas of reference and paranoid ideation. He also denies hallucinations. He is experiencing suicidal ideation with intent and plan but denied homicidal ideations.
His insight and judgment are fair at this moment in that he knows he needs treatment. The cognitive exam is grossly intact.
Alcohol level= 130; AST = 68 IU/L; ALT = 45 IU/L; GGT= 35U/L; other liver function tests are WNL.
Hemoglobin =13.4; hematocrit = 41; MCV =95; triglycerides = 200 mg/dl.
Alcohol Use Disorder (F 10.20)
Major Depressive Disorder, single episode, severe without psychotic features (F32.2)
1. Select one psych drug to treat the diagnosis of “alcohol use disorder and major depressive disorder, single episode, sever without psychotic features. Based on the provided information above. Please review all information to come up with an appropriate psych drug that can be prescribed with alcohol use. Please do not use Sertraline.
2. List medication class and mechanism of action for the psych drug chosen medication.
3. Write the prescription in prescription format.
4. Provide an evidence-based rationale for the selected medication using at least three scholarly references.
5. List any side effects or adverse effects associated with the medication you choose.
6. Include any required diagnostic testing. State the time frame for this testing (testing is before medication initiation or q 3 months, etc.). Includes normal results range for any listed laboratory tests.
1. Provide a minimum of three appropriate medication-related teaching points for the client and/or family. Cite a scholarly source. Accurately analyze, synthesize, and/or apply principles from evidence.
2. Cite all references and provide references for all citations.
Compelling correspondence is essential to the achievement all things considered but since of the changing idea of the present working environments, successful correspondence turns out to be more troublesome, and because of the numerous impediments that will permit beneficiaries to acknowledge the plan of the sender It is restricted. Misguided judgments.In spite of the fact that correspondence inside the association is rarely completely open, numerous straightforward arrangements can be executed to advance the effect of these hindrances.
Concerning specific contextual analysis, two significant correspondence standards, correspondence channel determination and commotion are self-evident. This course presents the standards of correspondence, the act of general correspondence, and different speculations to all the more likely comprehend the correspondence exchanges experienced in regular daily existence. The standards and practices that you learn in this course give the premise to additionally learning and correspondence.
This course starts with an outline of the correspondence cycle, the method of reasoning and hypothesis. In resulting modules of the course, we will look at explicit use of relational connections in close to home and expert life. These incorporate relational correspondence, bunch correspondence and dynamic, authoritative correspondence in the work environment or relational correspondence. Rule of Business Communication In request to make correspondence viable, it is important to follow a few rules and standards. Seven of them are fundamental and applicable, and these are clear, finished, brief, obliging, right, thought to be, concrete. These standards are frequently called 7C for business correspondence. The subtleties of these correspondence standards are examined underneath: Politeness Principle: When conveying, we should build up a cordial relationship with every individual who sends data to us.
To be inviting and polite is indistinguishable, and politeness requires an insightful and amicable activity against others. Axioms are notable that gracious “pay of graciousness is the main thing to win everything”. Correspondence staff ought to consistently remember this. The accompanying standards may assist with improving courtesy:Preliminary considering correspondence with family All glad families have the mystery of progress. This achievement originates from a strong establishment of closeness and closeness. Indeed, through private correspondence these cozy family connections become all the more intently. Correspondence is the foundation of different affiliations, building solid partners of obedient devotion, improving family way of life, and assisting with accomplishing satisfaction (Gosche, p. 1). In any case, so as to keep up an amicable relationship, a few families experienced tumultuous encounters. Correspondence in the family is an intricate and alluring marvel. Correspondence between families isn’t restricted to single messages between families or verbal correspondence.
It is a unique cycle that oversees force, closeness and limits, cohesiveness and flexibility of route frameworks, and makes pictures, topics, stories, ceremonies, rules, jobs, making implications, making a feeling of family life An intelligent cycle that makes a model. This model has passed ages. Notwithstanding the view as a family and family automatic framework, one of the greatest exploration establishments in between family correspondence centers around a family correspondence model. Family correspondence model (FCP) hypothesis clarifies why families impart in their own specific manner dependent on one another ‘s psychological direction. Early FCP research established in media research is keen on how families handle broad communications data. Family correspondence was perceived as an exceptional scholastic exploration field by the National Communications Association in 1989. Family correspondence researchers were at first impacted by family research, social brain science, and relational hypothesis, before long built up the hypothesis and began research in a family framework zeroed in on a significant job. Until 2001, the primary issue of the Family Communication Research Journal, Family Communication Magazine, was given. Family correspondence is more than the field of correspondence analysts in the family. Examination on family correspondence is normally done by individuals in brain science, humanism, and family research, to give some examples models. However, as the popular family correspondence researcher Leslie Baxter stated, it is the focal point of this intelligent semantic creation measure making the grant of family correspondence special. In the field of in-home correspondence, correspondence is normally not founded on autonomous messages from one sender to one beneficiary, yet dependent on the dynamic interdependency of data shared among families It is conceptualized. The focal point of this methodology is on the shared trait of semantic development inside family frameworks. As such, producing doesn’t happen in vacuum, however it happens in a wide scope of ages and social exchange.
Standards are rules end up being followed when performing work to agree to a given objective. Hierarchical achievement relies significantly upon compelling correspondence. So as to successfully impart, it is important to follow a few standards and rules. Coming up next are rules to guarantee powerful correspondence: clearness: lucidity of data is a significant guideline of correspondence. For beneficiaries to know the message plainly, the messages ought to be sorted out in a basic language. To guarantee that beneficiaries can without much of a stretch comprehend the importance of the message, the sender needs to impart unmistakably and unhesitatingly so the beneficiary can plainly and unquestionably comprehend the data.>