Discussion: Impulsive Disorder Case Study

Discussion: Impulsive Disorder Case Study

Discussion: Impulsive Disorder Case Study

Question One

A tantrum of not being able to go out with her boyfriend at age 11 is one indication of the impulsive disorder. She was unable to accept that she was too young and needed the guidance of her parents. She looked not be satisfied with her life and wanted to try out new things despite her parents’ advice. She was also aggressive and could easily fight her father after coming home late. Her behavior describes the psychopathologies that surround impulsive disorder.

Discussion: Impulsive Disorder Case Study

Impulsive disorder is characterized by the inability to consider other people’s opinions even when one is entirely wrong (Sadock,  Sadock & Ruiz, 2014). It involves one wanting their views to get satisfied most of the time. Sometimes, one may think that they are overwhelmed with the superego and the id since their interests are uncontrollable. They cannot resist their temptations which tend to dominate them.

She has lost control over problematic behavior, which means that she does not have the sense of reason concerning her problem and the ability to act appropriately. She has lost the ability to think correctly towards handling most of her mental issues, which influences her ability to function correctly. She also craves for the previously potentially bad behavior, which includes getting over their problems whereby they cannot check on most of the activities and interests that are not appropriate in determining their problems. They have lost control over their behaviors and are not ready to get over their problems whenever there is a need. She is not able to control her drinking despite being young and trials of control by her parents.

Question Two

The co-morbid factor that leads to Kara’s problem is the alcohol intake which shows that she could also be a drug addict. She is unable to control herself since she is not sober most of the time. Possible, getting an approach towards controlling her alcohol intake could be the first step towards determining the most appropriate therapy for her (Jakubczyk et al.,2018). She does not have the power to control herself, which could negatively impact her. Alcohol tends to acutely increase impulsivity which leads to worsened conditions of the victim (Wegmann, Müller, Turel & Brand, 2020). Kara is an adolescent, which means that she could be occasionally impulsive due to the changes in their physical appearance and feel that her parents do not give her space.  The impacts of alcohol can be worsened by the pre-existing state leading to impulsive disorder.

The adolescent age bracket and parenting also present a factor that leads to impulsive disorder. Most adolescents feel that their parents do not understand them, which makes most of the rebellious. To some people, the rebellious nature could be over-expressed, which means that they may not be able to have the correct expressions of the necessary symptoms to evaluate them. Kara could be a victim of assault or poor parenting through the expression that she fights her father. She could have grown to be rebellious to her parents that she resought to defend herself in a disagreement. She could also be  a victim of peer influence since she started spending time with those who are older than her when she was 13 years old.

References for Discussion: Impulsive Disorder Case Study

Jakubczyk, A., Trucco, E. M., Kopera, M., Kobyliński, P., Suszek, H., Fudalej, S., … & Wojnar, M. (2018). The association between impulsivity, emotion regulation, and symptoms of alcohol use disorder. Journal of substance abuse treatment, 91, 49-56. https://doi.org/10.1016/j.jsat.2018.05.004

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Baltimore, MD: Wolters Kluwer/Lippincott Williams & Wilkins Co. ISBN 9781609139711

Wegmann, E., Müller, S. M., Turel, O., & Brand, M. (2020). Interactions of impulsivity, general executive functions, and specific inhibitory control explain symptoms of social-networks-use disorder: An experimental study. Scientific reports, 10(1), 1-12.

Instructions – NURU-644: The Psychiatric Diagnostic Evaluation for Weeks 3, 5 (100 points) and Week 7 Signature Assignment (250 points)

CLOs 1-6

The Psychiatric Diagnostic Formulation is due 3 times throughout this semester – weeks 3, 5, and

  1. It is to be submitted as a written paper (with title page and references per APA 7) into Blackboard except for the final one which is submitted to the Live Text website, www.livetext.com. The worksheet should NOT be included in the paper but is meant to be used as a guide.

This is the form you may use to help you create a formal Psychiatric Diagnostic Evaluation; it is NOT to be turned in with your assignment but just used as a guide. Following the information gleaned from a patient interview, staff or family input, and chart review; follow this outline and submit the final Psychiatric Diagnostic Evaluation, in narrative form, utilizing the worksheet (as a guide only). It should be submitted as a Word document in APA 7 format. The table includes the elements to help fulfill these assignments. Go to the instructions for what to include in each section of the notes which we used in NURU 643.

