Case 2: Volume 1, Case #7: The case of physician do not heal thyself nursing sample paper
Case 2: Volume 1, Case #7: The case of physician do not heal thyself nursing sample paper
•Review this week’s Learning Resources and reflect on the insights they provide.
•Go to the Stahl Online website and examine the case study you were assigned.
•Take the pretest for the case study.
•Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.
•Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).
•Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.
•Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.
•Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.
•Review the posttest for the case study.
Learning Resources
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
This will be from Stahl’s on line we site:
- Case 1: Volume 1, Case #1 The man whose antidepressants stopped working
- Case: 2 Volume 1, Case #7 The case of physician do not heal thyself
- Case 3: Volume 1, Case #29 The depressed man who thought he was out of options
- NURS 6630 Discussion The Impact of Ethnicity on Antidepressant Therapy
•Chapter 7, “Antidepressants
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Case 2: Volume 1, Case #7: The case of physician do not heal thyself
Note: Retrieved from Walden Library databases.
Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21–24. doi:10.3928/02793695-20080901-06
Note: Retrieved from Walden Library databases.
Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(19), 21–24. doi:10.3928/02793695-20081001-05
Note: Retrieved from Walden Library databases.
NURS 6630 The Impact of Ethnicity on Antidepressant Therapy
Yasuda, S.U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417–423. Retrieved from http://www.fda.gov/downloads/Drugs/ScienceResearch/…/UCM085502.pdf
please answer each question with sub title of the question asked THAIS: QUESTION THEN ANSWER
•Review this week’s Learning Resources and reflect on the insights they provide.
•Go to the Stahl Online website and examine the case study you were assigned.
•Take the pretest for the case study.
•Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.
•Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).
•Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.
•Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.
•Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.
•Review the posttest for the case study.
Sample solution to Case 2: Volume 1, Case #7: The case of physician do not heal thyself nursing paper
Paper type: Case Study
Course Level: Master
Subject Area: Nursing
# Pages: 8
A Review of Learning Resources of the Week and Reflecting on their Insights
The learning materials provided for this week are specifically primarily archived online in the Stahl’s online website, whereby the students have to access them through the internet medium in order to read deeper into their informational contents. For precision, the week’s learning materials comprise of a single multi-chapter online book in which it has confined large volumes of medical information related to psychopharmacology discipline and the related essentials that help health professionals acquire an elevated degree of competence in this particular field of health. Thus, it would be right to say the provided education informational sources via the online website by Stahl (2013) provide the learners with an in-depth inner visualization and imagination of how psychiatrists specialize in the management of medications for mental disorders. The above-identified learning resource can be said to provide an insight to students/learners so as to fully comprehend about the exact structure and development of the human nervous system and the associated effects of the same on the neurological behaviors and functions (Stahl, 2008).
Examining the Assigned Case Study from the Stahl’s Online Website: The Case of Physician do not Heal Thyself
The assigned case study is Case#7, from volume 1 of the Stahl’s various case studies that contain relevant informational content related to the essentials of psychopharmacology. A generalized examination of the patient’s case presented via the chosen case study reveals that the 60-year-old man is not only a qualified and certified physician but also a difficult patient. This emanates from the treatment compliance behavioral patterns illustrated by the physician, which suggest that he is highly ignorant of doctor’s instructions on medications. Thus, he is termed as a difficult patient and the condition subsequently makes it difficult to treat the patient. The primary health problem that compelled the patient to seek for medical assistance was described as “being unstable,” which precisely meant that this individual was struggling with mental disorders which made his social life unbearable due to the inability to maintain friendly relationships due to his existing major depressive disorder. According to Stahl (2011), a combination of all the health and medical history of the patients indicates that this aged physician is particularly unstable as a result of his prevalent personality and genuine mood disorders. The patient has used different combinations of medications, some of which have emerged to be obsolete in accordance with helping him regain a normal cognition. Thus, the physician has occasionally interfered with his own treatment for he considered the caregivers to be prescribing unhelpful medication whilst he knew what exactly was required to correct his mental health condition.
