PRAC 6635 Comprehensive Psychiatric Evaluation and Patient Case Presentation

PRAC 6635 Comprehensive Psychiatric Evaluation and Patient Case Presentation

CC (chief complaint) – An 80-year-old female patient who is concerned that she forgets things easily. Her elder daughter, who is her caregiver, feels her mother needs time to recover after showing signs of stress and discomfort. 

HPI: Mrs. A, an 80-year-old female, is being evaluated psychiatrically for depression and dementia. She reports forgetting things easily and being unable to remember discussions. Patient states that her condition worsens when traumatic military events come to mind. She acknowledges having similar issues years ago but denies any family mental health history.

Past Psychiatric History: She denies any past suicidal or homicidal ideation. She confirms being previously hospitalized and medicated for dementia and depression. Her elder daughter is her caregiver.

General statement: Patient acknowledges having being treated for psychiatric illness.

Caregivers: Elder daughter who lives with the patient.

Hospitalizations: She was hospitalized in the past for dementia treatment.

Medication trials: Past mental evaluation scored her at 17 points, indicating memory loss and mild dementia. She also tested positive for depression.

Psychotherapy or Previous Psychiatric Diagnosis: Her prior diagnoses were dementia and depression after mental examination.

Substance Use and History: Patient denies any substance use. Reports about military involvement.

Family Psychiatric/Substance Use History: She denies any personal history of alcohol or substance abuse, though her father was an alcoholic.

Psychosocial History: She was married with three children and served over 40 years in the military, engaging in community activities. She began having memory and problem-solving issues after leaving the military.

Medical History: Psychiatric testing confirmed she has depression and dementia.

Current Medications: She takes 5mg Lexapro orally for six days and 10mg Aricept at bedtime for depression and dementia.

Allergies: She reports no known allergies.

Reproductive History: Post menopause. Not sexually active.

ROS:

GENERAL: She forgets things quickly but seems sober. She speaks clearly without mood changes. She appears smart and neat but is easily disrupted during conversation.

HEENT: She has poor vision and cannot see distant objects clearly. No hearing, dental issues.

SKIN: No rashes, wounds, or itching reported.

CARDIOVASCULAR: No chest pain, palpitations, or edema.

RESPIRATORY: No breathing or coughing difficulties reported.

GASTROINTESTINAL: No diarrhea, vomiting, or abdominal pain.

GENITOURINARY: No painful urination reported.

NEUROLOGICAL: She complains of dizziness and confusion.

MUSCULOSKELETAL: No back, muscle, or joint pain.

HEMATOLOGIC: No injuries or bleeding.

LYMPHATICS: No hepatectomy or splenectomy history.

ENDOCRINOLOGIC: No abnormal hormone levels reported.

Physical exam:

Diagnostic testing like mental status exams assessed her dementia and depression. She responded appropriately to questions about her conditions. Her MMSE score of 15/30 indicates worsening dementia. Her memory issues arose after leaving the military and have declined since. 

Assessment: 

Mental Status Exam: Mrs. A is an 80-year-old female forgetting things quickly, indicating possible dementia and depression. Her 40+ years of military service may have contributed, given worrying experiences and trauma. She appears neat, smartly dressed, communicates clearly and shows no mood changes during conversation. She denies any suicidal thoughts despite prior dementia and depression hospitalizations. She does become disrupted at times in conversation.

PRAC 6635 Comprehensive Psychiatric Evaluation and Patient Case Presentation
PRAC 6635 Comprehensive Psychiatric Evaluation and Patient Case Presentation

Differential Diagnoses:

Dementia disorder: Impacts judgement, reasoning and memory due to brain damage. Signs include short-term memory issues and difficulty with activities and thinking (Degerskär & Englund, 2020). Common in the elderly. Treatments include Donepezil and Memantine.

Depression disorder: Persistent feelings of sadness and loss of interest that disrupt daily activities and functioning (Choi & Wan, 2020). Symptoms include anxiety, irritability, fatigue, suicidal thoughts, restlessness and memory issues. Impacts thinking and causes physical and emotional problems. Treatments include counseling and medications like Lexapro and Aricept.

Anxiety disorder: Mental health condition making it difficult to get through the day. Signs include panic, fear, nervousness, rapid heartbeat and sweating (Seabrook & Rickard, 2016). Treatments include CBT and medications like antidepressants Prozac, Lexapro and Zoloft.

Reflections:

For a similar case, I would conduct a more comprehensive psychiatric history, including past hospitalizations, medication trials and therapy. Understanding treatment history can reveal patterns and intervention effectiveness. I would also involve the daughter more to gain additional insights into behaviors and symptoms. A relevant social determinant is the patient’s military service, which relates to economic stability. Military service can negatively impact mental health due to trauma, stress, and family separation. This may contribute to conditions like depression and PTSD (Freedman & Tuval Mashiach, 2018). To address mental health disparities for older adults like this patient, health promotion activities could provide mental health education and resources within military communities. This would focus on signs of conditions like depression and PTSD, emphasizing the importance of timely mental healthcare and support. It is crucial to educate the patient and her daughter on managing dementia and depression. The daughter needs strategies to support her mother, including providing structure, engaging in cognitive activities, promoting exercise and diet. Medication adherence should also be emphasized, ensuring the patient consistently takes her Lexapro and Aricept.

References

Choi, E. P. H., Hui, B. P. H., & Wan, E. Y. F. (2020). Depression and anxiety in Hong Kong during COVID-19. International journal of environmental research and public health, 17(10),       3740. https://doi.org/10.3390/ijerph17103740

Cohen, Z. D., & DeRubeis, R. J. (2018). Treatment selection in depression. Annual Review of Clinical Psychology, 14, 209-236. https://doi.org/10.1146/annurev-clinpsy-050817-084746

Degerskär, A. N. W., & Englund, E. M. (2020). Cause of death in autopsy‐confirmed dementia disorders. European Journal of Neurology, 27(12), 2415-2421. https://doi.org/10.1111/ene.14450

Freedman, S. A., & Tuval Mashiach, R. (2018). Shared trauma reality in war: Mental health therapists’ experience. PloS one, 13(2), e0191949. https://doi.org/10.1371/journal.pone.0191949

Seabrook, E. M., Kern, M. L., & Rickard, N. S. (2016). Social networking sites, depression, and   anxiety: a systematic review. JMIR mental health, 3(4), e5842. https://doi.org/10.2196/mental.5842