Stress and Anxiety Stress can appear at any time in our lives, but the college years (early adulthood) offer their own type of stressors because it is

Stress and Anxiety

Stress can appear at any time in our lives, but the college years (early adulthood) offer their own type of stressors because it is at this time that one assumes more (if not complete) responsibility for one’s lifestyle behaviors.

This written assignment provides an opportunity to demonstrate your knowledge of the assessment, diagnosis and treatment of a young adult patient via a case study example.

• Read the following case study and address the sections that follow.

IDENTIFICATION: The patient is a 24-year-old, single, Asian-American female.

CHIEF COMPLAINT: “I don’t want people noticing my scarred fingers.”

HISTORY OF CHIEF COMPLAINT: She has been biting her fingers since she was young. Is in the orchestra and doesn’t want people noticing her fingers. Is overwhelmed with the amount of work in graduate school, which she started two months ago. She states, “I’m worried about getting the work done. So I’ve been biting my fingers more.” Has developed scars on fingers and has become self-conscious about how it looks but cannot stop.

PAST PSYCHIATRIC HISTORY: No previous psychiatric treatment or medications. No history of suicide attempts or assaultive behavior.

MEDICAL HISTORY: Takes birth control pills. No operations. No medical conditions. Feels tired for the past month. Having difficulty getting to sleep and staying asleep.

HISTORY OF DRUG OR ALCOHOL ABUSE: Denied.

FAMILY HISTORY: Raised by both Korean-born parents with a younger sister. Father has a history of anemia. No psychiatric family history.

PERSONAL HISTORY

Perinatal: Full-term vaginal birth.

Childhood: Started biting her fingers. Started playing in school orchestra.

Adolescence: Had many friends. Participated in a number of school organizations.

Adulthood: Graduate student in music education for the past two months. Unemployed. Had worked in retail sales. Identifies as a Methodist. Has the same boyfriend for the past two years. No military service or legal history.

TRAUMA/ABUSE HISTORY: Denied.

MENTAL STATUS EXAMINATION

Appearance: Well groomed. Fingers are visibly scarred above the proximal interphalangeal joint.

Behavior and psychomotor activity: Good eye contact. No motor abnormalities. Cooperative.

Consciousness: Alert but appears tired.

Orientation: Oriented to all three spheres.

Memory: Grossly intact.

Concentration and attention: Reports difficulty concentrating. Pacing at night and unable to focus on her school requirements. Was generally attentive and focused during the interview.

Visuospatial ability: Not assessed.

Abstract thought: Not assessed formally but seems satisfactory.

Intellectual functioning: Average or above.

Speech and language: Normal rate and volume.

Perceptions: No altered perceptions.

Thought processes: Organized and logical.

Thought content: Preoccupied with academic demands.

Suicidality and homicidality: Denied.

Mood: Anxious.

Affect: Full range. Mood congruent.

Impulse control: Good other than not being able to control biting her fingers.

Judgment/Insight/Reliability: Good.

1. Title Page
2. Introduction
3. What screening tools (if any) or laboratory tests (if any) would you use to further evaluate this patient?
4. What are your differential diagnoses for this patient?
5. Include DMS-5 TR codes and ICD-10 codes
6. Include rationale for ruling in or ruling out the diagnoses.
7. What diagnosis would you rule in as your working diagnosis?
8. What pharmacological interventions would you include, if any?
9. Include the rationale for the medication(s), if prescribed.
10. Include any monitoring and titration if indicated.
11. What are the goals of the treatment?
12. What psychotherapeutic interventions would you complete that day, and what type of psychotherapy might you refer to a therapist?
13. Include the rationale for the types of therapy.
14. What are the goals of therapy?
15. What complementary and alternative medicine treatments might you recommend for this patient?
16. Include the rationale for your recommendations.
17. What are the goals of the treatments?
18. What patient education would you provide for this patient? Include:
19. Medications
20. Follow up
21. Referrals
22. Psychoeducation
23. What cultural and ethical considerations would you consider with this patient?
24. Summary
25. References

Your written assignment should be 4–5 pages (1,000–1,250 words) in length, not including the title page, references, graphics and appendices. Do not include the case study in the body of the assignment.

Assignment Requirements:

Before finalizing your work, you should:

• be sure to read the assignment description carefully (as displayed above);
• consult the Grading Rubric (located in Course Resources, Grading Rubrics submodule) to make sure you have included everything necessary; and
• utilize spelling and grammar check to minimize errors.

Your writing assignment should:

• follow the conventions of Standard English (correct grammar, punctuation, etc.);
• be well ordered, logical, and unified, as well as original and insightful;
• display superior content, organization, style, and mechanics; and
• use APA 7th edition format.