Taking the Pretest of the Case Study
Based on the health probe presented in the pretest of Case#7, the answer to the same would be False. The assertion is purely derived from the fact that frequent mood swings might not necessarily indicate the prevalence of mood disorders since a differential diagnosis may suggestively lead to other conditions such as generalized depression, or dysphoric and euphoric states. Thus, a personalized response to the pretest question would be inclined to propose that the statement “frequent mood swings are more of signs and symptoms of a mood disorder than they are of personality disorders” is absolutely flawed. Also, considering that the signs and symptoms of mood and personality disorders often overlap, it would unrealistic and irrational to decisively allege that frequent mood swings are seemingly indicative of mood disorders (Vahia, 2013). Hence, the pretest question’s right answer would be ‘False. This is because there is no way a health professional might distinguish between the two without further observational medical examinations.
A Review of the Patient’s Health and Medical History File, and Formulation of Probable Questions to Ask
Patient Intake Documentation
The patient file was updated with admission details which indicated that the physician was 60 years of age. He reported having been currently unstable in relation to his mental health for he had spent two-thirds of the past year struggling with a mixed dysphoric state, and the rest of the year fighting depression. The conditions were described by the patient to be waxing (increasing) and waning (decreasing) from time to time. Sample solution to Case 2: Volume 1, Case #7: The case of physician do not heal thyself nursing paper
Probable Questions
Based on the intake documentation, what factors made the patient undergo the waxing and waning experiences in his mental health condition?
Psychiatric History: Childhood-Adulthood
The physician-patient presented psychology-based health information indicating that he used to depict symptoms of separation and generalized anxieties during his childhood. Their experiences as a child were health-detrimental since his mother presented recurring episodes of either bipolar or unipolar depression, which led to her being physically unavailable to her son and thus, compelling him to be emotionally distant during times of depression while at home. Throughout his life, the physician had short-lived interpersonal relationships with friends, family members, and more so with women. During his adolescence, the patient had an obsessive-compulsive disorder with ruminations. At the age of 23, he was diagnosed with a major depression which was highly attributed to his increased transient depressed moods, suicidal thoughts, more anxiety, and unhappiness. This is why he tried to kill himself via a drug overdose.
The physicians were presenting many episodes of irritable dysphoric temperament, inflated self-esteem, being over-talkative, insomnia, increased goal-oriented work activity, and risky behaviors. This patient was married and divorced thrice at the age of 32-33, 35-36, and 46-58 respectively. All these marriage life incidences were commonly characterized by a depressive episode each.
Probable Questions
Based on the marriage life history, what exactly led to his marriage breakup severally?
Medication/Medical History
The physician-patient had been prescribed quite a number of medications to help with his mental health condition and these included; TCAs, Benzodiazepines, Lithium, Valproate, Risperidone, Verapamil, Clonazepam, Oxcarbazepine, Fluoxetine, and Azothiaprine and Remicaid which he is currently taking for the Crohn’s disease. Also, he is at the moment taking methylphenidate (Ritalin) for managing his attention disorder.
Probable Questions
Considering that the signs and symptoms of personality and mood disorders often overlap, was it necessary for the caregivers to prescribe all those medications listed above instead of a single drug that could suppress the symptoms all at once?
Social and Personal History
The patient presents information which affirms that he was married and divorced three times, and he is currently single. The featured person had no children, did not smoke or abuse any drug, he rarely drunk, and has been a successful businessman as well as a physician.
Probable Questions
Was the physician’s situation of having no children related to his unfriendliness with women?
Family Health History
The individual presented descriptive health information that revealed his father’s sleep disorder, the mother presented either unipolar or bipolar depression which was successfully treated with the drug ECT, his maternal uncle and aunt had depression, and his grandmother was diagnosed with a manic-depressive disorder.
Probable Questions
In a reflection of the family health history, could you say that the patient’s current mental health problems were hereditary?
Probable People from whom the Caregivers could seek Feedback
In the context of the patient’s case history, it would be advisable for the caregivers to seek feedback from people such as the family members like the parents for they are the people who know what specific situations that agitate the individual to act in an abnormal behavior or presents racing thoughts. Also, the healthcare providers might seek feedback from former healthcare colleagues with whom the physician used to work. This is essential for these health professionals might have probably experienced the onset of the mental disorder’s symptoms. Finally, the caregivers have the freedom to seek feedback from people like a personal psychiatrist who have lived and experienced the mental health disturbances of the patient in the past.
