Demonstrate adequate understanding of the common symptoms of major depression and PTSD.
1. Demonstrate adequate understanding of the common symptoms of major depression and PTSD.
2. Demonstrate a high level of knowledge on the underlying causes of posttraumatic stress disorder and suicide based on trauma, family issues, and life stressors.
3. Develop knowledge on mental status examination and prioritization of treatments for mental illness based on psychotherapy and pharmacology.
4. Demonstrate understanding of the possible lifestyle changes to improve physical and psychological outcomes among adults.
CC (chief complaint): “Suicidal thought to shoot himself in the head and frequent nightmares”
HPI: N.R is a 56-year-old male of African American origin who presented to the mental health facility with significant suicidal thoughts and nightmares. The police arrested him after he threatened to shoot himself in the head in front of his neighbor. N.R was placed on emergency hold by the police in response to the self-harm threat. He is a military veteran with seven years in Afghanistan. He has been unable to manage his grocery store due to suicidal thoughts experienced for the last four months. The patient told his neighbor, “I am going to shoot my head to remove demons that live inside.” The patient reported that he has been experiencing nightmares and hearing voices from his comrades who died in a raid during deployment. He has been planning to die by the bullet so that all his problems would come to an end. The patient reported that he has been unable to sleep for more than four hours at night. He prefers to sleep during daytime and feels tired most of the time. He reports feeling depressed most of the time for the last four months. He separated from his wife after ten years of marriage due to frequent physical violence. His patient records shared by psychiatrists show that he was treated for major depressive disorder two years ago. He reports that he has been unable to eat well due to poor appetite. The patient reports flashbacks related to his experience in the raid that resulted in the death of his best friend in the military. He has been trying to avoid discussions related to war or military action due to the negative memories. He experiences decreased interest in playing his favorite game with friends. He reports that he is always ready to shoot his enemies who are planning to attack at night. The patient reports that his family is not supportive and is happy about his current situation. The patient is aggressive and easily irritated during interactions. The patient reports feeling sad and having difficulty concentrating in the workplace.
Substance Current Use: Patient reports that he smokes two packets of cigarette every day. He reports occasional intake of alcohol at least once week when free. He denies illegal drug use or marijuana use. He was prescribed with morphine for pain management five years ago but did not develop dependence.
Past Psychiatric History: Patient was diagnosed with major depressive disorder 2 years ago and treated using medication. He has history of substance abuse disorder which was treated six years ago. He reports that he cannot remember his experience as a child related to trauma. He suffered trauma during military deployment in service.
Medical History: Has history of hypertension which is managed using medication and lifestyle change.
· Current Medications: Lisinopril 10 mg once daily for HTN and Prozac 20 mg once daily for depression.
· Allergies: Iodine.
· Reproductive Hx: Patient is heterosexual. He engages in sexual relationships with multiple women after divorce from his wife. He reports that he uses condoms for protecting against STI. He is unable to seek screening for prostate related problems due to the current mental illness.
Psychotherapy: Patient received cognitive behavioral therapy two years ago for depression.
Family Medical History: Father 76 years-old with history of diabetes mellitus and HTN. Mother 74 years with history of hypertension and hyperlipidemia. Younger brother, no known medical history.
Social History: Patient lives alone in a three-bedroom house in a middle-income neighborhood. He separated from his wife due to his behavior and aggression that resulted in physical violence. He is a father of two three children son 20, daughters 12, and 15. He is allowed to visit his children at least once every week after divorce. He pays child support for the children. He reports that his family is not supportive and feels isolated. He has been unable to go out with friends due to the psychological change. He reports that he is always aware of people planning to eliminate him during social events. He has been working at his grocery store with three other employees. He reports that the pandemic contributed to his current problems because he secured a bank loan to support his business. He reports smoking at least two packets every day. He reports alcohol intake occasionally once per week. Patient denies illegal drug use or marijuana. He has travelled to Europe, west Africa, and Middle East during military missions.
Family Psychiatric History: Father has history of major depressive disorder and suicidal thoughts. Mother has history of anxiety and bipolar II disorder.
· GENERAL: Pt is well-groomed. Alert and oriented x4. Reports weakness and fatigue for the past four months. No chills, fever. Reports weight loss of 10 pounds in the last five months.
· HEENT: Head: Normocephalic and symmetric to the body. TJM full ROM. Maxillary sinuses no tenderness. Eyes: Symmetrical, sclera white, conjunctiva pink. Eye movement intact. No hemorrhages, lens opacities or disk cupping. Ears: External ear no masses, tenderness or injuries. Nose: Nasal mucous moist and free from bleeding. Throat: Pink and most membranes. No difficulties swallowing or swelling.
· SKIN: Color appropriate to race. No lesions, rashes, or ulcers.
· CARDIOVASCULAR: Denies chest pain, heart murmur or edema. No cubbing or cyanosis.
· RESPIRATORY: No abnormal breathing sounds difficulties breathing. No wheezing or use of accessory muscles. No cough or sputum.
· GASTROINTESTINAL: Denies constipation, diarrhea, abdominal pain, or nausea. No blood in stool or swelling.
· GENITOURINARY: Denies frequent urination, blood in urine, swelling or difficulties starting urination.
· NEUROLOGICAL: Denies confusion, dizziness, or headache. Tongue protrudes midline.
· MUSCULOSKELETAL: Denies problems with ROM or pain in joints or muscle.
· HEMATOLOGIC: Denies bleeding, bruising or recent blood transfusion.
· LYMPHATICS: No swelling or tender lymph nodes noted or reported.
· ENDOCRINOLOGIC: Denies cold or heat intolerance.
· PSYCHIATRIC: Reports depressed mood, sadness, nightmares, and fatigue.
General Appearance: 56-year-old male. Well-groom and oriented x4.
Vital Signs & Measurements:
T 98.2, P 92, R 18, B/P 118/85, O2SATS 99% RA, WT 120 lbs, HGT 5’9”, BMI 18.5
· CBC, CMP, TSH, VITAMIN D LEVELS, UDS,-WNL
· A1C; 5.2%