Question

A 51-year-old female with a history of bipolar disorder presented to the ER claiming she was feeling suicidal, depressed and reported feelings of hopelessness, helplessness, and paranoia. She had jumped from a second story window and c/o pain in her back and both ankles. She was alert and oriented, but combative on admission to ED. C-collar in place, handcuffed to stretcher. “I was on the floor, my husband was trying to hurt me, so I jumped.” “I wanted to kill myself, and I wanted to hurt my husband.” The police reported that the patient was aggressive towards husband with scissors, attempted to cut self on her wrists. Patient’s husband has a restraining order against her. “She reported that her husband had been abusive to her through the years and he recently threatened to kill her.” Her ex-husband reported she has been deteriorating for 5 weeks, belligerent, aggressive, not sleeping and drinking wine.On admission—the patient reported she was depressed, suicidal, and scared. She reported a recent decreasedneed for sleep, euphoric mood, and racing thoughts. She has poor hygiene and is disheveled. She is restless, agitated; mood—depressed and anxious; speech—soft; thought process—circumstantial; judgment—poor impulse control, maladaptive; Insight—poor. Intelligence is below average. Concentration-distracted. Pt. suffered multiple comminuted fractured of her left ankle and fracture of L5, these injuries resulted from her jumping out of the second story window. She reported past history of manic symptoms along with psychotic symptoms. A decreased need for sleep, euphoria, bizarre behavior, racing thoughts, and increased goal oriented activity has led to hospitalizations in the past along with paranoia. She has had 12 psych admissions;most recent admission was 2 years ago. Reports one past suicide attempt 6 years ago when she left her husband and was in a shelter. At that time,she was discovered by staff and brought to the hospital. She then divorced her husband. She reports an occasional glass of beer or wine, no street drugs or abuse prescribed medications. Her blood alcohol level was negative and urine toxicology screen was negative. Her mother had schizophrenia and alcohol dependence and her niece committed suicide. 1.What is the probable Axis I diagnosis for this patient based on information presented thus far?What is the basis for this diagnosis? 2.Discuss the other possible diagnoses for this patient and why they are not appropriate based on DSM criteria. 3.Does this patient meet criteria for inpatient hospitalization? Why or why not? 4.What is your treatment plan withrationale?

Answer 1

Q. No. 1. Answer :

Diagnosis is for the patient based on information presented is " Depressive psychosis ".

The basis for these diagnosis is patient is having severe depression, suicidal thoughts, self care deficiencies, did jointed thoughts, bizarre behavior, and racing thoughts are seen in these disorder.

Q. No. 2. Answer :

Ather possible diagnosis is " Manic depressive psychosis ".

Q. No. 3. Answer :

Yes, patient meet criteria for inpatient hospitalization. Because she is having more psychiatric symptoms.

Q. No. 4. Andswer :

Treatment plan :

* Antidepressants,

* Antipsychotics,

* Behavioural therapy,

* general counseling.