Physical Examination and Diagnostic Testing

Physical Examination and Diagnostic Testing

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Volume 2, Case #11: The figment of a man who looked upon the lady

The client is a 42-year-old woman with a chief complaint of depression and interpersonal stress. She has a past psychiatric history of PTSD related to abuse in her childhood that led to a dependency on alcohol and drugs to cope. She has been 10 years sober and attends AA and Narcotics Anonymous meetings regularly which have helped with good results. The client reports occasional PTSD with nightmares, flashbacks and panic attacks. The questions I would ask her during this visit include:

When was the last time you had PTSD symptoms of nightmares, flashbacks and panic attacks? What is triggers these symptoms? The rationale behind this question is trying to establish a baseline and know the triggers that may result in flashbacks and panic attacks.
What happens when you experience these PTSD flashbacks and what coping mechanisms do you use at that time? Do you have any family support system? Have these coping mechanisms helped? Rationale: it is important to establish what type of behaviors the client exhibits during these times, and also if her coping mechanisms are truly assisting her to cope positively or negatively. Asking about her support system will inform me about what her support systems are outside of attending her regular AA and NA meetings or therapy appointments. It is also good to know if she has a good support system which could be family and friends can be present during her therapies or appointments as they may be able to help with de-escalating her thoughts and calming her down when she experiences these symptoms. Another peer support is defined as the process of giving and receiving nonprofessional help and assistance from people with similar conditions or circumstances to yours is listed as beneficial to the client’s success in treatment (Tracy & Wallace, 2016).
Do you have suicidal or homicidal ideations, auditory or visual hallucinations now or when you are experiencing these PTSD symptoms? Traumatic events such as childhood sexual abuse increase a person’s suicide or homicidal risk (Stahl, 2014). Do the thoughts that you might have nightmares prevent you from going to sleep? How many hours do you sleep at night? What is causing your present stress? Rationale: Ensuring that the patient and others around the patient are safe is a priority, and also knowing if the client is seeing images or hearing voices. Lack of adequate sleep can cause stress that may trigger the other symptoms that the client experiences. If the client is going through any type of stress which may be personal life or work life related, this may also trigger the symptoms she is having. Also, knowing if the client has taken any sleep aid in the past will determine if she can be put on sleep aid medication treatment and monitored. The client had initially stated that she has insomnia, however later in the case study, she talks about “little man” that watches her when she is trying to sleep this could be classified as visual hallucinations that may be related to insomnia. Identifying the specific sleep issues the patient is suffering from dictates the interventions that can be most useful.
Identify specific people in the patient’s life you would like to speak with and why

Firstly, I would obtain consent from the client to speak to her specific people in her life. Although she was able to list some of her family members’ medical and psychiatric history, I would like to speak to her parents, siblings, PCP, close friends and work colleagues. I would like to obtain information from her siblings and parents about the child abuse trauma that the client went through, what care did she receive to manage and cope? Did she receive any form of therapy? What behaviors did she exhibit before and after the trauma? What triggers have they observed that has brought about the PTSD symptoms. The data collected from the patient, family members, PCP, psychiatrist, and friends will be helpful to form a baseline to build on. I would suggest these treatments: Prolonged Exposure (PE) therapy, and Cognitive Processing Therapy (CPT) which are trauma-focused treatments that directly address memories of the traumatic event, as well as thoughts or feelings related to the traumatic event (Watkins, Sprang, & Rothbaum, 2018). Based on the information provided by the PCP and psychiatrist, it will help to collaborate well with the Psychiatrist and PCP about the client’s plan of care, to treat current medical comorbidities, and identify any medical issues that may be contributing to the patient’s psychiatric symptoms (Lakdawala, 2015).

Physical Examination and Diagnostic Testing