Each one of the 3 Case Formulations are to be on a different age group: you will need one on the child (which is the SA due in week 7), one on the adolescent (in week 3), one on the adult or geriatric patient (in week 5). Each one will have something different at the end specific to that population that you will include either as part of the assessment or after the workup in the form of a discussion about the case. References are required for this section of your paper and then should be no more than 5 years old unless they are classics (Erikson’s developmental stages).

Worksheet for Psychiatric Diagnostic Evaluation

AUTHOR /SOURCE OF CASE PRESENTATION
Identifying data – Do notinclude any real identifying data. No names, no locations
SUMMARY (Up to 150words summarizing the case presentation and outcome.)
BACKGROUND (Why doyou think this case is important-why did you decide to write it up?)
CASE PRESENTATION(Presenting features, medical/social/family history.)

Demographics should include: age, sex, who they live with, who they are accompanied by for your interview, who referred them to you. Payor source.

Source and reliability
Chief Complaint of Patient:
History of Present Illness
Current Medications
Past Psychiatric History
Past Psychiatric Medications
Substance Use/Abuse Assessment
Medical History
Allergies
Family History – Psychiatric and Addiction History. (Include Medical if Pertinent)
Developmental and Social
History
MSE:
Appearance and behavior
Motor activity
Speech
Mood
Affect
Thought content (sensorium)
Thought process
Perceptual disturbances
Cognition
Abstract Reasoning
Concentration
Impulsivity
Insight
Judgment
Threat to self or others
Motivation
Assets and Liabilities
PHYSICAL EXAMFINDINGS (Areas of concern; address positives only) Focused and as appropriate only. Do not include entire PE unless it can be justified by patient presentation. Discussion: Impulsive Disorder Case Study
General:
HEENT:
Neck:
Chest/Lungs:
Cardiovascular
Abdomen:
Musculoskeletal:
Neurological:
Genital/Rectal:
DIAGNOSTIC TESTS
CASE FORMULATIONDIFFERENTIAL DIAGNOSIS Formulation of diagnosis, Justification for diagnosis (what is your
thinking?) –DIAGNOSIS: (Include ICD 10 codes)
 Treatment Plan: Include all pertinent aspects here…..
  • Pharmacology
·       Diagnostic/Lab Work if indicated·       Evidence-Based Non-Pharmacological Interventions

·       Patient and Family Education

·       Referrals

 

PSYCHOTHERAPY TREATMENT PLAN: Create a treatment plan regarding psychotherapy with 3 specific items.

1):

2)

3)

 

Must include justification and references for your decisions and suggestions

OUTCOME AND FOLLOW-UP
DISCUSSION: Discuss case hypothesis and how it fits into the treatment plan including the psychotherapy aspects
Signature and Date
LEARNING POINTS (3-5 bullet points outlining key learning in this case.)
Strengths and deficits of Write Up
REFERENCES (APA 7 formatting, current within past 5 years.)

 

Child

Include in your assessment a work-up and/or questions for child specific disorders. What diagnostic tests/screening tools would you use for the child?

Include in your treatment plan specific types of therapy that are used when working with children.

Address in your narrative how family structure and dynamics affects the diagnosis and treatment of children. What are the family dynamics for this patient and how does it affect the mental status of this child.

What developmental stage should the child be in based on chronological age and is the child in that stage?

Address parenting styles that you observed with your patient and the family and whether these were working or not working.

How does culture affect the diagnosis and treatment plan for this child?

Adolescent

Include in your assessment a work-up and/or questions for adolescent specific disorders. What diagnostic tests/screening tools would you use for the adolescent?

Include in your treatment plan specific types of therapy that are used when working with adolescent.

Address in your narrative how family structure and dynamics affects the diagnosis and treatment of this adolescent. What are the family dynamics for this patient and how does it affect the mental status of this adolescent.

What developmental stage should the patient be in based on chronological age and is the patient in that stage?

Address parenting styles that you observed with your patient and the family and whether these were working or not working.

What is the ethical considerations when working with teens – how much do you share with the parents, do you have the parents in the room with you the whole time you are talking to the patient, who do you talk to first when they come in with a problem? What happens when they leave the nest?

Adults

Include in your assessment a genogram – minimum of 3 generations back from the patient and if they have children or grandchildren then also going forward. Watch for patterns.

