institutional affiliation · nursing home. she reports auditory hallucinations and voices that are...
TRANSCRIPT
Running head: PRACTICUM –WEEK 4 JOURNAL ENTRY 1
Practicum –Week 4 Journal Entry
Student’s Name:
Institutional Affiliation:
PRACTICUM –WEEK 4 JOURNAL ENTRY 2
Practicum –Week 4 Journal Entry
The purpose of this paper is to identify the pertinent history of the patient without
violating the HIPAA regulations, explain the diagnosis of the patient using the DSM-5 and
explain the effectiveness of cognitive-behavioral therapy to the patient. Moreover, the paper
explores the legal and ethical implications when counseling the patient.
The Patient
The patient in these cases is a 61-year-old Caucasian who is admitted to the hospital. In
the hospital, the patient is on a voluntary status. She presents with suicidal ideation, depression,
and aggressive behavior. She seeks to commit suicide by overdosing herself. Based on the
evaluation, the patient is awake, alert, and much disoriented. She recalls well the events that led
to her hospitalization and indicates that she is depressed and frustrated. She reports that she is
frustrated because her roommate attached her, and they fought. Her behavior is very
unpredictable, and she is unable to contract to safety at this moment. Being uncomfortable in a
nursing home is a significant trigger of her condition, and she is not willing to go back to the
nursing home. She reports auditory hallucinations and voices that are informing her to commit
suicide and to hurt others. Also, she experiences visual hallucinations of seeing faces and
shadows.
Past Psychiatric History
The patient presently indicates psychiatric symptoms, involving hallucinations, and
wanting to hurt others who need it. She is not afraid of hurting herself and those who are close to
her. Inpatient psychiatric hospitalization will be of benefit to her condition. Past psychiatric
history indicates that she has had bipolar disorder, schizophrenia, and depression.
PRACTICUM –WEEK 4 JOURNAL ENTRY 3
Current Medication
The current prescribed drug therapy is Seroquel 300mg, which will be administered at
bedtime. This drug will help to cure psychotic symptoms and to stabilize her moods. Besides,
Depakote 250 mg is prescribed to her to stabilize her moods. Lexapro 5mg daily is prescribed for
depression and Klonopin 1 mg every six hours for severe chronic anxiety. Her outpatient
medication list includes Benazepril, lamotrigine, famotidine, and chlorpromazine.
Medical History
The patient has per internist medical history, and she is allergic to sulfa. Previously she
had suffered from hyperlipidemia, hypertension, gastroesophageal reflux disorder, and type 2
diabetes mellitus. Moreover, she had substance abuse secondary to meth and tobacco use with
underlying bronchitis. She had no past surgical history and hospitalization. The patient smokes
almost a pack of tobacco in a day and denies having taken alcohol.
DSM-5 Diagnosis
Based on the diagnostic and statistical manual of mental health disorder (DSM), the
patient presents symptoms that indicate that she is suffering from schizophrenia
disease.Schizophrenia is a severe and chronic mental disorder that is characterized by
disturbance in behavior, thoughts, and perceptions. It involves a range of emotional, behavioral,
and cognitive symptoms (Murder & Galderisi, 2017). There is no lab test for this condition; the
treatment that is available involves recognition constellation of the symptoms that are affecting
the occupational and emotional functioning of the patient.
PRACTICUM –WEEK 4 JOURNAL ENTRY 4
According to the Diagnostic and statistical methods, the prevalence of the condition is
approximately 0.3% in a lifetime. According to DSM 5 diagnosis, for a patient to be diagnosed
with schizophrenia disorder, then the patient should show hallucinations, delusions, disorganized
speech, catatonic behavior, and diminished emotional expression( APA, n.d.). The patient
should at least show disorganized speech, hallucinations, or delusions for at least one month. The
patient is experiencing visual and auditory hallucinations that are disturbing to her. She is
hearing sounds that are telling her to kill herself and hurt others. Her friend had hurt her, and she
wants to hurt her; also, the patient is experiencing delusions.
Other associated features of this condition that are eminent in the patient include
dysphoric mood, anxiety, and phobias, social cognition deficits, hostility, and aggression. This
condition has functionality consequences and suicidal risk behavior. A study conducted
indicated that 6% of people diagnosed with schizophrenia commit suicide (Medscape, 2019).
About 20% of the patients also make attempts to commit suicide more than one time, and the
majority of them may have significant suicidal thoughts (Murder & Galderisi, 2017). The
suicidal behavior occurs in response to the hallucinations.
Besides, the suicide risk remains to be high in the lifespan of patients who are suffering
PRACTICUM –WEEK 4 JOURNAL ENTRY 5
from schizophrenia disorder (Murder & Galderisi, 2017). Therefore, the patient in this case study
needs medical therapy as well as cognitive behavior therapy to avert suicidal risk. The condition
is also associated with occupational and social dysfunction. Maintaining employment or
completing education remains to be a significant challenge for patients who are suffering from
schizophrenia disorder. The patient stays with her roommate at the nursing residence, and she is
not willing to go back there to continue with her education.