Additional Physical Exams for the Patient
The probable physical exams that a caregiver might carry out on this patient would be purely an observational examination, which would encompass activities like subjecting the patient to different sociable environments and subsequently keep track of his behavioral reactions. This would help the health professionals to decide on the right psychological therapeutic interventions which would help regulate the brain chemistry disturbances and in turn make the person behave and think normally most of the times (Rush et al., 2004).
Differential Diagnoses for the Patient
Under the presented mental health deterioration symptoms presented by the patient, it would be advisable for the primary caregiver to perform a differential diagnosis for psychosis, which is a mental health condition with similar symptoms just like mood/personality disorders (American Psychiatric Association, 2013). Thus, the additional diagnosis for differentiating between the two conditions is vital so as to rule out any signs suggestive of psychosis presence due to onsets of similar symptoms such as uneasiness with other people, spending more time alone, anxiety, agitation, insomnia, strong and inappropriate emotions, and difficulties in concentrating or thinking clearly.
Sample solution to Case 2: Volume 1, Case #7: The case of physician do not heal thyself nursing paper
Probable Medications that would be prescribed for the Patient
The current medications used by the patient are Azothiaprine and Remicaid for the Crohn’s disease and Methylphenidate for ADHD. However, they have failed to stabilize the mental health of the physician. Thus, in the case of the physician-patient existing health condition, it would be advisable to select a class of medications that have diverse functions in the human nervous system so as to suppress all the existing disorders simultaneously. Thus, the patient would require medications such as Bupropion, which comprises of brands such as Aplenzin, Zyban, and Wellbutrin. These drugs would help counter all mental health conditions related to bipolar depression, sexual dysfunction, major depressive disorder, and attention deficit hyperactivity disorder (Howland, 2008). Secondly, it would also make sense to prescribe drugs under the class of Alprazolam such as benzodiazepine, which would effectively help correct mental health conditions associated with insomnia, generalized anxiety disorder, acute mania and psychosis, and anxiety disorders associated with depression (Stahl & Grady, 2017).
A Review of the Posttest for the Case Study
The posttest has recurrently focused on answering the question presented in the pretest of the same study. The correct answer to the health-based inquiry is that the statement “Frequent mood swings are more a sign or symptom of a mood disorder than they are of a personality disorder” would be False. This is because both personality and mood disorders have their signs and symptoms overlapping each other, which makes it hard for one to observably distinguish between the two. Thus, mood swings can be said to be part of the primary signs associated with both personality and mood disorders.
References : Case 2: Volume 1, Case #7: The case of physician do not heal thyself nursing paper
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Howland, R. H. (2008). Sequenced Treatment Alternatives to Relieve Depression (STAR* D)–Part 2: Study Outcomes. Journal of psychosocial nursing and mental health services, 46(10), 21-24.
http://stahlonline.cambridge.org/case_studies.jsf?vol=1
Rush, A. J., Fava, M., Wisniewski, S. R., Lavori, P. W., Trivedi, M. H., Sackeim, H. A., … & Kupfer, D. J. (2004). Sequenced treatment alternatives to relieve depression (STAR* D): rationale and design. Controlled clinical trials, 25(1), 119-142.
Stahl, S. & Grady, M. (2017). Stahl’s essential psychopharmacology : prescriber’s guide. Cambridge, United Kingdom New York, NY: Cambridge University Press.
Stahl, S. (2011). Case studies : Stahl’s essential psychopharmacology. Cambridge, UK New York: Cambridge University Press.
Stahl, S. M. (2008). Essential Psychopharmacology Online. Retrieved December 11, 2017 from
Stahl, S. M. (2013). Stahl’s Essential Psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Vahia, V. N. (2013). Diagnostic and statistical manual of mental disorders 5: A quick glance. Indian journal of psychiatry, 55(3), 220.