Include in your treatment plan specific types of therapy that are used when working with adults with the diagnosis you have chosen.

Address in your narrative how family structure and dynamics affects the diagnosis and treatment of your patient. What are the family dynamics for this patient and how does it affect the mental status of this patient. Discussion: Impulsive Disorder Case Study

What developmental stage should the patient be in based on chronological age and is the patient in that stage?

Address parenting styles that you observed with your patient and the family and whether these were working or not working.

How does the family culture affect the diagnosis and treatment plan for this patient?

How did the patient’s family of origin impact this patient and the way the patient has adapted to work, school and current family life?

How does the patient’s diagnosis impact this patient and the way the patient has adapted to work, school and current family life?

What is this patient’s biggest stressor and how can the patient be taught to deal with it in a healthier manner?

Geriatric Adults

Include in your assessment of the patients preparation and attitude towards end of life care. Does the patient have arrangements made, have they shared their feelings with their families. How are they prepared financially, emotionally, and caregiver wise? Do they have a support system in place?

Include in your treatment plan specific types of therapy that are used when working with older adults with the diagnosis you have chosen.

Address in your narrative how family structure and dynamics affects the diagnosis and treatment of your patient. What are the family dynamics for this patient and how does it affect the mental status of this patient.

What developmental stage should the patient be in based on chronological age and is the patient in that stage?

How does the family culture affect the diagnosis and treatment plan for this patient?

How did the patient’s family of origin impact this patient and the way the patient has adapted to work, school and current family life?

How does the patient’s diagnosis impact this patient (and their family) and the way the patient has adapted to work, school and current family life?

What is this patient’s biggest stressor and how can the patient be taught to deal with it in a healthier manner?

Rubric for Week 3, 5 and Signature Assignment (SA) Week 7

 

Exemplary Proficient Developing Emerging Absent
5 4 3 2 0
Identifying data Complete Incomplete Case Background None
SUMMARY BACKGROU ND CASE PRESENTAT IONDemographics Source and reliability Appropriate. Appropriate Presentation not complete not complete present
5 points
Exemplary Proficient Developing Emerging Absent
10 8 6 4 0
Chief Complaint of Patient History of Present Illness CurrentMedications Past Psychiatric History

Past Psychiatric Medications Substance Use/Abuse Assessment

Complete Appropriate for this section Quote from patient Incomplete Appropriate for this section Quote from patient Complete Not all appropriate for this sectionNo quote from patient. Discussion: Impulsive Disorder Case Study Partially complete Not all appropriate for this sectionNo quote from patient None present
10 points
Exemplary Proficient Developing Emerging Absent
5 4 3 2 0
Medical History Allergies Family History– Psychiatric and Addiction History. (Include Medical if Pertinent) Developmental and Social History

 

DIAGNOSTIC TESTS

 

5 points

Complete Appropriate for this section Incomplete Appropriate for this section Complete Not all appropriate for this section Partially complete Not all appropriate for this section None present
Exemplary Proficient Developing Emerging Absent
5 4 3 2 0
Mental Status ExamAssets and Liabilities 5

points

Complete Appropriate for this section Incomplete Appropriate for this section Complete Not all appropriate for this section Partially complete Not all appropriate for this section None present
Exemplary Proficient Developing Emerging Absent
5 4 3 2 0
PHYSICAL EXAM Complete Complete but Complete Partially None
FINDINGS and ALL ALL sections but ALL complete present
5 points sections not focused sections but not all
focused as appropriately. not focused focused as
appropriate as appropriate
appropriate
Exemplary Proficient Developing Emerging Absent
5 4 3 2 0
Case Formulation Section 

5 points

Case formulation complete; ALLdiscussion items focused as appropriate Case formulation complete; discussion findings not focused appropriately Some elements of case presentation incomplete; exam findings not focused appropriately Several elements of case presentation incomplete, exam lacks focus. No case formulation
Exemplary Proficient Developing Emerging Absent
5 4 3 2 0
Differential Diagnoses 5 points Differential diagnoses list complete. Differential diagnoses list lacks complete but lacks DSMcodes Differential diagnoses list incomplete. Differential diagnoses list incomplete and lacks DSM codes. No Differential diagnoses list
Exemplary Proficient Developing Emerging Absent
15 12 9 6 0
Diagnosis Diagnosis is Diagnosis is Diagnosis Diagnosis is No
 15 points