Individualized Care Plan
The care plan of the patient will include drug therapy and cognitive behavioral therapy.
The patient will be expected to take the medication prescribed to her by the nursing practitioners.
These medications will help to stabilize her moods and reduce the aggression she has towards
herself and those surrounding her. Cognitive-behavioral therapy will enable her to have a change
of perception and focus on her life.
Cognitive-behavioral Therapy
PRACTICUM –WEEK 4 JOURNAL ENTRY 6
Cognitive behavior therapy (CBT) is a psychotherapeutic treatment that helps patients to
understand the feelings and thoughts that influence their behavior (Dobson & Dobson, 2018). It
is a common treatment for conditions such as anxiety, depression , additions, and other mental
disorders. Moreover, they help the patient to deal with a specific disease. During the therapy, the
patients can learn how they can be able to identify and handle disturbing and destructive
thoughts that impact their wellbeing. These are the thoughts that have severe consequences that
negatively impact the behavior and emotional patterns of the patient. It more common in dealing
with mental conditions since it is affordable compared to other types of therapy. It has shown to
be more effective, especially in helping patients to deal with a wide variety of maladaptive
behavior.
Cognitive-behavioral therapy would be most effective in helping this particular patient to
overcome behavioral dysfunction and co-exist well with those who are around her (Naeem, F.,
Khoury, Munshi, Ayub, Lecomte, Kingdon & Farooq, 2016). It will help the patient to overcome
the desire to kill her, and hurt others, improve her capacity to deal with traumatic events such as
verbal and physical abuse, with her roommate. The desire to hurt others started from the fight she
had with her roommate. Managing how to control her traumatic events will enable her to go back
PRACTICUM –WEEK 4 JOURNAL ENTRY 7
to the nursing home and continue her education. CBT therapy has remained to be effective in
treating schizophrenia disorder because it focuses on the feelings, behavior, and thoughts of the
patient (Dobson & Dobson, 2018). Therefore, through the application of cognitive-behavioral
therapy will help to change the negative thoughts of the patient, and avert the risk of her hurting
others and committing suicide.
Legal and Ethical Implication
Dealing with patients who are experiencing emotional challenges who have suicidal
thoughts requires the therapist to confine themselves within the ethical code of conduct
standards. This will promote the wellbeing of the patient as well as those of the therapist. The
therapist must ensure that they seek consent from the patient before the start of the therapy. The
patient should commit that she has authorized the therapist to help her to change her situation.
Failure to seek informed consent from the patient will amount to a breach of professional code of
conduct which has legal Implication such as withdrawal of service license to the therapist
(American Psychological Association, n.d.).
The therapist must promote the best interest of the patient as well as those who are close
to her. The patient threatens to hurt herself and others; therefore, the therapist should guide the
PRACTICUM –WEEK 4 JOURNAL ENTRY 8
patient to ensure that she does not hurt herself. This could be through close observation since she
is hospitalized, and following up on her medication. The therapist needs to uphold the
confidentiality of the patient information (American Psychological Association, n.d.). .Patients
information is personal, and so should it be treated like. The patient may be having more
underlying factors that are influencing her decision to commit suicide. Therefore, the therapist
should ensure that she confines vital information between her and the patient if it is not life-
threatening.
PRACTICUM –WEEK 4 JOURNAL ENTRY 9
PRACTICUM –WEEK 4 JOURNAL ENTRY
10
References
American Psychological Association. (n.d.). Ethical Principles of Psychologists and Code of
Conduct. Retrieved from https://www.apa.org/ethics/code/
APA. (n.d.). Diagnostic and Statistical Manual of Mental Disorders DSM-5 Fifth Edition.
Retrieved from
https://www.appi.org/diagnostic_and_statistical_manual_of_mental_disorders_dsm-
5_fifth_edition
Dobson, D., & Dobson, K. S. (2018). Evidence-based practice of cognitive-behavioral therapy.
Guilford Publications.Retrieved from
https://dl.uswr.ac.ir/bitstream/Hannan/130304/1/1606230204Cognitive-
Behavioral_TherapyB.pdf
Medscape. (2019, November 11). What are the DSM-5 criteria for schizophrenia? Retrieved
from https://www.medscape.com/answers/288259-13963/what-are-the-dsm-5-criteria-
for-schizophrenia
PRACTICUM –WEEK 4 JOURNAL ENTRY
11
Murder, S. R., & Galderisi, S. (2017). The current conceptualization of negative symptoms in
schizophrenia. World Psychiatry, 16(1), 14-24. Retrieved from
https://onlinelibrary.wiley.com/doi/pdf/10.1002/wps.20385
Naeem, F., Khoury, B., Munshi, T., Ayub, M., Lecomte, T., Kingdon, D., & Farooq, S. (2016).
Brief cognitive-behavioral therapy for psychosis (CBTp) for schizophrenia: literature
review and meta-analysis. International Journal of Cognitive Therapy, 9(1), 73-86.