 

5- accuracy

5 – both psych and medical

5 – DSM coded

accurate, includes psychiatric and medical, psychiatric diagnosis has DSM code accurate, includes psychiatric and medical, psychiatric diagnosis has no DSM code is accurate, includes psychiatric but no medical, psychiatric diagnosis has no DSM code not accurate, includes psychiatric but no medical, psychiatric diagnosishas no DSM code diagnoses present
Exemplary Proficient Developing Emerging Absent
15 12 9 6
Treatment Plan – 15 points 

1)     Pharmacology – 3 points

2)     Diagnostic/ Lab Work (if indicated)

– 3 points

3)     Evidence- Based Non- Pharmacologic al Interventions

– 3 points

4)     Patient and Family Education – 3 points

5)     Referral s – 3 points

Each section complete with accurate plan 4 sections complete with accurate plan 

Or

 

All sections complete but not all are accurate. Discussion: Impulsive Disorder Case Study

3 sections complete with accurate plan 

Or

 

Some sections complete but not all are accurate

2 sections complete with accurate plan 

Or

 

All sections complete but not all are accurate

No treatment plan
Exemplary Proficient Developing Emerging Absent
5 4 3 2 0
OUTCOME AND Complete Complete but Complete Partially None
FOLLOW-UP and ALL ALL sections but ALL complete present
DISCUSSION sections not focused sections but not all
Signature and Date LEARNING POINTSStrengths and deficits of Write Up focused as appropriate appropriately. not focused as appropriate focused as appropriate
REFERENCES
 5 points
Exemplary Proficient Developing Emerging Absent
25 20 15 10 0
Section specific to the age group 

25 points

Complete and ALL sections focused as appropriate Age specific questions answered and bolded area addressed Complete but ALL sections not focused appropriately. Age specific questions not answered and bolded area addressed Complete but ALL sections not focused as appropriate Age specific questions answered and bolded area not addressed Partially complete but not all focused as appropriate Age specific questions not answered and bolded area not addressed None present

Comprehensive Psychiatric Evaluation  – Discussion: Impulsive Disorder Case Study

No. 52; Updated October 2017

Evaluation by a child and adolescent psychiatrist is appropriate for any child or adolescent with emotional and/or behavioral problems. Most children and adolescents with serious emotional and behavioral problems need a comprehensive psychiatric evaluation. Discussion: Impulsive Disorder Case Study

Comprehensive psychiatric evaluations usually require a few hours over one or more office visits for the child and parents. With the parents’ permission, other significant people (such as the family physician, school personnel, or other relatives) may be contacted for additional information.

The comprehensive evaluation frequently includes the following:

  • Description of present problems and symptoms
  • Information about health, illness and treatment (both physical and psychiatric), including current medications
  • Parent and family health and psychiatric histories
  • Information about the child’s development
  • Information about school and friends
  • Information about family relationships
  • Interview of the child or adolescent
  • Interview of parents/guardians
  • If needed, laboratory studies such as blood tests, x-rays, or special assessments (for example, psychological, educational, speech and language evaluation)

The child and adolescent psychiatrist then develops a formulation. The formulation describes the child’s problems and explains them in terms that the parents and child can understand. The formulation combines biological, psychological, and social parts of the problem with developmental needs, history, and strengths of the child, adolescent, and family.

Time is made available to answer the parents’ and child’s questions. Parents often come to such evaluations with many concerns, including:

  • Is my child normal? Am I normal? Am I to blame?
  • Am I silly to worry?
  • Can you help us? Can you help my child?
  • What is wrong? What is the diagnosis?
  • Does my child need additional assessment and/or testing (medical, psychological etc.)?
  • What are your recommendations? How can the family help?
  • Does my child need treatment? Do I need treatment?
  • What will treatment cost, and how long will it take?

Parents are often worried about how they will be viewed during the evaluation. Child and adolescent psychiatrists are there to support families and to be a partner, not to judge or blame. They listen to concerns, and help the child or adolescent and his/her family define the goals of the evaluation. Parents should always ask for explanations of words or terms they do not understand.

When a treatable problem is identified, recommendations are provided and a specific treatment plan is developed. Child and adolescent psychiatrists are specifically trained and skilled in conducting comprehensive psychiatric evaluations with children, adolescents, and families.